Abstract
Accurate fiber tip tracking is a critical clinical problem during endovenous laser ablation (EVLA) of small perforating veins. Currently, ultrasound (US) imaging is the gold-standard modality for visualizing and for accurately placing the ablation fiber within the diseased vein. However, US imaging has limitations such as angular dependency and comet tail artifacts. In addition, EVLA is often performed without any real-time temperature monitoring, which could lead to an insufficient thermal dose or overheating the surrounding tissue. We propose a new technique that combines US and photoacoustic (PA) imaging for concurrent ablation fiber tip tracking and real-time temperature monitoring during EVLA procedures. Our intended implementation of PA imaging for fiber tracking requires minimal modification of existing systems, which makes this technology easy to adopt. Combining US and PA imaging modalities allows for simultaneous visualization of background anatomical structures as well as high contrast, artifact-free, and angle-independent localization of the ablation fiber tip. Preliminary data demonstrates that changes in the amplitude of the PA signal can be used to monitor the localized temperature at the tip of the ablation fiber, which will be invaluable during EVLA procedures. These improvements can enhance the physician’s accuracy in performing EVLA procedures and will have a significant impact on the treatment outcomes.
Highlights
It is predicted that nearly 20 percent of the adult population in the United States will develop varicose veins at some point in their lifetime[1]
We propose to add a low power pulsed laser to the CW beam being carried by the ablation fiber and the use of PA imaging for tracking the fiber tip, since the PA signal is only generated at the interface between the fiber tip and the tissue[29]
Straight orientation represents the scenario in which the ablation fiber is positioned parallel to the surface of the US transducer and no angular dependency issues are involved
Summary
It is predicted that nearly 20 percent of the adult population in the United States will develop varicose veins at some point in their lifetime[1]. An example of an invasive treatment method is venous phlebectomy[5], in which the vein is pulled out through a sequence of small incisions Another invasive technique known as ligation, involves tying the veins through a small incision, thereby obstructing the accumulation of blood. Invasive treatment methods for venous insufficiency include radiofrequency ablation (RFA)[9] and endovenous laser ablation EVLA10,11. In EVLA12, a fiber optic carrying a high power continuous-wave (CW) laser energy is inserted into the vein, and the localized heat produced at the fiber tip closes the diseased blood vessels[13]. The drawback with US imaging, is that it has some inherent artifact-related errors that limit its ability to track the fiber tip accurately.
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