MAGNETIC RESONANCE ELASTOGRAPHY FOR APPLICATIONS IN RADIATION THERAPY

Magnetic resonance elastography (MRE) is an imaging technique that combines mechanical waves and magnetic resonance imaging (MRI) to determine the elastic properties of tissue. Because MRE is non-invasive, there is great potential and interest for its use in the detection of cancer. The first part of this thesis concentrates on parameter optimization and imaging quality of an MRE system. To do this, we developed a customized quality assurance phantom, and a series of quality control tests to characterize the MRE system. Our results demonstrated that through optimizing scan parameters, such as frequency and amplitude, MRE could provide a good qualitative elastogram for targets with different elasticity values and dimensions. The second part investigated the feasibility of integrating MRE into radiation therapy (RT) workflow. With the aid of a tissue-equivalent prostate phantom (embedded with three dominant intraprostatic lesions (DILs)), an MRE-integrated RT framework was developed. This framework contains a comprehensive scan protocol including Computed Tomography (CT) scan, combined MRI/MRE scans and a Volumetric Modulated Arc Therapy (VMAT) technique for treatment delivery. The results showed that using the comprehensive information could boost the MRE defined DILs to 84 Gy while keeping the remainder of the prostate to 78 Gy. Using a VMAT based technique allowed us to achieve a highly conformal plan (conformity index for the prostate and combined DILs was 0.98 and 0.91). Based on our feasibility study, we concluded that MRE data can be used for targeted radiation dose escalation. In summary, this thesis demonstrates that MRE is feasible for applications in radiation oncology

Optical Coherence Tomography Distal Sensor Based Handheld Microsurgical Tools

Microsurgery is typically differentiated from a general surgery in that it requires a precise sub-millimeter manipulation that could only be achievable under optical magnification. For instance, microsurgeons use surgical microscopes to view surgical sites and train themselves several years to acquire surgical skills to perform the delicate procedures. However, such microsurgical approach imposes considerable physical stress and mental fatigue on the surgeons and these could be sources for surgical risks and complications. For these reasons, a variety of robotic based surgical guidance methods have been developed and studied with the hope of providing safer and more precise microsurgery. These robotic arm based systems have been developed to provide precise tool movement and to remove physiological hand tremor, which is one of the main limiting factors that prevents precise tool manipulation. In another approaches use simpler system that adds robotic functions to existing handheld surgical tools. It is a hybrid system that incorporates the advantages of conventional manual system and robot-assist system. The advantages of such hybrid handheld systems include portability, disposability, and elimination of the large robotic-assist systems in complex surgical environment. The most critical benefit of the hybrid handheld system is its ease of use since it allows surgeons to manipulate tools mostly using their hand. However due to the imprecise nature of tool control using hands, tool tracking is more critical in handheld microsurgical tool systems than that of robotic arm systems. In general, the accuracy of the tool control is largely determined by the resolution of the sensors and the actuators. Therefore, it is essential to develop a real-time high resolution sensor in order to develop a practical microsurgical tools. For this reason, a novel intuitive targeting and tracking scheme that utilizes a common-path swept source optical coherence tomography (CP-SSOCT) distal sensor was developed integrated with handheld microsurgical tools. To achieve micron-order precision control, a reliable and accurate OCT distal sensing method was developed. The method uses a prediction algorithm is necessary to compensate for the system delay associated with the computational, mechanical and electronic latencies. Due to the multi-layered structure of retina, it was also necessary to develop effective surface detection methods rather than simple peak detection. The OCT distal sensor was integrated into handheld motion-guided micro-forceps system for highly accurate depth controlled epiretinal membranectomy. A touch sensor and two motors were used in the forceps design to minimize the motion artifact induced by squeezing, and to independently control the depth guidance of the tool-tip and the grasping action. We also built a depth guided micro-injector system that enables micro-injection with precise injection depth control. For these applications, a smart motion monitoring and a guiding algorithm were developed to provide precise and intuitive freehand control. Finally, phantom and ex-vivo bovine eye experiments were performed to evaluate the performance of the proposed OCT distal sensor and validate the effectiveness of the depth-guided micro-forceps and micro-injector over the freehand performance

Identification of proprioceptive thalamocortical tracts in children : comparison of fMRI, MEG, and manual seeding of probabilistic tractography

Studying white matter connections with tractography is a promising approach to understand the development of different brain processes, such as proprioception. An emerging method is to use functional brain imaging to select the cortical seed points for tractography, which is considered to improve the functional relevance and validity of the studied connections. However, it is unknown whether different functional seeding methods affect the spatial and microstructural properties of the given white matter connection. Here, we compared functional magnetic resonance imaging, magnetoencephalography, and manual seeding of thalamocortical proprioceptive tracts for finger and ankle joints separately. We showed that all three seeding approaches resulted in robust thalamocortical tracts, even though there were significant differences in localization of the respective proprioceptive seed areas in the sensorimotor cortex, and in the microstructural properties of the obtained tracts. Our study shows that the selected functional or manual seeding approach might cause systematic biases to the studied thalamocortical tracts. This result may indicate that the obtained tracts represent different portions and features of the somatosensory system. Our findings highlight the challenges of studying proprioception in the developing brain and illustrate the need for using multimodal imaging to obtain a comprehensive view of the studied brain process.Peer reviewe

Optical coherence tomography angiography

Optical coherence tomography (OCT) was one of the biggest advances in ophthalmic imaging. Building on that platform, OCT angiography (OCTA) provides depth resolved images of blood flow in the retina and choroid with levels of detailed far exceeding that obtained with older forms of imaging. This new modality is challenging because of the need for new equipment and processing techniques, current limitations of imaging capability, and rapid advancements in both imaging and in our understanding of the imaging and applicable pathophysiology of the retina and choroid, and the requirement for understanding the origins of image artifacts. These factors lead to a steep learning curve, even for those with a working understanding dye-based ocular angiography. All for a method of imaging that is a little more than 10 years old. This review begins with a historical account of the development of OCTA, and the methods used in OCTA, including signal processing, image generation, and display techniques. This forms the basis to understand what OCTA images show as well as how image artifacts arise. The anatomy and imaging of specific vascular layers of the eye are reviewed. The integration of OCTA in multimodal imaging in the evaluation of retinal vascular occlusive diseases, diabetic retinopathy, uveitis, inherited diseases, age-related macular degeneration, and disorders of the optic nerve is presented. OCTA is an exciting, disruptive technology. Its use is rapidly expanding in clinical practice as well as for research into the pathophysiology of diseases of the posterior pole