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      Clinical Brain Monitoring with Time Domain NIRS: A Review and Future Perspectives

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      Applied Sciences
      MDPI AG

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          Abstract

          Near-infrared spectroscopy (NIRS) is an optical technique that can measure brain tissue oxygenation and haemodynamics in real-time and at the patient bedside allowing medical doctors to access important physiological information. However, despite this, the use of NIRS in a clinical environment is hindered due to limitations, such as poor reproducibility, lack of depth sensitivity and poor brain-specificity. Time domain NIRS (or TD-NIRS) can resolve these issues and offer detailed information of the optical properties of the tissue, allowing better physiological information to be retrieved. This is achieved at the cost of increased instrument complexity, operation complexity and price. In this review, we focus on brain monitoring clinical applications of TD-NIRS. A total of 52 publications were identified, spanning the fields of neonatal imaging, stroke assessment, traumatic brain injury (TBI) assessment, brain death assessment, psychiatry, peroperative care, neuronal disorders assessment and communication with patient with locked-in syndrome. In all the publications, the advantages of the TD-NIRS measurement to (1) extract absolute values of haemoglobin concentration and tissue oxygen saturation, (2) assess the reduced scattering coefficient, and (3) separate between extra-cerebral and cerebral tissues, are highlighted; and emphasize the utility of TD-NIRS in a clinical context. In the last sections of this review, we explore the recent developments of TD-NIRS, in terms of instrumentation and methodologies that might impact and broaden its use in the hospital.

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          Most cited references125

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          A review on continuous wave functional near-infrared spectroscopy and imaging instrumentation and methodology.

          This year marks the 20th anniversary of functional near-infrared spectroscopy and imaging (fNIRS/fNIRI). As the vast majority of commercial instruments developed until now are based on continuous wave technology, the aim of this publication is to review the current state of instrumentation and methodology of continuous wave fNIRI. For this purpose we provide an overview of the commercially available instruments and address instrumental aspects such as light sources, detectors and sensor arrangements. Methodological aspects, algorithms to calculate the concentrations of oxy- and deoxyhemoglobin and approaches for data analysis are also reviewed. From the single-location measurements of the early years, instrumentation has progressed to imaging initially in two dimensions (topography) and then three (tomography). The methods of analysis have also changed tremendously, from the simple modified Beer-Lambert law to sophisticated image reconstruction and data analysis methods used today. Due to these advances, fNIRI has become a modality that is widely used in neuroscience research and several manufacturers provide commercial instrumentation. It seems likely that fNIRI will become a clinical tool in the foreseeable future, which will enable diagnosis in single subjects. Copyright © 2013 Elsevier Inc. All rights reserved.
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            Optical properties of biological tissues: a review.

            A review of reported tissue optical properties summarizes the wavelength-dependent behavior of scattering and absorption. Formulae are presented for generating the optical properties of a generic tissue with variable amounts of absorbing chromophores (blood, water, melanin, fat, yellow pigments) and a variable balance between small-scale scatterers and large-scale scatterers in the ultrastructures of cells and tissues.
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              Time resolved reflectance and transmittance for the non-invasive measurement of tissue optical properties.

              When a picosecond light pulse is incident on biological tissue, the temporal characteristics of the light backscattered from, or transmitted through, the sample carry information about the optical absorption and scattering coefficients of the tissue. We develop a simple model, based on the diffusion approximation to radiative transfer theory, which yields analytic expressions for the pulse shape in terms of the interaction coefficients of a homogeneous slab. The model predictions are in good agreement with the results of preliminary in vivo experiments and Monte Carlo simulations.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                ASPCC7
                Applied Sciences
                Applied Sciences
                MDPI AG
                2076-3417
                April 2019
                April 18 2019
                : 9
                : 8
                : 1612
                Article
                10.3390/app9081612
                81576b1b-67cf-4d7c-8eab-5e5f46c7a804
                © 2019

                https://creativecommons.org/licenses/by/4.0/

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