Abstract
There are vibrant developments of optical imaging systems and contrast-enhancing methods that are geared to enhancing surgical vision and the outcome of surgical procedures. Such optical technologies designed for intraoperative use can offer high integration in the operating room compared to conventional radiological modalities adapted to intraoperative applications. Simple fluorescence epi-illumination imaging, in particular, appears attractive but may lead to inaccurate observations due to the complex nature of photon-tissue interaction. Of importance therefore are emerging methods that account for the background optical property variation in tissues and can offer accurate, quantitative imaging that eliminates the appearance of false negatives or positives. In parallel, other nonfluorescent optical imaging methods are summarized and overall progress in surgical optical imaging applications is outlined. Key future directions that have the potential to shift the paradigm of surgical health care are also discussed.
Highlights
Optical imaging is the primary surgical visualization modality by means of the surgeon’s visual perception
Intraoperative imaging studies involving indocyanine green (ICG) or fluorescein have been performed for outlining gliomas
Imaging in these applications was based on commercially available epiillumination near-infrared (NIR) imaging systems operating in video mode, using appropriate excitation light for ICG and cutoff filters for fluorescence detection
Summary
Optical imaging is the primary surgical visualization modality by means of the surgeon’s visual perception. Optical microscopes have been adapted to surgical systems for improving resolution. Human vision is significantly limited to visualizing only superficial contrast. Despite its ability to efficiently recognize anatomical features, human vision can distinguish only a relatively small number of spectral features and virtually no molecular-based features, which results in reduced contrast for separating cancer from surrounding tissue. The emergence of fluorescence imaging offers a potent modality for improving the surgical outcome, by imparting specific functional and molecular contrast and by allowing penetration of several millimeters to centimeters into tissue. Elaborate spectral imaging or high-resolution methods have shown potential for accurately distinguishing tissue fluorochromes and improving the physiological information available to the surgeon. Many of the original systems described for intraoperative optical imaging operated as modifications to surgical microscopes or as epi-illumination (photography/video) fluorescence systems.
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