Advanced Intraoperative Imager for Nerve Identification

项目摘要/摘要 在这个研发计划中，物理科学公司(PSI)与达特茅斯希区柯克医疗公司合作 中心(DHMC)建议展示并商业化一种先进的术中荧光 可以有效地突出手术床上神经存在的成像仪，从而消除 神经损伤。意外的神经损伤是许多手术并发症的主要原因，尤其是在软组织 组织矫形外科、耳鼻喉科、颅面外科和泌尿生殖外科手术。独特的可视化效果 来自邻近结缔组织和脂肪组织的神经具有挑战性，因此神经损伤仍然是一个主要问题。 手术并发症。基于神经标记剂的荧光引导手术(FGS)具有潜在的 以提高神经识别能力。FGS的一个突出问题是强烈环境的负面影响 光，干扰微弱的荧光信号。目前，这个问题可以通过关灯来缓解 在手术室(OR)的荧光成像过程中。然而，这会导致不必要的 手术工作流程的中断，从而挫伤了外科医生的积极性，减少了手术时间。 临床采用FGS技术的潜力。 PSI和DHMC将开发一种荧光成像仪，该成像仪可以克服当前FGS的大多数问题 系统。所提出的技术使用一种新颖的时间空间调制(TSM)照明方案， 这显著减少了环境光背景的负面影响。在第一阶段的努力中， 我们成功地展示了一种稳健的成像器，它可以通过以下方式抑制环境光背景 一万六千英镑的倍数。高背景排斥率使高对比度神经- 在常规高亮度或灯光下高亮显示图像。 在第二阶段计划中，我们建议进一步优化和成熟这项技术，并展示 它的适宜性和临床使用准备就绪。第二阶段的工作将集中在：1)改进技术 通过同时结合双波长荧光和反射白光成像来实现性能； 2)通过广泛的活体动物研究证明这项技术的好处；3)评估 成像仪的临床适用性和准备情况；以及4)对关键意见进行仪器演示 领导者和与潜在客户的接触。这一研发项目将为术中提供可靠的解决方案 在标准或照明条件下的荧光成像，避免中断 正常的手术流程就是关掉房间的灯。这将促进术中荧光成像 将程序无缝集成到当前的临床工作流程中，以实现最佳的患者结果。

Project Summary/Abstract In this R&D program, Physical Sciences Inc. (PSI), in collaboration with Dartmouth Hitchcock Medical Center (DHMC), proposes to demonstrate and commercialize an advanced intraoperative fluorescence imager that can efficiently highlight nerve presence in the surgical bed and thus eliminate risk for nerve damage. Unintended nerve injury is a major cause of morbidity for many surgeries, especially in soft tissue orthopedic, otolaryngology, craniofacial, and genitourinary operations. Distinctive visualization of nerves from adjacent connective and fat tissues is challenging, and therefore nerve injury remains a major surgical complication. Fluorescence guided surgery (FGS) based on nerve-labelling agents has the potential to improve nerve identification. An outstanding problem in FGS is the negative impact of the strong ambient light, which interferes the weak fluorescence signal. Currently, this problem is mitigated by turning off the light in the operating room (OR) during the fluorescence imaging procedure. However, this causes unwanted interruption to the surgical workflow and thus dampens the enthusiasm of the surgeons and diminishes the potential for clinical adoption of FGS technologies. PSI and DHMC will develop a fluorescence imager that overcomes most of the issues of the current FGS systems. The proposed technology uses a novel tempo-spatially modulated (TSM) illumination scheme, which significantly reduces the negative impact of the ambient light background. During the Phase I effort, we successfully demonstrated a robust imager that is cable of suppressing the ambient light background by a factor of >16,000. The high rate of background rejection enabled the collection of high-contrast nerve- highlighting images under the regular high-brightness OR light. During the Phase II program, we propose to further optimize and mature this technology and demonstrate its suitability and readiness for clinical use. The Phase II effort will focus on: 1) improving the technical performance by incorporating simultaneous dual-wavelength fluoresce and reflection white-light imaging; 2) demonstrating the benefits of the technology through extensive in vivo animal studies; 3) evaluating the clinical suitability and readiness of the imager; and 4) performing instrument demonstrations to key opinion leaders and outreach to potential customers. This R&D project will lead to a reliable solution for intraoperative fluorescence imaging in the presence of standard OR lighting conditions, avoiding the interruption to the normal surgical workflow by turning off the room light. This will promote intraoperative fluorescence imaging procedures to be seamlessly integrated into current clinical workflows for optimal patient outcome.