Minimally invasive photoacoustic imaging:Current status and future perspectives

Photoacoustic imaging (PAI) is an emerging biomedical imaging modality that is based on optical absorption contrast, capable of revealing distinct spectroscopic signatures of tissue at high spatial resolution and large imaging depths. However, clinical applications of conventional non-invasive PAI systems have been restricted to examinations of tissues at depths less than a few cm due to strong light attenuation. Minimally invasive photoacoustic imaging (miPAI) has greatly extended the landscape of PAI by delivering excitation light within tissue through miniature fibre-optic probes. In the past decade, various miPAI systems have been developed with demonstrated applicability in several clinical fields. In this article, we present an overview of the current status of miPAI and our thoughts on future perspectives.status: publishe

Developing Ultrasound-Guided Intervention Technologies Enabled by Sensing Active Acoustic and Photoacoustic Point Sources

Image-guided therapy is a central part of modern medicine. By incorporating medical imaging into the planning, surgical, and evaluation process, image-guided therapy has helped surgeons perform less invasive and more precise procedures. Of the most commonly used medical imaging modalities, ultrasound imaging offers a unique combination of cost-effectiveness, safety, and mobility. Advanced ultrasound guided interventional systems will often require calibration and tracking technologies to enable all of their capabilities. Many of these technologies rely on localizing point based fiducials to accomplish their task. In this thesis, I investigate how sensing and localizing active acoustic and photoacoustic point sources can have a substantial impact in intraoperative ultrasound. The goals of these methods are (1) to improve localization and visualization for point targets that are not easily distinguished under conventional ultrasound and (2) to track and register ultrasound sensors with the use of active point sources as non-physical fiducials or markers. We applied these methods to three main research topics. The first is an ultrasound calibration framework that utilizes an active acoustic source as the phantom to aid in in-plane segmentation as well as out-of-plane estimation. The second is an interventional photoacoustic surgical system that utilizes the photoacoustic effect to create markers for tracking ultrasound transducers. We demonstrate variations of this idea to track a wide range of ultrasound transducers (three-dimensional, two-dimensional, bi-planar). The third is a set of interventional tool tracking methods combining the use of acoustic elements embedded onto the tool with the use of photoacoustic markers

Enhanced Photoacoustic Visualisation of Clinical Needles by Combining Interstitial and Extracorporeal Illumination of Elastomeric Nanocomposite Coatings

Ultrasound (US) image guidance is widely used for minimally invasive procedures, but the invasive medical devices (such as metallic needles), especially their tips, can be poorly visualised in US images, leading to significant complications. Photoacoustic (PA) imaging is promising for visualising invasive devices and peripheral tissue targets. Light-emitting diodes (LEDs) acting as PA excitation sources facilitate the clinical translation of PA imaging, but the image quality is degraded due to the low pulse energy leading to insufficient contrast with needles at deep locations. In this paper, photoacoustic visualisation of clinical needles was enhanced by elastomeric nanocomposite coatings with superficial and interstitial illumination. Candle soot nanoparticle-polydimethylsiloxane (CSNP-PDMS) composites with high optical absorption and large thermal expansion coefficients were applied onto the needle exterior and the end-face of an optical fibre placed in the needle lumen. The excitation light was delivered at the surface by LED arrays and through the embedded optical fibre by a pulsed diode laser to improve the visibility of the needle tip. The performance was validated using an ex-vivo tissue model. An LED-based PA/US imaging system was used for imaging the needle out-of-plane and in-plane insertions over approach angles of 20 deg to 55 deg. The CSNP-PDMS composite conferred substantial visual enhancements on both the needle shaft and the tip, with an average of 1.7- and 1.6-fold improvements in signal-to-noise ratios (SNRs), respectively. With the extended light field involving extracorporeal and interstitial illumination and the highly absorbing coatings, enhanced visualisation of the needle shaft and needle tip was achieved with PA imaging, which could be helpful in current US-guided minimally invasive surgeries

Photoacoustic imaging of intracardiac medical devices using internal illumination of carbon nanotube / PDMS composite coatings

Accurate localisation of medical devices is of crucial importance for a wide range of ultrasound-guided interventions. In this study, we investigated visualisation of medical devices by photoacoustic excitation of optically absorbing coatings. Photoacoustic excitation light was provided through optical fibres positioned within a cardiac needle and a steerable-tip catheter. Using a swine heart model, photoacoustic and B-mode ultrasound images were received with a clinical ultrasound scanner in conjunction with a transoesophageal imaging probe. In the photoacoustic images, prominent signals were obtained from the coatings. This study demonstrated that photoacoustic imaging could play a useful role with medical device imaging

Enhancing photoacoustic visualization of medical devices with elastomeric nanocomposite coatings

Ultrasound (US) imaging is widely used for guiding minimally invasive procedures. However, with this modality, there can be poor visibility of interventional medical devices such as catheters and needles due to back-reflections outside the imaging aperture and low echogenicity. Photoacoustic (PA) imaging has shown promise with visualising bare metallic needles. In this study, we demonstrate the feasibility of a light emitting diode (LED)-based PA and US dual-modality imaging system for imaging metallic needles and polymeric medical catheters in biological tissue. Four medical devices were imaged with the system: two 20-gauge spinal needles with and without a multi-walled carbon nanotube / polydimethylsiloxane (MWCNT/PDMS) composite coating, and two 18-gauge epidural catheters with and without the MWCNT/PDMS composite coating. These devices were sequentially inserted into layers of chicken breast tissue within the US imaging plane. Interleaved PA and US imaging was performed during insertions of the needle and catheter. With US imaging, the uncoated needle had very poor visibility at an insertion angle of 45°. With PA imaging, the uncoated needle was not visible, but its coated counterpart was clearly visualised up to depths of 35 mm. Likewise, both catheters were not visible with US imaging. The uncoated catheter was not visible on PA images, but its coated counterpart was clearly visualised up to depths of 35 mm. We conclude that the highly absorbing CNT/PDMS composite coating conferred excellent visibility for medical devices with the LED-based PA imaging system and that it is promising for translation in minimally invasive procedures

Photoacoustic-guided endovenous laser ablation: Characterization and in vivo canine study

Endovenous laser ablation (EVLA) is a minimally invasive surgical procedure, often guided by ultrasound (US) imaging, for treating venous insufficiencies. US imaging limitations in accurately visualizing the catheter and the lack of a temperature monitoring system can lead to sub-optimal outcomes. An integrated photoacoustic (PA)-guided EVLA system has been previously developed and reported to overcome the shortcomings of US-guided procedure. In this study, we further characterized the system and tested the in vivo utility. In addition, PA thermometry was further explored by compensating the variation of PA signal with temperature with respect to the temperature-dependent absorption of blood and water. In vivo imaging results indicated that the PA-guided EVLA system can provide high contrast and accurate images of the ablation catheter tip overlaid on US images of the background tissue. Additionally, absorption-compensated PA signal amplitudes over a relevant range of temperature were measured and demonstrated

Improving needle visibility in LED-based photoacoustic imaging using deep learning with semi-synthetic datasets

Photoacoustic imaging has shown great potential for guiding minimally invasive procedures by accurate identification of critical tissue targets and invasive medical devices (such as metallic needles). The use of light emitting diodes (LEDs) as the excitation light sources accelerates its clinical translation owing to its high affordability and portability. However, needle visibility in LED-based photoacoustic imaging is compromised primarily due to its low optical fluence. In this work, we propose a deep learning framework based on U-Net to improve the visibility of clinical metallic needles with a LED-based photoacoustic and ultrasound imaging system. To address the complexity of capturing ground truth for real data and the poor realism of purely simulated data, this framework included the generation of semi-synthetic training datasets combining both simulated data to represent features from the needles and in vivo measurements for tissue background. Evaluation of the trained neural network was performed with needle insertions into blood-vessel-mimicking phantoms, pork joint tissue ex vivo and measurements on human volunteers. This deep learning-based framework substantially improved the needle visibility in photoacoustic imaging in vivo compared to conventional reconstruction by suppressing background noise and image artefacts, achieving 5.8 and 4.5 times improvements in terms of signal-to-noise ratio and the modified Hausdorff distance, respectively. Thus, the proposed framework could be helpful for reducing complications during percutaneous needle insertions by accurate identification of clinical needles in photoacoustic imaging

Deep Learning for Instrumented Ultrasonic Tracking: From synthetic training data to in vivo application

Instrumented ultrasonic tracking is used to improve needle localisation during ultrasound guidance of minimally-invasive percutaneous procedures. Here, it is implemented with transmitted ultrasound pulses from a clinical ultrasound imaging probe that are detected by a fibre-optic hydrophone integrated into a needle. The detected transmissions are then reconstructed to form the tracking image. Two challenges are considered with the current implementation of ultrasonic tracking. First, tracking transmissions are interleaved with the acquisition of B-mode images and thus, the effective B-mode frame rate is reduced. Second, it is challenging to achieve an accurate localisation of the needle tip when the signal-to-noise ratio is low. To address these challenges, we present a framework based on a convolutional neural network (CNN) to maintain spatial resolution with fewer tracking transmissions and to enhance signal quality. A major component of the framework included the generation of realistic synthetic training data. The trained network was applied to unseen synthetic data and experimental in vivo tracking data. The performance of needle localisation was investigated when reconstruction was performed with fewer (up to eight-fold) tracking transmissions. CNN-based processing of conventional reconstructions showed that the axial and lateral spatial resolution could be improved even with an eight-fold reduction in tracking transmissions. The framework presented in this study will significantly improve the performance of ultrasonic tracking, leading to faster image acquisition rates and increased localisation accuracy

Dual-modality fibre optic probe for simultaneous ablation and ultrasound imaging

All-optical ultrasound (OpUS) is an emerging high resolution imaging paradigm utilising optical fibres. This allows both therapeutic and imaging modalities to be integrated into devices with dimensions small enough for minimally invasive surgical applications. Here we report a dual-modality fibre optic probe that synchronously performs laser ablation and real-time all-optical ultrasound imaging for ablation monitoring. The device comprises three optical fibres: one each for transmission and reception of ultrasound, and one for the delivery of laser light for ablation. The total device diameter is < 1 mm. Ablation monitoring was carried out on porcine liver and heart tissue ex vivo with ablation depth tracked using all-optical M-mode ultrasound imaging and lesion boundary identification using a segmentation algorithm. Ablation depths up to 2.1 mm were visualised with a good correspondence between the ultrasound depth measurements and visual inspection of the lesions using stereomicroscopy. This work demonstrates the potential for OpUS probes to guide minimally invasive ablation procedures in real time