Smart laser osteotomy: integrating a pulsed 1064nm fiber laser into the sample arm of a fiber optic 1310nm OCT system for ablation monitoring

The LMIT: Light-mediated minimally-invasive theranostics in oncology

Minimally-invasive diagnosis and therapy have gradually become the trend and research hotspot of current medical applications. The integration of intraoperative diagnosis and treatment is a development important direction for real-time detection, minimally-invasive diagnosis and therapy to reduce mortality and improve the quality of life of patients, so called minimally-invasive theranostics (MIT). Light is an important theranostic tool for the treatment of cancerous tissues. Light-mediated minimally-invasive theranostics (LMIT) is a novel evolutionary technology that integrates diagnosis and therapeutics for the less invasive treatment of diseased tissues. Intelligent theranostics would promote precision surgery based on the optical characterization of cancerous tissues. Furthermore, MIT also requires the assistance of smart medical devices or robots. And, optical multimodality lay a solid foundation for intelligent MIT. In this review, we summarize the important state-of-the-arts of optical MIT or LMIT in oncology. Multimodal optical image-guided intelligent treatment is another focus. Intraoperative imaging and real-time analysis-guided optical treatment are also systemically discussed. Finally, the potential challenges and future perspectives of intelligent optical MIT are discussed.

Real-time closed-loop tissue-specific laser osteotomy using deep-learning-assisted optical coherence tomography

This article presents a real-time noninvasive method for detecting bone and bone marrow in laser osteotomy. This is the first optical coherence tomography (OCT) implementation as an online feedback system for laser osteotomy. A deep-learning model has been trained to identify tissue types during laser ablation with a test accuracy of 96.28 %. For the hole ablation experiments, the average maximum depth of perforation and volume loss was 0.216 mm and 0.077 mm³, respectively. The contactless nature of OCT with the reported performance shows that it is becoming more feasible to utilize it as a real-time feedback system for laser osteotomy.

Towards OCT-Guided Endoscopic Laser Surgery-A Review

Optical Coherence Tomography (OCT) is an optical imaging technology occupying a unique position in the resolution vs. imaging depth spectrum. It is already well established in the field of ophthalmology, and its application in other fields of medicine is growing. This is motivated by the fact that OCT is a real-time sensing technology with high sensitivity to precancerous lesions in epithelial tissues, which can be exploited to provide valuable information to clinicians. In the prospective case of OCT-guided endoscopic laser surgery, these real-time data will be used to assist surgeons in challenging endoscopic procedures in which high-power lasers are used to eradicate diseases. The combination of OCT and laser is expected to enhance the detection of tumors, the identification of tumor margins, and ensure total disease eradication while avoiding damage to healthy tissue and critical anatomical structures. Therefore, OCT-guided endoscopic laser surgery is an important nascent research area. This paper aims to contribute to this field with a comprehensive review of state-of-the-art technologies that may be exploited as the building blocks for achieving such a system. The paper begins with a review of the principles and technical details of endoscopic OCT, highlighting challenges and proposed solutions. Then, once the state of the art of the base imaging technology is outlined, the new OCT-guided endoscopic laser surgery frontier is reviewed. Finally, the paper concludes with a discussion on the constraints, benefits and open challenges associated with this new type of surgical technology.

Effects of Tungsten Disulphide Coating on Tapered Microfiber for Relative Humidity Sensing Applications

Tungsten disulphide (WS₂) is a two-dimensional transition-metal dichalcogenide material that can be used to improve the sensitivity of a variety of sensing applications. This study investigated the effect of WS₂ coating on tapered region microfiber (MF) for relative humidity (RH) sensing applications. The flame brushing technique was used to taper the standard single-mode fiber (SMF) into three different waist diameter sizes of MF 2, 5, and 10 µm, respectively. The MFs were then coated with WS₂ via a facile deposition method called the drop-casting technique. Since the MF had a strong evanescent field that allowed fast near-field interaction between the guided light and the environment, depositing WS₂ onto the tapered region produced high humidity sensor sensitivity. The experiments were repeated three times to measure the average transmitted power, presenting repeatability and sensing stability. Each MF sample size was tested with varying humidity levels. Furthermore, the coated and non-coated MF performances were compared in the RH range of 45–90% RH at room temperature. It was found that the WS₂ coating on 2 µm MF had a high sensitivity of 0.0861 dB/% RH with linearity over 99%. Thus, MF coated with WS₂ encourages enhancement in the evanescent field effect in optical fiber humidity sensor applications.

Machine learning monitoring for laser osteotomy

This work proposes a new online monitoring method for an assistance during laser osteotomy. The method allows differentiating the type of ablated tissue and the applied dose of laser energy. The setup analyzes the laser-induced acoustic emission, detected by an airborne microphone sensor. The analysis of the acoustic signals is carried out using a machine learning algorithm that is pre-trained in a supervised manner. The efficiency of the method is experimentally evaluated with several types of tissues, which are: skin, fat, muscle, and bone. Several cutting-edge machine learning frameworks are tested for the comparison with the resulting classification accuracy in the range of 84-99%. It is shown that the datasets for the training of the machine learning algorithms are easy to collect in real-life conditions. In the future, this method could assist the doctors during laser osteotomy, minimizing the damage of the nearby healthy tissues and provide cleaner pathologic tissue removal.

Optimization of laser osteotomy at 1064 nm using a graphite topical absorber and a nitrogen assist gas jet

Laser ablation of bone for the purposes of osteotomy is not as well understood as ablation of homogeneous, non-biological materials such as metals and plastics. Ignition times and etch rate can vary during ablation of cortical bone. In this study, we propose the use of two techniques to optimize bone ablation at 1064nm using a coaxial nitrogen jet as an assist gas and topical application of graphite as a highly absorbing chromophore. We show a two order of magnitude reduction in mean time to ignition and variance by using the graphite topical chromophore. We also show that an increase in volumetric flow rate of the assist gas jet does show an initial increase in etch rate, but increased pressure beyond a certain point shows decreased return. This study also demonstrates a 2 ^nd order relationship between exposure time, volumetric flow rate of nitrogen, and etch rate of cortical bone. The results of this study can be used to optimize the performance of laser ablation systems for osteotomy. This is a companion study to an earlier one carried out by Wong et al. [Biomedical Opt. Express6, 1 (2015)].