This book is written for clinicians and engineers looking to learn about the new and exciting uses of ultrasound. Because it focuses on applications of ultrasound specifically for neurosurgery, the book addresses some of the reasons the use of ultrasound in neurosurgery has been slow compared to other fields of medicine (for example, cardiology, orthopedics, etc.). While review papers and books on similar topics have been published, these are not fully comprehensive nor up to date on all of the potential applications of ultrasound in neurosurgery. Our hope is to provide researchers within the field a new title that will expand their understanding of the burgeoning field of ultrasound in neurosurgery.
Multiple image quality metrics are currently available to assess target detectability in photoacoustic images. Common metrics include contrast, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR). The generalized contrast-to-noise ratio (gCNR) is a relatively new image quality metric to assess the probability of photoacoustic target detectability. This paper demonstrates the applicability of gCNR to assess photoacoustic image quality using simulated and experimental images created with delay-and-sum (DAS), short-lag spatial coherence (SLSC), generalized coherence factor weighting combined with DAS (GCF+DAS), and minimum variance (MV) beamforming. Images were created from data acquired with a fixed light source with output energy values increasing from 2 mJ to 35 mJ. The gCNR converged to 0.93, 0.98, 0.99, and 0.85 for DAS, SLSC, GCF+DAS, and MV beamforming, respectively, at energies of approximately 20, 10, 10, and 20 mJ, respectively. These results indicate that gCNR has the potential to determine the minimum laser energy needed to maximize the detectability of a photoacoustic target for any given image formation method.
Abdominal surgeries carry considerable risk of gastrointestinal and intra-abdominal hemorrhage, which could possibly cause patient death. Photoacoustic imaging is one solution to overcome this challenge by providing visualization of major blood vessels during surgery. We investigate the feasibility of in vivo blood vessel visualization for photoacoustic-guided liver and pancreas surgeries. In vivo photoacoustic imaging of major blood vessels in these two abdominal organs was successfully achieved after a laparotomy was performed on two swine. Three-dimensional photoacoustic imaging with a robot-controlled ultrasound (US) probe and color Doppler imaging were used to confirm vessel locations. Blood vessels in the in vivo liver were visualized with energies of 20 to 40 mJ, resulting in 10 to 15 dB vessel contrast. Similarly, an energy of 36 mJ was sufficient to visualize vessels in the pancreas with up to 17.3 dB contrast. We observed that photoacoustic signals were more focused when the light source encountered a major vessel in the liver. This observation can be used to distinguish major blood vessels in the image plane from the more diffuse signals associated with smaller blood vessels in the surrounding tissue. A postsurgery histopathological analysis was performed on resected pancreatic and liver tissues to explore possible laser-related damage. Results are generally promising for photoacoustic-guided abdominal surgery when the US probe is fixed and the light source is used to interrogate the surgical workspace. These findings are additionally applicable to other procedures that may benefit from photoacoustic-guided interventional imaging of the liver and pancreas (e.g., biopsy and guidance of radiofrequency ablation lesions in the liver).
Liver surgeries carry considerable risk of injury to major blood vessels, which can lead to hemorrhaging and possibly patient death. Photoacoustic imaging is one solution to enable intraoperative visualization of blood vessels, which has the potential to reduce the risk of accidental injury to these blood vessels during surgery. This paper presents our initial results of a feasibility study, performed during laparotomy procedures on two pigs, to determine in vivo vessel visibility for photoacoustic-guided liver surgery. Delay-and-sum beamforming and coherence-based beamforming were used to display photoacoustic images and differentiate the signal inside blood vessels from surrounding liver tissue. Color Doppler was used to confirm vessel locations. Results lend insight into the feasibility of photoacoustic-guided liver surgery when the ultrasound probe is fixed and the light source is used to interrogate the surgical workspace.
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