Slit-scanning confocal microendoscope for high-resolution in vivo imaging

Technology Selection for Inline Topography Measurement with Rover-Borne Laser Spectrometers

This work studies enhancing the capabilities of compact laser spectroscopes integrated into space-exploration rovers by adding 3D topography measurement techniques. Laser spectroscopy enables the in situ analysis of sample composition, aiding in the understanding of the geological history of extraterrestrial bodies. To complement spectroscopic data, the inclusion of 3D imaging is proposed to provide unprecedented contextual information. The morphological information aids material characterization and hence the constraining of rock and mineral histories. Assigning height information to lateral pixels creates topographies, which offer a more complete spatial dataset than contextual 2D imaging. To aid the integration of 3D measurement into future proposals for rover-based laser spectrometers, the relevant scientific, rover, and sample constraints are outlined. The candidate 3D technologies are discussed, and estimates of performance, weight, and power consumptions guide the down-selection process in three application examples. Technology choice is discussed from different perspectives. Inline microscopic fringe-projection profilometry, incoherent digital holography, and multiwavelength digital holography are found to be promising candidates for further development.

Polarization state tomography technique based on coherent synthesis of polarization state and orthogonal polarization state separation method for comprehensive optical imaging

Comprehensive optical imaging of the intensity, phase, and birefringent information of the biological sample is important because important physical or pathological changes always accompany the changes in multiple optical parameters. Current studies lack such a metric that can present the comprehensive optical property of the sample in one figure. In this paper, a polarization state synthesis tomography (PoST) method, which is based on the principle of polarization state coherent synthesis and demodulation, is proposed to achieve full-field tomographic imaging of the comprehensive information (i.e., intensity, phase, and birefringence) of the biological sample. In this method, the synthesis of the polarization state is achieved by the time-domain full-field low coherence interferometer, where the polarization states of the sample beam and the reference beam are set to be orthogonal for the synthesis of the polarization state. The synthesis of the polarization state enables two functions of the PoST system: (1) Depth information of the sample can be encoded by the synthesized polarization state because only when the optical path length difference between the two arms is within the coherence length, a new polarization state can be synthesized; (2) Since the scattering coefficient, refractive index and the birefringent property of the sample can modulate the intensity and phase of the sample beam, the synthesized polarization state is sensitive to all these three parameters and can provide the comprehensive optical information of the sample. In this work, the depth-resolved ability and the comprehensive optical imaging metric have been demonstrated by the standard samples and the onion cells, demonstrating the potential application value of this method for further investigation of the important physical or pathological process of the biological tissues.

Real-timing processing of fiber bundle endomicroscopy images in Python using PyFibreBundle

Fiber imaging bundles allow the transfer of optical images from place-to-place along narrow and flexible conduits. Traditionally used extensively in medical endoscopy, bundles are now finding new applications in endoscopic microscopy and other emerging techniques. PyFibreBundle is an open-source Python package for fast processing of images acquired through imaging bundles. This includes detection and removal of the fiber core pattern by filtering or interpolation, and application of background and flat-field corrections. It also allows images to be stitched together to create mosaics and resolution to be improved by combining multiple shifted images. This paper describes the technical implementation of PyFibreBundle and provides example results from three endomicroscopy imaging systems: color transmission, monochrome transmission, and confocal fluorescence. This allows various processing options to be compared quantitatively and qualitatively, and benchmarking demonstrates that PyFibreBundle can achieve state-of-the-art performance in an open-source package. The paper demonstrates core removal by interpolation and mosaicing at over 100 fps, real-time multi-frame resolution enhancement and the first demonstration of real-time endomicroscopy image processing, including core removal, on a Raspberry Pi single board computer. This demonstrates that PyFibreBundle is potentially a valuable tool for the development of low-cost, high-performance fiber bundle imaging systems.

Reduced motion artifacts and speed improvements in enhanced line-scanning fiber bundle endomicroscopy

SIGNIFICANCE

Confocal laser scanning enables optical sectioning in fiber bundle endomicroscopy but limits the frame rate. To be able to better explore tissue morphology, it is useful to stitch sequentially acquired frames into a mosaic. However, low frame rates limit the maximum probe translation speed. Line-scanning (LS) confocal endomicroscopy provides higher frame rates, but residual out-of-focus light degrades images. Subtraction-based approaches can suppress this residue at the expense of introducing motion artifacts.

AIM

To generate high-frame-rate endomicroscopy images with improved optical sectioning, we develop a high-speed subtraction method that only requires the acquisition of a single camera frame.

APPROACH

The rolling shutter of a CMOS camera acts as both the aligned and offset detector slits required for subtraction-based sectioning enhancement. Two images of the bundle are formed on different regions of the camera, allowing both images to be acquired simultaneously.

RESULTS

We confirm improved optical sectioning compared to conventional LS, particularly far from focus, and show that motion artifacts are not introduced. We demonstrate high-speed mosaicing at frame rates of up to 240 Hz.

CONCLUSION

High-speed acquisition of optically sectioned images using the new subtraction based-approach leads to improved mosaicing at high frame rates.

Image computing for fibre-bundle endomicroscopy: A review

Endomicroscopy is an emerging imaging modality, that facilitates the acquisition of in vivo, in situ optical biopsies, assisting diagnostic and potentially therapeutic interventions. While there is a diverse and constantly expanding range of commercial and experimental optical biopsy platforms available, fibre-bundle endomicroscopy is currently the most widely used platform and is approved for clinical use in a range of clinical indications. Miniaturised, flexible fibre-bundles, guided through the working channel of endoscopes, needles and catheters, enable high-resolution imaging across a variety of organ systems. Yet, the nature of image acquisition though a fibre-bundle gives rise to several inherent characteristics and limitations necessitating novel and effective image pre- and post-processing algorithms, ranging from image formation, enhancement and mosaicing to pathology detection and quantification. This paper introduces the underlying technology and most prevalent clinical applications of fibre-bundle endomicroscopy, and provides a comprehensive, up-to-date, review of relevant image reconstruction, analysis and understanding/inference methodologies. Furthermore, current limitations as well as future challenges and opportunities in fibre-bundle endomicroscopy computing are identified and discussed.

Versatile high-speed confocal microscopy using a single laser beam

We present a new flexible high speed laser scanning confocal microscope and its extension by an astigmatism particle tracking velocimetry (APTV) device. Many standard confocal microscopes use either a single laser beam to scan the sample at a relatively low overall frame rate or many laser beams to simultaneously scan the sample and achieve a high overall frame rate. The single-laser-beam confocal microscope often uses a point detector to acquire the image. To achieve high overall frame rates, we use, next to the standard 2D probe scanning unit, a second 2D scan unit projecting the image directly onto a 2D CCD-sensor (re-scan configuration). Using only a single laser beam eliminates crosstalk and leads to an imaging quality that is independent of the frame rate with a lateral resolution of 0.235 µm. The design described here is suitable for a high frame rate, i.e., for frame rates well above the video rate (full frame) up to a line rate of 32 kHz. The dwell time of the laser focus on any spot in the sample (122 ns) is significantly shorter than those in standard confocal microscopes (in the order of milli- or microseconds). This short dwell time reduces phototoxicity and bleaching of fluorescent molecules. The new design opens up further flexibility and facilitates coupling to other optical methods. The setup can easily be extended by an APTV device to measure three dimensional dynamics while being able to show high resolution confocal structures. Thus, one can use the high resolution confocal information synchronized with an APTV dataset.

Line scanning, fiber bundle fluorescence HiLo endomicroscopy with confocal slit detection

Fiber bundle fluorescence endomicroscopy is an effective method for in vivo imaging of biological tissue samples. Line-scanning confocal laser endomicroscopy realizes confocal imaging at a much higher frame rate compared to the point scanning system, but with reduced optical sectioning. To address this problem, we describe a fiber bundle endomicroscopy system that utilizes the HiLo technique to enhance the optical sectioning while still maintaining high image acquisition rates. Confocal HiLo endomicroscopy is achieved by synchronizing the scanning hybrid-illumination laser line with the rolling shutter of a CMOS camera. An evident improvement of axial sectioning is achieved as compared to the line-scanning confocal endomicroscopy without the HiLo technique. Comparisons are also made with epifluorescence endomicroscopy with and without HiLo. The optical sectioning enhancement is demonstrated on lens tissue as well as porcine kidney tissue.

Intravital microscopy: Imaging host-parasite interactions in the brain

Intravital fluorescence microscopy (IVM) is a powerful technique for imaging multiple organs, including the brain of living mice and rats. It enables the direct visualisation of cells in situ providing a real-life view of biological processes that in vitro systems cannot. In addition, to the technological advances in microscopy over the last decade, there have been supporting innovations in data storage and analytical packages that enable the visualisation and analysis of large data sets. Here, we review the advantages and limitations of techniques predominantly used for brain IVM, including thinned skull windows, open skull cortical windows, and a miniaturised optical system based on microendoscopic probes that can be inserted into deep tissues. Further, we explore the relevance of these techniques for the field of parasitology. Several protozoan infections are associated with neurological symptoms including Plasmodium spp., Toxoplasma spp., and Trypanosoma spp. IVM has led to crucial findings on these parasite species, which are discussed in detail in this review.

Improving nuclear morphometry imaging with real-time and low-cost line-scanning confocal microendoscope

Fiber-optic endomicroscopy is a minimally invasive tool to probe disease progression with subcellular resolution. In this Letter, we demonstrate a low-cost and compact fluorescence microendoscope capable of line-scanning confocal imaging by synchronizing a digital light projector with a CMOS camera. We present the digital aperture design to enable real-time confocal imaging, and we implement parallel illumination to improve the optical sectioning performance. Furthermore, we show that the confocal microendoscope can enhance visualization of disease-associated features when imaging highly scattering esophageal specimens.

Line-field confocal time-domain optical coherence tomography with dynamic focusing

A time-domain optical coherence tomography technique is introduced for high-resolution B-scan imaging in real-time. The technique is based on a two-beam interference microscope with line illumination and line detection using a broadband spatially coherent light source and a line-scan camera. Multiple (2048) A-scans are acquired in parallel by scanning the sample depth while adjusting the focus. Quasi-isotropic spatial resolution of 1.3 µm × 1.1 µm (lateral × axial) is achieved. In vivo cellular-level resolution imaging of human skin is demonstrated at 10 frames per second with a penetration depth of ∼500 µm.

Fast confocal fluorescence imaging in freely behaving mice

Fluorescence imaging in the brain of freely behaving mice is challenging due to severe miniaturization constraints. In particular, the ability to image a large field of view at high temporal resolution and with efficient out-of-focus background rejection still raises technical difficulties. Here, we present a novel fiberscope system that provides fast (up to 200 Hz) background-free fluorescence imaging in freely behaving mice over a field of view of diameter 230 μm. The fiberscope is composed of a custom-made multipoint-scanning confocal microscope coupled to the animal with an image guide and a micro-objective. By simultaneously registering a multipoint-scanning confocal image and a conventional widefield image, we subtracted the residual out-of-focus background and provided a background-free confocal image. Illumination and detection pinholes were created using a digital micromirror device, providing high adaptability to the sample structure and imaging conditions. Using this novel imaging tool, we demonstrated fast fluorescence imaging of microvasculature up to 120 μm deep in the mouse cortex, with an out-of-focus background reduced by two orders of magnitude compared with widefield microscopy. Taking advantage of the high acquisition rate (200 Hz), we measured red blood cell velocity in the cortical microvasculature and showed an increase in awake, unrestrained mice compared with anaesthetized animals.

Near-infrared probe-based confocal microendoscope for deep-tissue imaging

In this work, a near-infrared probe-based confocal microendoscope (pCM) with a 785 nm laser source, a long working distance, and a probe with diameter of 2.6 mm that can be compatible with a conventional endoscope is demonstrated to produce deep-tissue images at cellular resolutions with enhanced contrast and signal-to-noise ratio. Theoretical simulations and experiments confirm that near-infrared light can optimize the image quality. Abundant details of mouse esophagus obtained at different depths demonstrate the system's ability to image deep tissues at cellular resolutions, which makes it possible to diagnose diseases in the digestive tract in real time, laying a solid foundation for clinical applications.

Redox-Magnetohydrodynamically Controlled Fluid Flow with Poly(3,4-ethylenedioxythiophene) Coupled to an Epitaxial Light Sheet Confocal Microscope for Image Cytometry Applications

We present the merging of two technologies to perform continuous high-resolution fluorescence imaging of cellular suspensions in a deep microfluidics chamber with no moving parts. An epitaxial light sheet confocal microscope (e-LSCM) was used to image suspensions enabled by fluid transport via redox-magnetohydrodynamics (R-MHD). The e-LSCM features a linear solid state sensor, oriented perpendicular to the direction of flow, that can bin the emission across different numbers of pixels, yielding electronically adjustable optical sectioning. This, in addition to intensity thresholding, defines the axial resolution, which was validated with an optical phantom of polystyrene microspheres suspended in agarose. The linear fluid speed within the microfluidics chamber was uniform (0.16-2.9%) across the 0.5-1.0 mm lateral field of view (dependent upon the chosen magnification) with continuous acquisition. Also, the camera's linear exposure periods were controlled to ensure an accurate image aspect ratio across this span. Poly(3,4-ethylenedioxythiophene) (PEDOT) was electrodeposited as an immobilized redox film on electrodes of a chip for R-MHD, and the fluid flow was calibrated to specific linear speeds as a function of applied current. Images of leukocytes stained with acridine orange, a fluorescent, amphipathic vital dye that intercalates DNA, were acquired in the R-MHD microfluidics chamber with the e-LSCM to demonstrate imaging of biological samples. The combination of these technologies provides a miniaturizable platform for large sample volumes and high-throughput, image-based analysis without the requirement of moving parts, enabling development of robust, point-of-care image cytometry.

Multiplexed holographic non-axial-scanning slit confocal fluorescence microscopy

A non-axial-scanning multi-plane microscopic system incorporating multiplexed volume holographic gratings and slit array detection to simultaneously acquire optically sectioned images from different depths is presented. The proposed microscopic system is configured such that multiplexed volume holographic gratings are utilized to selectively produce axial focal points in two or more planes inside the sample, and then to use confocal slit apertures to simultaneously image these multiple planes onto corresponding detection areas of a CCD. We describe the design, implementation, and experimental data demonstrating this microscopic system's ability to obtain optically sectioned multi-plane images of fluorescently labeled standard micro-spheres and tissue samples without scanning in axial directions.

Augmented line-scan focal modulation microscopy for multi-dimensional imaging of zebrafish heart in vivo

Multi-dimensional fluorescence imaging of live animal models demands strong optical sectioning, high spatial resolution, fast image acquisition, and minimal photobleaching. While conventional laser scanning microscopes are capable of deep penetration and sub-cellular resolution, they are generally too slow and causing excessive photobleaching for volumetric or time-lapse imaging. We demonstrate the performance of an augmented line-scan focal modulation microscope (aLSFMM), a high-speed imaging platform that affords above video-rate imaging speed by the use of line scanning. Exceptional background rejection is accomplished by combining a confocal slit with focal modulation. The image quality is further improved by merging the information from simultaneously acquired focal modulation and confocal images. Such a hybrid imaging scheme makes it possible to use very low power excitation light in high-speed imaging, and therefore leads to reduced photobleaching that is desirable for three-dimensional (3D) and four-dimensional (4D) in vivo image acquisition.

Line-scanning confocal microendoscope for nuclear morphometry imaging

Fiber-optic endomicroscopy is a minimally invasive method to image cellular morphology in vivo. Using a coherent fiber bundle as an image relay, it allows additional imaging optics to be placed at the distal end of the fiber outside the body. In this research, we use this approach to demonstrate a compact, low-cost line-scanning confocal fluorescence microendoscope that can be constructed for <$5000. Confocal imaging is enabled without the need for mechanical scanning by synchronizing a digital light projector with the rolling shutter of a CMOS camera. Its axial performance is characterized in comparison with a nonscanned high-resolution microendoscope. We validate the optical sectioning capability of the microendoscope by imaging a two-dimensional phantom and ex vivo mouse esophageal and colon tissues. Results show that optical sectioning using this approach improves visualization of nuclear morphometry and suggest that this low-cost line-scanning microendoscope can be used to evaluate various pathological conditions.

Towards Practical Endoscopic Mass Spectrometry

In this paper, we briefly review the remote mass spectrometric techniques that are viable to perform "endoscopic mass spectrometry," i.e., in-situ and in-vivo MS analysis inside the cavity of human or animal body. We also report our experience with a moving string sampling probe for the remote sample collection and the transportation of adhered sample to an ion source near the mass spectrometer. With a miniaturization of the probe, the method described here has the potential to be fit directly into a medical endoscope.

High speed wavefront sensorless aberration correction in digital micromirror based confocal microscopy

The quality of fluorescence microscopy images is often impaired by the presence of sample induced optical aberrations. Adaptive optical elements such as deformable mirrors or spatial light modulators can be used to correct aberrations. However, previously reported techniques either require special sample preparation, or time consuming optimization procedures for the correction of static aberrations. This paper reports a technique for optical sectioning fluorescence microscopy capable of correcting dynamic aberrations in any fluorescent sample during the acquisition. This is achieved by implementing adaptive optics in a non conventional confocal microscopy setup, with multiple programmable confocal apertures, in which out of focus light can be separately detected, and used to optimize the correction performance with a sampling frequency an order of magnitude faster than the imaging rate of the system. The paper reports results comparing the correction performances to traditional image optimization algorithms, and demonstrates how the system can compensate for dynamic changes in the aberrations, such as those introduced during a focal stack acquisition though a thick sample.

Bessel-beam illumination in dual-axis confocal microscopy mitigates resolution degradation caused by refractive heterogeneities

One of the main challenges for laser-scanning microscopy of biological tissues with refractive heterogeneities is the degradation in spatial resolution that occurs as a result of beam steering and distortion. This challenge is particularly significant for dual-axis confocal (DAC) microscopy, which achieves improved spatial-filtering and optical-sectioning performance over traditional confocal microscopy through off-axis illumination and collection of light with low-numerical aperture (NA) beams that must intersect precisely at their foci within tissues. DAC microscope image quality is sensitive to positional changes and distortions of these illumination- and collection-beam foci. Previous studies have shown that Bessel beams display improved positional stability and beam quality than Gaussian beams when propagating through tissues with refractive heterogeneities, which suggests that Bessel-beam illumination may enhance DAC microscopy of such tissues. Here, we utilize both Gaussian and Bessel illumination in a point-scanned DAC microscope and quantify the resultant degradation in resolution when imaging within heterogeneous optical phantoms and fresh tissues. Results indicate that DAC microscopy with Bessel illumination exhibits reduced resolution degradation from microscopic tissue heterogeneities compared to DAC microscopy with conventional Gaussian illumination.

Pilot Clinical Evaluation of a Confocal Microlaparoscope for Ovarian Cancer Detection

OBJECTIVE

The aim of this study is to evaluate the performance of a confocal fluorescence microlaparoscope for in vivo detection of ovarian cancer.

METHODS/MATERIALS

Seventy-one patients scheduled for open or laparoscopic oophorectomy were consented for the imaging study. High-resolution confocal microlaparoscopic images of the epithelial surface of the ovary were acquired in vivo or ex vivo after tissue staining using acridine orange. Standard histologic evaluation of extracted tissue samples was performed and used as the gold standard of disease diagnosis. Trained human observers from different specialties viewed the microlaparoscopic images, rating each image on a 6-point scale ranging from "definitely not cancer" to "definitely cancer." Receiver operating characteristic curves were generated using these scores and the gold standard histopathologic diagnosis. Area under the receiver operating characteristic curve (AUC) was calculated as a performance metric.

RESULTS

Forty-five of the consented patients were used in the final evaluation study. From these 45 patients, 63 tissue locations or samples were identified and imaged with the confocal microlaparoscope. Twenty of the samples were high-grade cancers, and the remaining 43 samples were normal or noncancerous. Twenty-three of the samples were imaged in vivo, and the remaining 40 samples were imaged ex vivo. The average AUC score and standard error (SE) for detection of cancer in all images were 0.88 and 0.02, respectively. An independent-samples t test was conducted to compare AUC scores for in vivo and ex vivo conditions. No statistically significant difference in the AUC score for in vivo (AUC, 0.850; SE, 0.049) and ex vivo (AUC, 0.888; SE, 0.027) conditions was observed, t(6) = 1.318, P = 0.2355.

CONCLUSIONS

Area under the receiver operating characteristic curve scores indicate that high-resolution in vivo images obtained by the confocal laparoscope can distinguish between normal and malignant ovarian surface epithelium. In addition, in vivo performance is similar to that which can be obtained from ex vivo tissue.

Line-scanning fiber bundle endomicroscopy with a virtual detector slit

Coherent fiber bundles can be used to relay the image plane from the distal tip of an endomicroscope to an external confocal microscopy system. The frame rate is therefore determined by the speed of the microscope's laser scanning system which, at 10-20 Hz, may be undesirably low for in vivo clinical applications. Line-scanning allows an increase in the frame rate by an order of magnitude in exchange for some loss of optical sectioning, but the width of the detector slit cannot easily be adapted to suit different imaging conditions. The rolling shutter of a CMOS camera can be used as a virtual detector slit for a bench-top line-scanning confocal microscope, and here we extend this idea to endomicroscopy. By synchronizing the camera rolling shutter with a scanning laser line we achieve confocal imaging with an electronically variable detector slit. This architecture allows us to acquire every other frame with the detector slit offset by a known distance, and we show that subtracting this second image leads to improved optical sectioning.

Miniature in vivo MEMS-based line-scanned dual-axis confocal microscope for point-of-care pathology

There is a need for miniature optical-sectioning microscopes to enable in vivo interrogation of tissues as a real-time and noninvasive alternative to gold-standard histopathology. Such devices could have a transformative impact for the early detection of cancer as well as for guiding tumor-resection procedures. Miniature confocal microscopes have been developed by various researchers and corporations to enable optical sectioning of highly scattering tissues, all of which have necessitated various trade-offs in size, speed, depth selectivity, field of view, resolution, image contrast, and sensitivity. In this study, a miniature line-scanned (LS) dual-axis confocal (DAC) microscope, with a 12-mm diameter distal tip, has been developed for clinical point-of-care pathology. The dual-axis architecture has demonstrated an advantage over the conventional single-axis confocal configuration for reducing background noise from out-of-focus and multiply scattered light. The use of line scanning enables fast frame rates (16 frames/sec is demonstrated here, but faster rates are possible), which mitigates motion artifacts of a hand-held device during clinical use. We have developed a method to actively align the illumination and collection beams in a DAC microscope through the use of a pair of rotatable alignment mirrors. Incorporation of a custom objective lens, with a small form factor for in vivo clinical use, enables our device to achieve an optical-sectioning thickness and lateral resolution of 2.0 and 1.1 microns respectively. Validation measurements with reflective targets, as well as in vivo and ex vivo images of tissues, demonstrate the clinical potential of this high-speed optical-sectioning microscopy device.

Five-lens, easy-to-implement miniature objective for a fluorescence confocal microendoscope

A fluorescence confocal microendoscope requires a high-performance miniature objective. We present a miniature objective comprising four glass lenses and one plastic aspheric lens. The 0.5 NA objective is achromatized in the wavelength range of 488-550 nm, has a field of view (FOV) of 360 μm, and an outer diameter of 2.6 mm. The assembled miniature objective can resolve features separated by as little as 0.78 μm. The imaging quality of the fluorescence confocal microendoscope with the miniature objective is similar to that of a commercial confocal microscope. It can resolve cellular structures such as crypt structures and epithelial cells.

Line-scanning confocal microscopy for high-resolution imaging of upconverting rare-earth-based contrast agents

Rare-earth (RE) doped nanocomposites emit visible luminescence when illuminated with continuous wave near-infrared light, making them appealing candidates for use as contrast agents in biomedical imaging. However, the emission lifetime of these materials is much longer than the pixel dwell times used in scanning intravital microscopy. To overcome this limitation, we have developed a line-scanning confocal microscope for high-resolution, optically sectioned imaging of samples labeled with RE-based nanomaterials. Instrument performance is quantified using calibrated test objects. NaYF4 : Er,Yb nanocomposites are imaged in vitro, and in ex vivo tissue specimens, with direct comparison to point-scanning confocal microscopy. We demonstrate that the extended pixel dwell time of line-scanning confocal microscopy enables subcellular-level imaging of these nanomaterials while maintaining optical sectioning. The line-scanning approach thus enables microscopic imaging of this emerging class of contrast agents for preclinical studies, with the potential to be adapted for real-time in vivo imaging in the clinic.

Trends in fluorescence image-guided surgery for gliomas

Mounting evidence suggests that a more extensive surgical resection is associated with an improved life expectancy for both low-grade and high-grade glioma patients. However, radiographically complete resections are not often achieved in many cases because of the lack of sensitivity and specificity of current neurosurgical guidance techniques at the margins of diffuse infiltrative gliomas. Intraoperative fluorescence imaging offers the potential to improve the extent of resection and to investigate the possible benefits of resecting beyond the radiographic margins. Here, we provide a review of wide-field and high-resolution fluorescence-imaging strategies that are being developed for neurosurgical guidance, with a focus on emerging imaging technologies and clinically viable contrast agents. The strengths and weaknesses of these approaches will be discussed, as well as issues that are being addressed to translate these technologies into the standard of care.

Force adaptive robotically assisted endomicroscopy for intraoperative tumour identification

PURPOSE

For effective tumour margin definition for cancer surgery, there is an increasing demand for the development of real-time intraoperative tissue biopsy techniques. Recent advances in miniaturized biophotonics probes have permitted the development of endomicroscopy techniques that are clinically attractive. With these approaches, cellular-level imaging can be achieved through millimetre-scale flexible probes and be performed in real-time, in vivo and in situ. Due to the limited field of view and flexibility of these probes, however, large area tissue coverage for acquiring histology-like images over complex three-dimensional surfaces is challenging. This is particularly the case because current surgical robots, such as the Da Vinci ®, lack haptic feedback, making it difficult to maintain optimum tissue contact when these probes are deployed in vivo.

METHODS

This paper proposes a simple force-controlled pick-up probe that can be integrated with the Da Vinci instruments for intraoperative endomicroscopy imaging. The device uses a new low-friction air bearing with adaptive axial force control to maintain constant contact between the tissue and the imaging probe, facilitating microscopy scans over complex surfaces. Detailed ex vivo user experiments have been conducted to demonstrate the effectiveness of the technique.

RESULTS

The adaptive probe mount could achieve consistent low-magnitude probe-sample contact forces compared with a rigid mount. In the user study, the adaptive probe combined with a high frame rate endomicroscopy system allowed larger mosaics to be generated over curved surfaces.

CONCLUSIONS

The device can improve the performance of large area mosaicking over complex 3D surfaces with improved handling and intraoperative control.

High speed, line-scanning, fiber bundle fluorescence confocal endomicroscopy for improved mosaicking

A significant limitation of fiber bundle endomicroscopy systems is that the field of view tends to be small, usually only several hundred micrometers in diameter. Image mosaicking techniques can increase the effective image size, but require careful manipulation of the probe to ensure sufficient overlap between adjacent frames. For confocal endomicroscopes, which typically have frame rates on the order of 10 fps, this is particularly challenging. In this paper we demonstrate that line-scanning confocal endomicroscopy can, by use of a high speed linear CCD camera, achieve a frame rate of 120 fps while maintaining sufficient resolution and signal-to-noise ratio to allow imaging of topically stained gastrointestinal tissues. This leads to improved performance of a cross-correlation based mosaicking algorithm when compared with lower frame-rate systems.

Varifocal MOEMS fiber scanner for confocal endomicroscopy

Based on an advanced silicon optical bench technology with integrated MOEMS (Micro-Opto-Electro-Mechanical-System) components, a piezo-driven fiber scanner for confocal microscopy has been developed. This highly-miniaturized technology allows integration into an endoscope with a total outer probe diameter of 2.5 mm. The system features a hydraulically-driven varifocal lens providing axial confocal scanning without any translational movement of components. The demonstrated resolutions are 1.7 μm laterally and 19 μm axially.

Design and Performance of a Multi-Point Scan Confocal Microendoscope

Confocal fluorescence microendoscopy provides high-resolution cellular-level imaging via a minimally invasive procedure, but requires fast scanning to achieve real-time imaging in vivo. Ideal confocal imaging performance is obtained with a point scanning system, but the scan rates required for in vivo biomedical imaging can be difficult to achieve. By scanning a line of illumination in one direction in conjunction with a stationary confocal slit aperture, very high image acquisition speeds can be achieved, but at the cost of a reduction in image quality. Here, the design, implementation, and experimental verification of a custom multi-point aperture modification to a line-scanning multi-spectral confocal microendoscope is presented. This new design improves the axial resolution of a line-scan system while maintaining high imaging rates. In addition, compared to the line-scanning configuration, previously reported simulations predicted that the multi-point aperture geometry greatly reduces the effects of tissue scatter on image quality. Experimental results confirming this prediction are presented.

Confocal microlaparoscope for imaging the fallopian tube

Recent evidence suggests that ovarian cancer can originate in the fallopian tube. Unlike many other cancers, poor access to the ovary and fallopian tubes has limited the ability to study the progression of this deadly disease and to diagnosis it during the early stage when it is most amenable to therapy. A rigid confocal microlaparoscope system designed to image the epithelial surface of the ovary in vivo was previously reported. A new confocal microlaparoscope with an articulating distal tip has been developed to enable in vivo access to human fallopian tubes. The new microlaparoscope is compatible with 5-mm trocars and includes a 2.2-mm-diameter articulating distal tip consisting of a bare fiber bundle and an automated dye delivery system for fluorescence confocal imaging. This small articulating device should enable the confocal microlaparoscope to image early stage ovarian cancer arising inside the fallopian tube. Ex vivo images of animal tissue and human fallopian tube using the new articulating device are presented along with in vivo imaging results using the rigid confocal microlaparoscope system.

Sheet-scanned dual-axis confocal microscopy using Richardson-Lucy deconvolution

We have previously developed a line-scanned dual-axis confocal (LS-DAC) microscope with subcellular resolution suitable for high-frame-rate diagnostic imaging at shallow depths. Due to the loss of confocality along one dimension, the contrast (signal-to-background ratio) of a LS-DAC microscope is deteriorated compared to a point-scanned DAC microscope. However, by using a sCMOS camera for detection, a short oblique light-sheet is imaged at each scanned position. Therefore, by scanning the light sheet in only one dimension, a thin 3D volume is imaged. Both sequential two-dimensional deconvolution and three-dimensional deconvolution are performed on the thin image volume to improve the resolution and contrast of one en face confocal image section at the center of the volume, a technique we call sheet-scanned dual-axis confocal (SS-DAC) microscopy.

Advances in imaging probes and optical microendoscopic imaging techniques for early in vivo cancer assessment

A new chapter in the history of medical diagnosis happened when the first X-ray technology was invented in the late 1800s. Since then, many non-invasive and minimally invasive imaging techniques have been invented for clinical diagnosis to research in cellular biology, drug discovery, and disease monitoring. These imaging modalities have leveraged the benefits of significant advances in computer, electronics, and information technology and, more recently, targeted molecular imaging. The development of targeted contrast agents such as fluorescent and nanoparticle probes coupled with optical imaging techniques has made it possible to selectively view specific biological events and processes in both in vivo and ex vivo systems with great sensitivity and selectivity. Thus, the combination of targeted molecular imaging probes and optical imaging techniques have become a mainstay in modern medicinal and biological research. Many promising results have demonstrated great potentials to translate to clinical applications. In this review, we describe a discussion of employing imaging probes and optical microendoscopic imaging techniques for cancer diagnosis.

Comparison of line-scanned and point-scanned dual-axis confocal microscope performance

The point-scanned dual-axis confocal (PS-DAC) microscope has been shown to exhibit superior capability to reject out-of-focus and multiply scattered light in comparison to its conventional single-axis counterpart. However, the slow frame rate (typically <5 Hz) resulting from point-by-point data collection makes these systems vulnerable to motion artifacts. While video-rate point-scanned confocal microscopy is possible, a line-scanned dual-axis confocal (LS-DAC) microscope provides a simpler means of achieving high-speed imaging through line-by-line data collection, but sacrifices contrast due to loss of confocality along one dimension. Here we evaluate the performance trade-offs between an LS-DAC and PS-DAC microscope with identical spatial resolutions. Characterization experiments of the LS-DAC and PS-DAC microscopes with tissue phantoms, in reflectance mode, are shown to match results from Monte Carlo scattering simulations of the systems. Fluorescence images of mouse brain vasculature, obtained using resolution-matched LS-DAC and PS-DAC microscopes, demonstrate the comparable performance of LS-DAC and PS-DAC microscopy at shallow depths.

Optimizing the performance of dual-axis confocal microscopes via Monte-Carlo scattering simulations and diffraction theory

Dual-axis confocal (DAC) microscopy has been found to exhibit superior rejection of out-of-focus and multiply scattered background light compared to conventional single-axis confocal microscopy. DAC microscopes rely on the use of separated illumination and collection beam paths that focus and intersect at a single focal volume (voxel) within tissue. While it is generally recognized that the resolution and contrast of a DAC microscope depends on both the crossing angle of the DAC beams, 2θ, and the focusing numerical aperture of the individual beams, α, a detailed study to investigate these dependencies has not been performed. Contrast and resolution are considered as two main criteria to assess the performance of a point-scanned DAC microscope (DAC-PS) and a line-scanned DAC microscope (DAC-LS) as a function of θ and α. The contrast and resolution of these designs are evaluated by Monte-Carlo scattering simulations and diffraction theory calculations, respectively. These results can be used for guiding the optimal designs of DAC-PS and DAC-LS microscopes.

Chromatic confocal microscopy for multi-depth imaging of epithelial tissue

We present a novel chromatic confocal microscope capable of volumetric reflectance imaging of microstructure in non-transparent tissue. Our design takes advantage of the chromatic aberration of aspheric lenses that are otherwise well corrected. Strong chromatic aberration, generated by multiple aspheres, longitudinally disperses supercontinuum light onto the sample. The backscattered light detected with a spectrometer is therefore wavelength encoded and each spectrum corresponds to a line image. This approach obviates the need for traditional axial mechanical scanning techniques that are difficult to implement for endoscopy and susceptible to motion artifact. A wavelength range of 590-775 nm yielded a >150 µm imaging depth with ~3 µm axial resolution. The system was further demonstrated by capturing volumetric images of buccal mucosa. We believe these represent the first microstructural images in non-transparent biological tissue using chromatic confocal microscopy that exhibit long imaging depth while maintaining acceptable resolution for resolving cell morphology. Miniaturization of this optical system could bring enhanced speed and accuracy to endomicroscopic in vivo volumetric imaging of epithelial tissue.

Building large mosaics of confocal edomicroscopic images using visual servoing

Probe-based confocal laser endomicroscopy provides real-time microscopic images of tissues contacted by a small probe that can be inserted in vivo through a minimally invasive access. Mosaicking consists in sweeping the probe in contact with a tissue to be imaged while collecting the video stream, and process the images to assemble them in a large mosaic. While most of the literature in this field has focused on image processing, little attention has been paid so far to the way the probe motion can be controlled. This is a crucial issue since the precision of the probe trajectory control drastically influences the quality of the final mosaic. Robotically controlled motion has the potential of providing enough precision to perform mosaicking. In this paper, we emphasize the difficulties of implementing such an approach. First, probe-tissue contacts generate deformations that prevent from properly controlling the image trajectory. Second, in the context of minimally invasive procedures targeted by our research, robotic devices are likely to exhibit limited quality of the distal probe motion control at the microscopic scale. To cope with these problems visual servoing from real-time endomicroscopic images is proposed in this paper. It is implemented on two different devices (a high-accuracy industrial robot and a prototype minimally invasive device). Experiments on different kinds of environments (printed paper and ex vivo tissues) show that the quality of the visually servoed probe motion is sufficient to build mosaics with minimal distortion in spite of disturbances.

Assessing the tissue-imaging performance of confocal microscope architectures via Monte Carlo simulations

Various confocal microscope architectures have been developed for in vivo tissue imaging, including single-axis confocal (SAC) and dual-axis confocal (DAC) configurations utilizing both point-scanning (PS) and line-scanning (LS) approaches. While it is known that these design variations lead to tradeoffs in imaging performance, a quantitative comparison of the imaging performance of these configurations in highly turbid media would be of value. Here, we perform Monte Carlo simulations to evaluate the optical-sectioning capability of these various confocal microscope architectures in reflectance mode. In particular, we investigate the axial and transverse responses of these configurations to reflective targets at various depths within a homogenous scattering medium. We find that the DAC-PS configuration results in superior rejection of multiply scattered background light compared to all other configurations, followed in performance by the SAC-PS, the DAC-LS, and then the SAC-LS. Line scanning with both the DAC and SAC configurations leads to photon crosstalk between pixels. However, at shallow depths, the axial and transverse resolution of all configurations is maintained in a homogeneous scattering medium.

A miniaturized platform for laser speckle contrast imaging

Imaging the brain in animal models enables scientists to unravel new biological insights. Despite critical advancements in recent years, most laboratory imaging techniques comprise of bulky bench top apparatus that require the imaged animals to be anesthetized and immobilized. Thus, animals are imaged in their non-native state severely restricting the scope of behavioral experiments. To address this gap, we report a miniaturized microscope that can be mounted on a rat's head for imaging in awake and unrestrained conditions. The microscope uses laser speckle contrast imaging (LSCI), a high resolution yet wide field imaging modality for imaging blood vessels and perfusion. Design details of both the image formation and acquisition modules are presented. A Monte Carlo simulation was used to estimate the depth of tissue penetration achievable by the imaging system while the produced speckle Airy disc patterns were simulated using Fresnel's diffraction theory. The microscope system weighs only 7 g and occupies less than 5 cm³ and was successfully used to generate proof of concept LSCI images of rat brain vasculature. We validated the utility of the head-mountable system in an awake rat brain model by confirming no impairment to the rat's native behavior.

Confocal endomicroscopy: instrumentation and medical applications

Advances in fiber optic technology and miniaturized optics and mechanics have propelled confocal endomicroscopy into the clinical realm. This high resolution, non-invasive imaging technology provides the ability to microscopically evaluate cellular and sub-cellular features in tissue in vivo by optical sectioning. Because many cancers originate in epithelial tissues accessible by endoscopes, confocal endomicroscopy has been explored to detect regions of possible neoplasia at an earlier stage by imaging morphological features in vivo that are significant in histopathologic evaluation. This technique allows real-time assessment of tissue which may improve diagnostic yield by guiding biopsy. Research and development continues to reduce the overall size of the imaging probe, increase the image acquisition speed, and improve resolution and field of view of confocal endomicroscopes. Technical advances will continue to enable application to less accessible organs and more complex systems in the body. Lateral and axial resolutions down to 0.5 and 3 μm, respectively, field of view as large as 800 × 450 μm, and objective lens and total probe outer diameters down to 0.35 and 1.25 mm, respectively, have been achieved. We provide a review of the historical developments of confocal imaging in vivo, the evolution of endomicroscope instrumentation, and the medical applications of confocal endomicroscopy.

Performance of full-pupil line-scanning reflectance confocal microscopy in human skin and oral mucosa in vivo

Point-scanning reflectance confocal microscopes continue to be successfully translated for detection of skin cancer. Line-scanning, with the use of a single scanner and a linear-array detector, offers a potentially smaller, simpler and lower cost alternative approach, to accelerate widespread dissemination into the clinic. However, translation will require an understanding of imaging performance deep within scattering and aberrating human tissues. We report the results of an investigation of the performance of a full-pupil line-scanning reflectance confocal microscope in human skin and oral mucosa, in terms of resolution, optical sectioning, contrast, signal-to-noise ratio, imaging and the effect of speckle noise.

Dispersion management for controlling image plane in Fourier-domain spectrally encoded endoscopy

Spectrally encoded endoscopy (SEE) uses single optical fiber and miniature diffractive optics to allow imaging through a miniature probe. Utilizing Fourier-domain interferometry, SEE was shown capable of video-rate three-dimensional imaging, albeit at limited depth of field due to the limited spectral resolution of the detection spectrometer. We show that by using dispersion management at the reference arm of the interferometer, the tilt and curvature of the field of view could be adjusted without modifying the endoscopic probe itself. By controlling the group velocity dispersion, this technique is demonstrated useful for imaging specimen regions which reside outside the system's depth of field. This approach could be used to improve usability, functionality and image quality of SEE without affecting probe size and flexibility.

Design and characterization of a miniaturized epi-illuminated microscope

The ability to observe functional and morphological changes in the brain is critical in understanding behavioral and developmental neuroscience. With advances in electronics and miniaturization, electrophysiological recordings from awake, behaving animals has allowed investigators to perform a multitude of behavioral studies by observing changes as an animal is engaged in certain tasks. Imaging offers advantages of observing structure as well as function, and the ability to monitor activity over large areas. However, imaging from an awake, behaving animal has not been explored well. We present the design and characterization of a miniaturized epi-illuminated optical system that is part of a larger goal to perform optical imaging in awake, behaving animals. The system comprises of a tunable light source and imaging optics in a small footprint of 18 mm diameter, 18 mm height and weight 5.7 grams. It offers a spatial illumination non-uniformity of 3.2% over a maximum field of view of 1.5 mm x 1.5 mm, negligible temporal illumination and temperature variation and controllable magnification. Uncorrected radial distortion was 5.3% (corrected to 1.8%) and the spatial frequency response was comparable to a reference system. The system was used to image cortical vasculature in an anesthetized rat.

In vivo imaging of ovarian tissue using a novel confocal microlaparoscope

OBJECTIVE

The objective of the study was to develop a clinical confocal microlaparoscope for imaging ovary epithelium in vivo with the long-term objective of diagnosing cancer in vivo.

STUDY DESIGN

A confocal microlaparoscope was developed and used to image the ovaries of 21 patients in vivo using fluorescein sodium and acridine orange as the fluorescent contrast agents.

RESULTS

The device was tested in vivo and demonstrated to be safe and function as designed. Real-time cellular visualization of ovary epithelium was demonstrated.

CONCLUSION

The confocal microlaparoscope represents a new type of in vivo imaging device. With its ability to image cellular details in real time, it has the potential to aid in the early diagnosis of cancer. Initially the device may be used to locate unusual regions for guided biopsies. In the long term, the device may be able to supplant traditional biopsies and allow the surgeon to identify early-stage ovarian cancer.

Advances in light microscopy for neuroscience

Since the work of Golgi and Cajal, light microscopy has remained a key tool for neuroscientists to observe cellular properties. Ongoing advances have enabled new experimental capabilities using light to inspect the nervous system across multiple spatial scales, including ultrastructural scales finer than the optical diffraction limit. Other progress permits functional imaging at faster speeds, at greater depths in brain tissue, and over larger tissue volumes than previously possible. Portable, miniaturized fluorescence microscopes now allow brain imaging in freely behaving mice. Complementary progress on animal preparations has enabled imaging in head-restrained behaving animals, as well as time-lapse microscopy studies in the brains of live subjects. Mouse genetic approaches permit mosaic and inducible fluorescence-labeling strategies, whereas intrinsic contrast mechanisms allow in vivo imaging of animals and humans without use of exogenous markers. This review surveys such advances and highlights emerging capabilities of particular interest to neuroscientists.

Terminal reflections in fiber-optic image guides

Fibered image guides for confocal reflectance endomicroscopy suffer from Fresnel reflections at the fiber terminals, which can limit signal-to-noise ratio in these systems. A model that describes these terminal reflections is presented to better understand how they can be managed most effectively. An expression for the refractive index of termination that minimizes the reflection as a function of the fiber's normalized frequency is derived for step-index fibers, while a graphical solution is presented for graded-index fibers. The model predicts that terminal reflections from graded-index fibers are more sensitive to variations in fiber size and changes in wavelength than step-index fibers. A method is also presented to measure the refractive index that allows one to minimize the terminal reflections in an image guide. The technique uses the inherent mode coupling of the fibers in the image guide, allowing the isolation and measurement of reflections from only one end of the fiber. An achievable minimum backreflection of -36 dB was measured at 635 nm in a commercial image guide with 30,000 fibers.

Clinical confocal microlaparoscope for real-time in vivo optical biopsies

Successful treatment of cancer is highly dependent on the stage at which it is diagnosed. Early diagnosis, when the disease is still localized at its origin, results in very high cure rates-even for cancers that typically have poor prognosis. Biopsies are often used for diagnosis of disease. However, because biopsies are destructive, only a limited number can be taken. This leads to reduced sensitivity for detection due to sampling error. A real-time fluorescence confocal microlaparoscope has been developed that provides instant in vivo cellular images, comparable to those provided by histology, through a nondestructive procedure. The device includes an integrated contrast agent delivery mechanism and a computerized depth scan system. The instrument uses a fiber bundle to relay the image plane of a slit-scan confocal microlaparoscope into tissue. It has a 3-mum lateral resolution and a 25-mum axial resolution. Initial in vivo clinical testing using the device to image human ovaries has been done in 21 patients. Results indicate that the device can successfully image organs in vivo without complications. Results with excised tissue demonstrate that the instrument can resolve sufficient cellular detail to visualize the cellular changes associated with the onset of cancer.

Experimental and theoretical analysis of core-to-core coupling on fiber bundle imaging

Flexible endoscopes commonly use coherent fiber bundles with high core density to facilitate in vivo imaging. Small, closely spaced cores are desired for achieving a high number of resolvable pixels in a small diameter fiber bundle. On the other hand, closely spaced cores potentially lead to strong core-to-core coupling. Based on numerical simulations, it was previously explained that image fiber bundles can successfully transmit images because of nonuniformities in the core size that reduce coupling. In this paper, we show numerically and experimentally that, due to the randomness of the structural nonuniformity, significant core-to-core coupling still exists in fiber bundles that are routinely used for imaging. The coupling is highly dependent on the illumination wavelength and polarization state. We further show that the resolution achievable by a fiber bundle depends not only on the core density, but also on the inter-core coupling strength. Finally, we propose that increasing the core-cladding index contrast is a promising approach to achieve a fiber bundle with low core coupling, high core density, and effectively single moded propagation in individual cores.

Multispectral confocal microendoscope for in vivo and in situ imaging

We describe the design and operation of a multispectral confocal microendoscope. This fiber-based fluorescence imaging system consists of a slit-scan confocal microscope coupled to an imaging catheter that is designed to be minimally invasive and allow for cellular level imaging in vivo. The system can operate in two imaging modes. The grayscale mode of operation provides high resolution real-time in vivo images showing the intensity of fluorescent signal from the specimen. The multispectral mode of operation uses a prism as a dispersive element to collect a full multispectral image of the fluorescence emission. The instrument can switch back and forth nearly instantaneously between the two imaging modes (less than half a second). In the current configuration, the multispectral confocal microendoscope achieves 3-microm lateral resolution and 30-microm axial resolution. The system records light from 500 to 750 nm, and the minimum resolvable wavelength difference varies from 2.9 to 8.3 nm over this spectral range. Grayscale and multispectral imaging results from ex-vivo human tissues and small animal tissues are presented.

Computer-aided identification of ovarian cancer in confocal microendoscope images

The confocal microendoscope is an instrument for imaging the surface of the human ovary. Images taken with this instrument from normal and diseased tissue show significant differences in cellular distribution. A real-time computer-aided system to facilitate the identification of ovarian cancer is introduced. The cellular-level structure present in ex vivo confocal microendoscope images is modeled as texture. Features are extracted based on first-order statistics, spatial gray-level-dependence matrices, and spatial-frequency content. Selection of the features is performed using stepwise discriminant analysis, forward sequential search, a nonparametric method, principal component analysis, and a heuristic technique that combines the results of these other methods. The selected features are used for classification, and the performance of various machine classifiers is compared by analyzing areas under their receiver operating characteristic curves. The machine classifiers studied included linear discriminant analysis, quadratic discriminant analysis, and the k-nearest-neighbor algorithm. The results suggest it is possible to automatically identify pathology based on texture features extracted from confocal microendoscope images and that the machine performance is superior to that of a human observer.

Subcellular-resolution molecular imaging within living tissue by fiber microendoscopy

Conventional histopathology involves sampling, sectioning and staining of tissue specimens prior to microscopic evaluation, and provides diagnostic information at a single location and point in time. In vivo microscopy and molecular-targeted optical labeling are two rapidly developing fields, which together have the potential to provide anatomical and functional indications of disease by staining and imaging tissue in situ. To address the need for high-resolution imaging instrumentation, we have developed a compact, robust, and inexpensive fiber-optic microendoscopy system based around wide-field LED illumination, a flexible 1 mm diameter fiber-optic bundle, and a color CCD camera. We demonstrate the sub-cellular resolution imaging capabilities of the system through a series of experiments, beginning with simultaneous imaging of three different cancer cell lines in culture, each targeted with a distinct fluorescent label. We used the narrow diameter probe to access subcutaneous tumors in an in vivo murine model, allowing direct comparison of microendoscopy images with macroscopic images and histopathology. A surgically resected tissue specimen from the human oral cavity was imaged across the clinical margin, demonstrating qualitative and quantitative distinction between normal and cancerous tissue based on sub-cellular image features. Finally, the fiber-optic microendoscope was used on topically-stained normal human oral mucosa in vivo, resolving epithelial cell nuclei and membranes in real-time fluorescence images. Our results demonstrate that this imaging system can potentially complement conventional diagnostic techniques, and support efforts to translate emerging molecular-diagnostic and therapeutic agents into clinical use.