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      Photoacoustic-based approach to surgical guidance performed with and without a da Vinci robot

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          Death and paralysis are significant risks of modern surgeries, caused by injury to blood vessels and nerves hidden by bone and other tissue. We propose an approach to surgical guidance that relies on photoacoustic (PA) imaging to determine the separation between these critical anatomical features and to assess the extent of safety zones during surgical procedures. Images were acquired as an optical fiber was swept across vessel-mimicking targets, in the absence and presence of teleoperation with a research da Vinci Surgical System. Vessel separation distances were measured directly from PA images. Vessel positions were additionally recorded based on the fiber position (calculated from the da Vinci robot kinematics) that corresponded to an observed PA signal, and these recordings were used to indirectly measure vessel separation distances. Amplitude- and coherence-based beamforming were used to estimate vessel separations, resulting in 0.52- to 0.56-mm mean absolute errors, 0.66- to 0.71-mm root-mean-square errors, and 65% to 68% more accuracy compared to fiber position measurements obtained through the da Vinci robot kinematics. Similar accuracy was achieved in the presence of up to 4.5-mm-thick ex vivo tissue. Results indicate that PA image-based measurements of the separation among anatomical landmarks could be a viable method for real-time path planning in multiple interventional PA applications.

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          Most cited references 33

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          Image-guided surgery using invisible near-infrared light: fundamentals of clinical translation.

          The field of biomedical optics has matured rapidly over the last decade and is poised to make a significant impact on patient care. In particular, wide-field (typically > 5 cm), planar, near-infrared (NIR) fluorescence imaging has the potential to revolutionize human surgery by providing real-time image guidance to surgeons for tissue that needs to be resected, such as tumors, and tissue that needs to be avoided, such as blood vessels and nerves. However, to become a clinical reality, optimized imaging systems and NIR fluorescent contrast agents will be needed. In this review, we introduce the principles of NIR fluorescence imaging, analyze existing NIR fluorescence imaging systems, and discuss the key parameters that guide contrast agent development. We also introduce the complexities surrounding clinical translation using our experience with the Fluorescence-Assisted Resection and Exploration (FLARE™) imaging system as an example. Finally, we introduce state-of-the-art optical imaging techniques that might someday improve image-guided surgery even further.
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            Microsurgical anatomy of the sellar region.

            Fifty adult sellae and surrounding structures were examined under magnification with special attention given to anatomical variants important to the transfrontal and transsphenoidal surgical approaches. The discovered variants considered disadvantageous to the transsphenoidal approach were as follows: 1) large anterior intercavernous sinuses extending anterior to the gland just posterior to the anterior sellar wall in 10%; 2) a thin diaphragm in 62%, or a diaphragm with a large opening in 56%; 3) carotid arteries exposed in the sphenoid sinus with no bone over them in 4%; 4) carotid arteries that approach within 4 mm of midline within the sella in 10%; 5) optic canals with bone defects exposing the optic nerves in the sphenoid sinus in 4%; 6) a thick sellar floor in 18%; 7) sphenoid sinuses with no major septum in 28% or a sinus with the major septum well off midline in 47%; and 8) a presellar type of sphenoid sinus with no obvious bulge of the sellar floor into the sphenoid sinus in 20%. Variants considered disadvantageous to the transfrontal approach were found as follows: 1) a prefixed chiasm in 10% and a normal chiasm with 2 mm or less between the chiasm and tuberculum sellae in 14%; 2) an acute angle between the optic nerves as they entered the chiasm in 25%; 3) a prominent tuberculum sella protruding above a line connecting the optic nerves as they entered the optic canals in 44%; and 4) carotid arteries approaching within 4 mm of midline within or above the sella turcica in 12%.
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              Short-lag spatial coherence of backscattered echoes: imaging characteristics.

              Conventional ultrasound images are formed by delay-and-sum beamforming of the backscattered echoes received by individual elements of the transducer aperture. Although the delay-and-sum beamformer is well suited for ultrasound image formation, it is corrupted by speckle noise and challenged by acoustic clutter and phase aberration. We propose an alternative method of imaging utilizing the short-lag spatial coherence (SLSC) of the backscattered echoes. Compared with matched B-mode images, SLSC images demonstrate superior SNR and contrast-to-noise ratio in simulated and experimental speckle-generating phantom targets, but are shown to be challenged by limited point target conspicuity. Matched B-mode and SLSC images of a human thyroid are presented. The challenges and opportunities of real-time implementation of SLSC imaging are discussed.

                Author and article information

                J Biomed Opt
                J Biomed Opt
                Journal of Biomedical Optics
                Society of Photo-Optical Instrumentation Engineers
                24 August 2017
                December 2017
                : 22
                : 12
                [a ]University of Virginia , Department of Electrical and Computer Engineering, Charlottesville, Virginia, United States
                [b ]Smith College , Department of Physics, Northampton, Massachusetts, United States
                [c ]Johns Hopkins University , Department of Computer Science, Maryland, United States
                [d ]Johns Hopkins University , Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
                [e ]Johns Hopkins University , Department of Biomedical Engineering, Baltimore, Maryland, United States
                Author notes
                [* ]Address all correspondence to: Muyinatu A. Lediju Bell, E-mail: mledijubell@ 123456jhu.edu
                JBO-170265SSPR 170265SSPR
                © The Authors.

                Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

                Page count
                Figures: 14, Tables: 1, References: 36, Pages: 12
                Funded by: National Science Foundation http://dx.doi.org/10.13039/100000001
                Award ID: EEC-1460674
                Award ID: NRI-1208540
                Funded by: National Institutes of Health http://dx.doi.org/10.13039/100000002
                Award ID: R00-EB018994
                Special Section on Translational Biophotonics
                Custom metadata
                Gandhi et al.: Photoacoustic-based approach to surgical guidance performed…


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