Patrick Steiner

Noninvasive referencing of intraocular tumors for external beam radiation therapy using optical coherence tomography: A proof of concept

PURPOSE External beam radiation therapy is currently considered the most common treatment modality for intraocular tumors. Localization of the tumor and efficient compensation of tumor misalignment with respect to the radiation beam are crucial. According to the state of the art procedure, localization of the target volume is indirectly performed by the invasive surgical implantation of radiopaque clips or is limited to positioning the head using stereoscopic radiographies. This work represents a proof-of-concept for direct and noninvasive tumor referencing based on anterior eye topography acquired using optical coherence tomography (OCT). METHODS A prototype of a head-mounted device has been developed for automatic monitoring of tumor position and orientation in the isocentric reference frame for LINAC based treatment of intraocular tumors. Noninvasive tumor referencing is performed with six degrees of freedom based on anterior eye topography acquired using OCT and registration of a statistical eye model. The proposed prototype was tested based on enucleated pig eyes and registration accuracy was measured by comparison of the resulting transformation with tilt and torsion angles manually induced using a custom-made test bench. RESULTS Validation based on 12 enucleated pig eyes revealed an overall average registration error of 0.26 ± 0.08° in 87 ± 0.7 ms for tilting and 0.52 ± 0.03° in 94 ± 1.4 ms for torsion. Furthermore, dependency of sampling density on mean registration error was quantitatively assessed. CONCLUSIONS The tumor referencing method presented in combination with the statistical eye model introduced in the past has the potential to enable noninvasive treatment and may improve quality, efficacy, and flexibility of external beam radiotherapy of intraocular tumors.

Retinal Laser Lesion Visibility in Simultaneous Ultra-High Axial Resolution Optical Coherence Tomography

Ex vivo porcine retina laser lesions applied with varying laser power (20 mW-2 W, 10 ms pulse, 196 lesions) are manually evaluated by microscopic and optical coherence tomography (OCT) visibility, as well as in histological sections immediately after the deposition of the laser energy. An optical coherence tomography system with 1.78 μm axial resolution specifically developed to image thin retinal layers simultaneously to laser therapy is presented, and visibility thresholds of the laser lesions in OCT data and fundus imaging are compared. Optical coherence tomography scans are compared with histological sections to estimate the resolving power for small optical changes in the retinal layers, and real-time time-lapse scans during laser application are shown and analyzed quantitatively. Ultrahigh-resolution OCT inspection features a lesion visibility threshold 40-50 mW (17% reduction) lower than for visual inspection. With the new measurement system, 42% of the lesions that were invisible using state-of-the-art ophthalmoscopic methods could be detected.

Influence and compensation of autocorrelation terms in depth-resolved spectroscopic Fourier-domain optical coherence tomography

We demonstrate depth-resolved spectral absorption measurements in the wavelength range from 750 to 850 nm using a broadband light source consisting of three spectrally shifted superluminescent light-emitting diode modules and a low-cost spectrometer-based Fourier-domain optical coherence tomography system. We present the theoretical model and experimental verification of interferences between autocorrelation terms and the signal carrying cross-correlation terms, strongly affecting the absorption measurements. A simple background subtraction, minimizing the artifacts caused by the interferences of autocorrelation and cross-correlation terms, is presented.

Time-Resolved Ultra–High Resolution Optical Coherence Tomography for Real-Time Monitoring of Selective Retina Therapy

PURPOSE Selective retina therapy (SRT) is a novel treatment for retinal pathologies, solely targeting the RPE. During SRT, the detection of an immediate tissue reaction is challenging, as tissue effects remain limited to intracellular RPE photodisruption. Time-resolved ultra-high axial resolution optical coherence tomography (OCT) is thus evaluated for the monitoring of dynamic optical changes at and around the RPE during SRT. METHODS An experimental OCT system with an ultra-high axial resolution of 1.78 μm was combined with an SRT system and time-resolved OCT M-scans of the target area were recorded from four patients undergoing SRT. Optical coherence tomography scans were analyzed and OCT morphology was correlated with findings in fluorescein angiography, fundus photography, and cross-sectional OCT. RESULTS In cases in which the irradiation caused RPE damage proven by fluorescein angiography, the lesions were well discernible in time-resolved OCT images but remained invisible in fundus photography and cross-sectional OCT acquired after treatment. If RPE damage was introduced, all applied SRT pulses led to detectable signal changes in the time-resolved OCT images. The extent of optical signal variation seen in the OCT data appeared to scale with the applied SRT pulse energy. CONCLUSIONS The first clinical results proved that successful SRT irradiation induces detectable changes in the OCT M-scan signal while it remains invisible in conventional ophthalmoscopic imaging. Thus, real-time high-resolution OCT is a promising modality to monitor and analyze tissue effects introduced by selective retina therapy and may be used to guide SRT in an automatic feedback mode (www.swissmedic.ch number, 2011-MD-0006).

Assessment of ultra-high resolution optical coherence tomography for monitoring tissue effects caused by laser photocoagulation of ex-vivo porcine retina

Retinal laser photocoagulation is an established and successful treatment for a variety of retinal diseases. While being a valuable treatment modality, laser photocoagulation shows the drawback of employing high energy lasers which are capable of physically destroying the neural retina. For reliable therapy, it is therefore crucial to closely monitor the therapy effects caused in the retinal tissue. A depth resolved representation of optical tissue properties as provided by optical coherence tomography may provide valuable information about the treatment effects in the retinal layers if recorded simultaneously to laser coagulation. Therefore, in this work, the use of ultra-high resolution optical coherence tomography to represent tissue changes caused by conventional and selective retinal photocoagulation is investigated. Laser lesions were placed on porcine retina ex-vivo using a 577 nm laser as well as a pulsed laser at 527 nm built for selective treatment of the retinal pigment epithelium. Applied energies were varied to generate lesions best representing the span from under- to overtreatment. The lesions were examined using a custom-designed optical coherence tomography system with an axial resolution of 1.78 μm and 70 kHz Ascan rate. Optical coherence tomography scans included volume scans before and after irradiation, as well as time lapse scans (Mscan) of the lesions. Results show OCT lesion visibility thresholds to be below the thresholds of ophthalmoscopic inspection. With the ultra-high resolution OCT, 42% - 44% of ophthalmoscopically invisible lesions could be detected and lesions that were under- or overexposed could be distinguished using the OCT data.

Real-time optical coherence tomography observation of retinal tissue damage during laser photocoagulation therapy on ex-vivo porcine samples

Retinal laser photocoagulation represents a widely used treatment for retinal pathologies such as diabetic chorioretinopathy or diabetic edema. For effective treatment, an appropriate choice of the treatment energy dose is crucial to prevent excessive tissue damage caused by over-irradiation of the retina. In this manuscript we investigate simultaneous and time-resolved optical coherence tomography for its applicability to provide feedback to the ophthalmologist about the introduced retinal damage during laser photocoagulation. Time-resolved and volumetric optical coherence tomography data of 96 lesions on ex-vivo porcine samples, set with a 577 nm laser prototype and irradiance of between 300 and 8800 W=cm2 were analyzed. Time-resolved scans were compared to volumetric scans of the lesion and correlated with ophthalmoscopic visibility. Lastly, image parameters extracted from optical coherence tomography Mscans, suitable for lesion classification were identified. Results presented in this work support the hypothesis that simultaneous optical coherence tomography provides valuable information about the extent of retinal tissue damage and may be used to guide retinal laser photocoagulation in the future.

Automatic estimation of noise parameters in Fourier-domain optical coherence tomography cross sectional images using statistical information

We present an application and sample independent method for the automatic discrimination of noise and signal in optical coherence tomography Bscans. The proposed algorithm models the observed noise probabilistically and allows for a dynamic determination of image noise parameters and the choice of appropriate image rendering parameters. This overcomes the observer variability and the need for a priori information about the content of sample images, both of which are challenging to estimate systematically with current systems. As such, our approach has the advantage of automatically determining crucial parameters for evaluating rendered image quality in a systematic and task independent way. We tested our algorithm on data from four different biological and nonbiological samples (index finger, lemon slices, sticky tape, and detector cards) acquired with three different experimental spectral domain optical coherence tomography (OCT) measurement systems including a swept source OCT. The results are compared to parameters determined manually by four experienced OCT users. Overall, our algorithm works reliably regardless of which system and sample are used and estimates noise parameters in all cases within the confidence interval of those found by observers.

Multi-channel near-infrared spectrometer for functional depth-resolved tissue examination and positioning applications

We present a multi-channel spectrometer that allows simultaneous acquisition of up to eight channels in order to perform parallel optical coherence tomography or low coherence interferometry. The rigid and compact design is employed in polarization sensitive optical coherence tomography measurements. Furthermore it is employed in distances and wedgeangle measurements between two glass slides. The spectrometer operates at a central wavelength of 835 nm and at a spectral bandwidth of 45 nm. This facilitates an axial resolution of 7.7 μm. The key feature is the simultaneous acquisition of up to eight channels, at a maximum frame rate of 6.5 kHz. The sensitivity is 91 dB at an integration time of 11 μs and an optical power of 0.7 mW at each of the sample arms. We obtained polarization sensitive OCT images of technical and biological samples and investigated the system inherent phase stability to multipoint low coherence interferometry measurements.

Quality Assessment and Enhancement Method for high-resolution Fourier-Domain OCT Imaging of Retina Laser Lesions

We present an image quality assessment and enhancement method for high-resolution Fourier-Domain OCT imaging like in sub-threshold retina therapy. A Maximum-Likelihood deconvolution algorithm as well as a histogram-based quality assessment method are evaluated.

Design and realization of a spectroscopic optical coherence tomography system for medical applications

In this manuscript, we present the design and realization of a Fourier-Domain Spectroscopic-OCT system with a simple spectrometer, based on off-the-shelf parts and a low-cost, state-of-the-art broadband S-LED light source with three spectrally shifted S-LED modules. Depth resolved spectral absorption measurements in the wavelength range from 750 nm to 850 nm are demonstrated using an expansion of OCT called spectroscopic OCT (SOCT). The realized setup was tested and evaluated towards its ability to measure physical parameters such as blood oxygen saturation quantitatively in vivo. Different sample configurations including multilayer setups and scattering layers were used. Additionally, we present the theoretical model and experimental verification of interferences between autocorrelation terms and the signal carrying crosscorrelation terms, strongly affecting the absorption measurements. A simple background subtraction, minimizing the artifacts caused by the interferences of autocorrelation and crosscorrelation terms is presented and verified.