Vinayakrishnan Rajan

Review of methodological developments in laser Doppler flowmetry

Laser Doppler flowmetry is a non-invasive method of measuring microcirculatory blood flow in tissue. In this review the technique is discussed in detail. The theoretical and experimental developments to improve the technique are reviewed. The limitations of the method are elaborated upon, and the research done so far to overcome these limitations is critically assessed.

Effect and safety of spinal cord stimulation for treatment of chronic pain caused by diabetic neuropathy

AIM Spinal cord stimulation (SCS) has been shown effective as a therapy for different chronic painful conditions, but the effectiveness of this treatment for pain as a result of peripheral diabetic neuropathy is not well established. The primary objectives of this study were to evaluate the effect and safety of SCS for treatment of pain and the effects on microcirculatory blood flow in the affected areas in patients with refractory peripheral diabetic neuropathy. METHOD The study was designed as a prospective, open-label study. Data were collected during screening, at implant and at regular intervals, after initiation of therapy. Eleven diabetic patients with chronic pain in their lower limbs and no response to conventional treatment were studied. The SCS electrode was implanted in the thoracic epidural space. Neuropathic pain relief was assessed by Visual Analogue Scale (VAS) and microcirculatory skin perfusion was measured with Laser Doppler flowmetry. RESULTS Nine subjects had significant pain relief with the percutaneous electrical stimulator. Average pain score for all nine patients was 77 at baseline and 34 at 6 months after implantation. At the end of the study, eight of nine patients continued to experience significant pain relief and have been able to significantly reduce their pain medication. For six of them, the stimulator was the sole treatment for their neuropathic pain. No significant changes in microcirculatory perfusion were recorded. CONCLUSION Spinal cord stimulation offers an effective and safe therapy for chronic diabetic neuropathic pain.

Path-length-resolved measurements of multiple scattered photons in static and dynamic turbid media using phase-modulated low-coherence interferometry

In optical Doppler measurements, the path length of the light is unknown. To facilitate quantitative measurements, we develop a phase-modulated Mach-Zehnder interferometer with separate fibers for illumination and detection. With this setup, path-length-resolved dynamic light scattering measurements of multiple scattered light in static and dynamic turbid media are performed. Optical path length distributions spanning a range from 0 to 11 mm are measured from the area under the phase modulation peak around the modulation frequency in the power spectrum. A Doppler-broadened phase modulation interference peak is observed that shows an increase in the average Doppler shift with optical path length, independent of absorption. Validation of the estimated path length distributions is done by measuring their deformation for increasing absorption and comparing these observations with predictions based on Lambert-Beers law.

The relationship between local scalp skin temperature and cutaneous perfusion during scalp cooling

Cooling the scalp during administration of chemotherapy can prevent hair loss. It reduces both skin blood flow and hair follicle temperature, thus affecting drug supply and drug effect in the hair follicle. The extent to which these mechanisms contribute to the hair preservative effect of scalp cooling remains unknown. The purpose of this study was to establish a relationship between local scalp skin temperature and cutaneous blood flow during scalp cooling. We measured skin temperature and cutaneous perfusion during a cooling and re-warming experiment. Experiments on a single subject showed that the measurements were reproducible and that the response was identical for the two positions that were measured. Inter-subject variability was investigated on nine subjects. We found that for the first 10 degrees C of cooling, perfusion of the scalp skin decreases to below 40%. Perfusion can be further reduced to below 30% by a few degrees more cooling, but a plateau is reached after that. We found that a generally accepted relation in thermal physiology between temperature and perfusion (i.e. Q(10) relation) does not describe the data well, but we found an alternative relation that describes the average behavior significantly better.

Speckles in laser Doppler perfusion imaging

We report on the quantitative influence of speckles in laser Doppler perfusion imaging. The influence of speckles on the signal amplitude and on the Doppler spectrum is demonstrated experimentally for particle suspensions with different scattering levels and various beam widths. It is shown that the type of tissue affects the instrumental response through the effect of lateral light diffusion on the number of speckles involved in the detection process. These effects are largest for narrow beams.

Influence of tissue optical properties on laser Doppler perfusion imaging, accounting for photon penetration depth and the laser speckle phenomenon

The influence of tissue optical properties on laser Doppler perfusion imaging (LDPI) is not well understood. We address this problem by quantifying the dependence of the signal response to tissue optical properties based on speckles or coherence areas and on photon statistics. We investigate the effect in vivo, showing the amplitude of photocurrent fluctuations in normal skin and port-wine stain with a range of beam diameters, and its relation to the speckle size variation difference between these two tissues. For the case of a low concentration of moving particles moving within a static turbid medium, a model is described and applied to predict the influence of speckles on the overall and depth sensitivity of LDPI, for a range of scattering levels and absorption levels. The results show that the speckle related effects on overall and depth sensitivity are large and that the depth sensitivity is highly likely to be misinterpreted without taking the speckle phenomenon into account.

Quantification of optical Doppler broadening and optical path lengths of multiply scattered light by phase modulated low coherence interferometry

We show experimental validation of a novel technique to measure optical path length distributions and path length resolved Doppler broadening in turbid media for different reduced scattering coefficients and anisotropies. The technique involves a phase modulated low coherence Mach-Zehnder interferometer, with separate fibers for illumination and detection. Water suspensions of Polystyrene microspheres with high scattering and low absorption levels are used as calibrated scattering phantoms. The path length dependent diffusion broadening or Doppler broadening of scattered light is shown to agree with Diffusive Wave Spectroscopy within 5%. The optical path lengths are determined experimentally from the zero order moment of the phase modulation peak around the modulation frequency in the power spectrum and the results are validated with Monte Carlo simulations.

Path-length-resolved optical Doppler perfusion monitoring

We report the first path-length-resolved perfusion measurements on human skin measured with a phase-modulated low-coherence Mach-Zehnder interferometer with spatially separated fibers for illumination and detection. Optical path lengths of Doppler shifted and unshifted light and path-length-dependent Doppler broadening of multiply scattered light from skin are measured from the Doppler broadened interference peaks appearing in the power spectrum. Perfusion and its variations during occlusion are measured in real time for a given optical path length, and the results are compared with the perfusion signal obtained with a conventional laser Doppler perfusion monitor.

Measurement of particle flux in a static matrix with suppressed influence of optical properties, using low coherence interferometry

Perfusion measurements using conventional laser Doppler techniques are affected by the variations in tissue optical properties. Differences in absorption and scattering will induce different path lengths and consequently will alter the probability that a Doppler shift will occur. In this study, the fraction of Doppler shifted photons and the Doppler broadening of a dynamic medium, are measured with a phase modulated low coherence Mach-Zehnder interferometer. Path length-resolved dynamic light scattering measurements are performed in various media having a constant concentration of dynamic particles inside a static matrix with different scattering properties and the results are compared with a conventional laser Doppler technique, with a simple model and with Monte Carlo simulations. We demonstrate that, for larger optical path lengths, the scattering coefficient of the static matrix in which the moving particles are embedded have a small to minimal effect on the measured fraction of Doppler shifted photons and on the measured average Doppler frequency of the Doppler shifted light. This approach has potential applications in measuring perfusion independent of the influence of optical properties in the static tissue matrix.

In vivo optical path lengths and path length resolved doppler shifts of multiply scattered light.

In laser Doppler measurements, perfusion values averaged over different and basically unknown path lengths are recorded. To facilitate quantitative path length resolved perfusion measurements, we developed a phase modulated Mach–Zehnder interferometer with spatially separated fibers for illumination and detection. The goal of this study is to measure in vivo optical path lengths and path length resolved Doppler shifts and to compare these with conventional laser Doppler perfusion measurements.