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Obtaining access to blood vessels can be difficult, especially in children. Visualization of subsurface blood vessels might be a solution. Ultrasound and visible light have been used to this purpose, but have some drawbacks. Near-infrared light might be a better option since subsurface blood vessels can be visualized in high contrast due to less absorption and scattering in tissue as compared to visible light. Our findings with a multispectral imaging system support this theory. A device, the VascuLuminator, was developed, based on transillumination of the puncture site with near-infrared light. The VascuLuminator was designed to meet the requirements of compact and safe use. A phantom study showed that the maximum depth of visibility (5.5mm for a 3.6mm blood vessel) is sufficient to visualize blood vessels in typical locations for peripheral venous and arterial access. A quantitative comparison of the VascuLuminator and to two other vessel imaging devices, using reflection of near-infrared light instead of transillumination, was conducted. The VascuLuminator is able to decrease failure at first attempt in blood withdrawal in pediatric patients from 10/80 (13%) to 1/45 (2%; P=.05).

Objectives: To determine the difference in light reflection of oral mucosa covering titanium (Ti) or zirconia (ZrO2) abutments as it relates to the thickness of the covering mucosa. Material and methods: Fifteen anterior implants (Astra Osseo speed®) in 11 patients were fitted with a Ti or a ZrO2 abutment (cross-over, within-subject comparison). Hyper-spectral images were taken with a camera fitted on a surgical microscope. High-resolution images with 70 nm interval between 440 and 720 nm were obtained within 30 s (1392 × 1024 pixels). Black- and white-point reference was used for spatial and spectral normalization as well as correction for motion during exposure. Reflection spectra were extracted from the image on a line mid-buccal of the implant, starting 1 mm above the soft tissue continuing up to 3 mm apically. Results: Median soft tissue height is 2.3 mm (min: 1.2 mm and max: 3.1 mm). The buccal mucosa rapidly increases in the thickness, when moving apically. At 2.2 mm, thickness is 3 mm. No perceivable difference between the Ti and ZrO2 abutment can be observed when the thickness of the mucosa is 2±0.1 mm (95% confidence interval) or more. Conclusion: It is expected that the difference in light reflection of soft tissue covering Ti or ZrO2 abutments is no longer noticeable for the human eye when the mucosa thickness exceeds 2 mm. Haemoglobin peaks in the reflection spectrum can be observed and make hyper-spectral imaging a practical and useful tool for measuring soft tissue health. To cite this article: van Brakel R, Noordmans HJ, Frenken J, de Roode R, de Wit GC, Cune MS. The effect of zirconia and titanium implant abutments on light reflection of the supporting soft tissues. Clin. Oral Impl. Res. 22, 2011; 1172–1178 doi: 10.1111/j.1600-0501.2010.02082.x

An epilepsy patient with recurring sensorimotor seizures involving the left hand every 10 min, was imaged with a hyperspectral camera during surgery. By calculating the changes in oxygenated, deoxygenated blood, and total blood volume in the cortex, a focal increase in oxygenated and total blood volume could be observed in the sensory cortex, corresponding to the seizure-onset zone defined by intracranial electroencephalography (EEG) findings. This probably reflects very local seizure activity. After multiple subpial transections in this motor area, clinical seizures abated.

Introduction. This study aims to evaluate for the first time the value of visualizing veins by a prototype of a near-infrared (NIR) vascular imaging system for venipuncture in children. Methods. An observational feasibility study of venipunctures in children (0-6 years) attending the clinical laboratory of a pediatric university hospital during a period of 2 months without (n = 80) and subsequently during a period of 1 month with a prototype of an NIR vascular imaging system (n = 45) was conducted. Failure rate (ie, more than 1 puncture) and time of needle manipulation were determined. Results. With the NIR vascular imaging system, failure rate decreased from 10/80 to 1/45 ( P = .05) and time decreased from 2 seconds (1-10) to 1 second (1-4, P = .07). Conclusion . This study showed promising results on the value of an NIR vascular imaging system in facilitating venipunctures.

An objective method to measure the effectiveness of regional anesthesia can reduce time and unintended pain inflicted to the patient. A prospective observational study was performed on 22 patients during a local anesthesia before undergoing hand surgery. Two non-invasive techniques thermal and oxygenation imaging were applied to observe the region affected by the peripheral block and the results were compared to the standard cold sensation test. The supraclavicular block was placed under ultrasound guidance around the brachial plexus by injecting 20 cc Ropivacaine. The sedation causes a relaxation of the muscles around the blood vessels resulting in dilatation and hence an increase of blood perfusion, skin temperature and skin oxygenation in the lower arm and hand. Temperatures were acquired with an IR thermal camera (FLIR ThermoCam SC640). The data were recorded and analyzed with the ThermaCam TM Researcher and Matlab software. Narrow band spectral images were acquired at selected wavelengths with a CCD camera either combined with a Liquid Crystal Tunable Filter (420-730 nm) or a tunable hyper-wavelength LED light source (450-880nm). Concentration changes of oxygenated and deoxygenated hemoglobin in the dermis of the skin were calculated using the modified Lambert Beer equation. Both imaging methods showed distinct oxygenation and temperature differences at the surface of the skin of the hand with a good correlation to the anesthetized areas. A temperature response was visible within 5 minutes compared to the standard of 30 minutes. Both non-contact methods show to be more objective and can have an earlier prediction for the effectiveness of the anesthetic block.

To observe local variations in temperature, oxygenation and blood perfusion over time, four imaging systems were developed and compared: Two systems consisting of white broadband light source and a CCD camera in combination with a Liquid Crystal Tunable Filter, one in the visual domain, 420-730 nm, and one in the infrared domain, 650-1100 nm. Thirdly, a CCD camera in combination with a software controlled hyper-spectral light source consisting of a panel with 600 LEDs divided in 17 spectral groups in the range from 370 to 880 nm so that specific spectral distributions can be generated at high repetition rate (>1000 Hz) and, fourthly a standard IR thermal camera for comparison. From the acquired images at the selected wavelengths chromophores concentration images of oxy and deoxy hemoglobin can be calculated applying different algorithms. These imaging techniques were applied and compared for various clinical applications: Tumor demarcation, early inflammation, effectiveness of peripheral nerve block anesthesia, and localization of epileptic seizure. The relative changes in oxygenation and temperature could be clearly observed in good correlation with the physiological condition. The algorithms and data collection/processing can be optimized to enable a real-time diagnostic technique.

To determine the difference in light reflection of oral mucosa covering titanium (Ti) or zirconia (ZrO(2)) abutments as it relates to the thickness of the covering mucosa.Fifteen anterior implants (Astra Osseo speed(®)) in 11 patients were fitted with a Ti or a ZrO(2) abutment (cross-over, within-subject comparison). Hyper-spectral images were taken with a camera fitted on a surgical microscope. High-resolution images with 70 nm interval between 440 and 720 nm were obtained within 30 s (1392 × 1024 pixels). Black- and white-point reference was used for spatial and spectral normalization as well as correction for motion during exposure. Reflection spectra were extracted from the image on a line mid-buccal of the implant, starting 1 mm above the soft tissue continuing up to 3 mm apically.Median soft tissue height is 2.3 mm (min: 1.2 mm and max: 3.1 mm). The buccal mucosa rapidly increases in the thickness, when moving apically. At 2.2 mm, thickness is 3 mm. No perceivable difference between the Ti and ZrO(2) abutment can be observed when the thickness of the mucosa is 2±0.1 mm (95% confidence interval) or more.It is expected that the difference in light reflection of soft tissue covering Ti or ZrO(2) abutments is no longer noticeable for the human eye when the mucosa thickness exceeds 2 mm. Haemoglobin peaks in the reflection spectrum can be observed and make hyper-spectral imaging a practical and useful tool for measuring soft tissue health.

Regional anesthetic blocks are performed on patients who will undergo surgery of the hand. In this study, thermal and oxygenation imaging techniques were applied to observe the region affected by the peripheral block as a fast objective, non-contact, method compared to the standard pinpricks or cold sensation tests. The temperature images were acquired with an IR thermal camera (FLIR ThermoCam SC640). The data were recorded and analyzed with the ThermaCamTM Researcher software. Images at selected wavelengths were obtained with a CCD camera combined with a Liquid Crystal Tunable Filter (420-730 nm). The concentration changes of oxygenated and deoxygenated hemoglobin in the dermis of the skin were calculated using the modified Lambert Beer equation. In 10 patients an anesthetic block was placed by administering 20-30 ml Ropivacaine 7,5 mg/ml around the plexus brachialis. The anesthetic block of the axillary, ulnar, median and radial nerve causes dilatation of the blood vessels inducing an increase of blood flow and, consequently, an increase of the skin temperature and skin oxygenation in the lower arm. Both imaging methods showed distinct oxygenation and temperature differences at the surface of the skin of the hand with a good correlation with the areas with the nerve blocks. For oxygenation imaging a CCD camera with LED light source of selected wavelengths might be a relative inexpensive method to observe the effectiveness of regional blocks.

Tissue oxygenation imaging is a promising diagnostics tool to study the changes and dynamics of tissue perfusion reflecting pathologic and/or physiologic conditions of tissue. In clinical settings, imaging of local oxygenation or blood perfusion variations can be useful for e.g. detection of skin cancer, detection of early inflammation, effectiveness of peripheral nerve block anesthesia, study of the process of wound healing or localization of the cerebral area causing an epileptic attack. In this study, two oxygenation imaging methods based on multi-spectral techniques were evaluated: one system consisting of a CCD camera in combination with a Liquid Crystal Tunable Filter (420 - 730 nm or 650-1100 nm) and a broad band (white) light source, while the second system was a CCD camera in combination with a tunable multispectral LED light source (450-890nm). By collecting narrowband images at selected wavelengths, concentration changes of the different chromophores at the surface of the tissue (e.g. dO2Hb, dHHb and dtHb) can be calculated using the modified Lambert Beer equation. Two analyzing methods were used to calculate the concentration changes this to reduce the errors caused by movement of the tissue. In vivo measurements were obtained during skin oxygen changes induced by temporary arm clamping to validate the methods and algorithms. Functional information from the tissue surface was collected, in non-contact mode, by imaging the hemodynamic and oxygenation changes just below that surface. Both multi-spectral imaging techniques show promising results for detecting dynamic changes in the hemoglobin concentrations. The algorithms need to be optimized and image acquisition and processing needs to be developed top real time for practical clinical applications.

This study describes noninvasive noncontact methods to acquire and analyze functional information from the skin. Multispectral images at several selected wavelengths in the visible and near infrared region are collected and used in mathematical methods to calculate concentrations of different chromophores in the epidermis and dermis of the skin. This is based on the continuous wave Near Infrared Spectroscopy method, which is a well known non-invasive technique for measuring oxygenation changes in the brain and in muscle tissue. Concentration changes of hemoglobin (dO 2 Hb, dHHb and dtHb) can be calculated from light attenuations using the modified Lambert Beer equation. We applied this technique on multi-spectral images taken from the skin surface using different algorithms for calculating changes in O 2 Hb, HHb and tHb. In clinical settings, the imaging of local oxygenation variations and/or blood perfusion in the skin can be useful for e.g. detection of skin cancer, detection of early inflammation, checking the level of peripheral nerve block anesthesia, study of wound healing and tissue viability by skin flap transplantations. Images from the skin are obtained with a multi-spectral imaging system consisting of a 12-bit CCD camera in combination with a Liquid Crystal Tunable Filter. The skin is illuminated with either a broad band light source or a tunable multi wavelength LED light source. A polarization filter is used to block the direct reflected light. The collected multi-spectral imaging data are images of the skin surface radiance; each pixel contains either the full spectrum (420 - 730 nm) or a set of selected wavelengths. These images were converted to reflectance spectra. The algorithms were validated during skin oxygen saturation changes induced by temporary arm clamping and applied to some clinical examples. The initial results with the multi-spectral skin imaging system show good results for detecting dynamic changes in oxygen concentration. However, the optimal algorithm needs to be determined. Multi-spectral skin imaging shows to be a promising technique for various clinical applications were the local distribution of oxygenation is of major importance.

A multi-spectral dermatoscope was used to investigate the effect of laser hair removal. Ten volunteers underwent three laser treatments, 6 weeks apart. In a subsequent trial, three volunteers received one laser treatment after which the skin region was imaged at short intervals. Practical solutions were developed to re-locate the investigated skin area. After exact matching using rigid and elastic registration software, the images showed acute and delayed effects on the hairs, pigment and vasculature after laser hair removal and subsequent healing response. The multi-spectral dermatoscope provides a perfect tool to study the efficacy and side effects of laser hair removal procedures and can be used to optimize the treatment plan.

A practical system to visualize vessels underneath the skin has been developed, based on near-infrared (NIR) transillumination. A study in the clinical setting proved the system to be useful as a support in blood withdrawal in young children. During clinical application it was found that performance varied depending on vessel size, depth of vessels and surrounding lighting conditions. To gain more insight on the different variables that determine functioning of the system, we performed phantom studies. A combined liquid/solid phantom was fabricated with similar optical properties as the tissue layers of skin reported in literature at 850 nm. This phantom was used to estimate the depth of visibility in the relation to vessel size and darkness of the skin. Vessel contrast was determined analytically from images and evaluated by 3 independent observers. The knowledge gained from these experiments will be helpful to improve the imaging system and develop a solid phantom to be used as a gold standard to test the system under various clinical lighting conditions. The working range of the system was found to be appropriate to visualize the vessels used for the most procedures, such as blood withdrawal and placement of intravenous lines.

An interactive image matching program has been developed to help ophthalmologists in perceiving subtle differences between sequential images obtained during fluorescein angiography. In a pilot experiment, it appeared that the image matching program could effectively correct camera alignment errors. By offering simple tools like image overlay, blinking and image subtraction, differences between angiograms can be greatly enhanced and interpreted. It appeared that newly formed, leaking blood vessels could be detected at an earlier stage of the disease process using these tools. Treatment can be initiated right away, thereby preventing the patient from having additional visual loss. The matching program seems to improve the quality of fundus diagnostics but needs to be validated in future studies.

Continuous wave Near Infrared Spectroscopy is a well known non invasive technique for measuring changes in tissue oxygenation. Absorption changes (DO2Hb and DHHb) are calculated from the light attenuations using the modified Lambert Beer equation. Generally, the concentration changes are calculated relative to the concentration at a starting point in time (delta time method). It is also possible, under certain assumptions, to calculate the concentrations by subtracting the equations at different wavelengths (delta wavelength method). We derived a new algorithm and will show the possibilities and limitations. In the delta wavelength method, the assumption is that the oxygen independent attenuation term will be eliminated from the formula even if its value changes in time, we verified the results with the classical delta time method using extinction coefficients from different literature sources for the wavelengths 767nm, 850nm and 905nm. The different methods of calculating concentration changes were applied to the data collected from animal experiments. The animals (lambs) were in a stable normoxic condition; stepwise they were made hypoxic and thereafter they returned to normoxic condition. The two algorithms were also applied for measuring two dimensional blood oxygen saturation changes in human skin tissue. The different oxygen saturation levels were induced by alterations in the respiration and by temporary arm clamping. The new delta wavelength method yielded in a steady state measurement the same changes in oxy and deoxy hemoglobin as the classical delta time method. The advantage of the new method is the independence of eventual variation of the oxygen independent attenuations in time.

Venipunctures to draw blood for diagnostics can be cumbersome. Multiple puncture attempts are distressing, painful and traumatic, especially for small children. Drawing blood from babies, in particular, is a problem, due to the cutaneous baby fat, tiny veins and, worst case, a pigmented skin. We developed a practical vein viewing system based on IR translumination that, contrary to commercial systems available, has the advantage of: a) low cost, b) easily implemented in routine practice, c) normal and IR image simultaneously available, d) small add-on, e) child friendly IR illuminator and f) efficient IR light coupling. Before introducing the vessel viewer for clinical application in the children's department, parameters were measured in 194 patients (age 0-17 yrs): time to draw blood, number of attempts, skin characteristics, discomfort of patient, and experience of nurse. In this control group, time to draw blood increases significantly with decreasing age of the children. The instant feedback from the nurses has been valuable for the improvements of especially the illumination sources. A clinical trial has been performed in 125 patients (age 0-6 yrs) to prove effectivity of the system in the blood withdrawal procedure. There was a significant decrease from 13% to 2% in failure rate. Also time needed to search for a vein was significantly decreased. A practical and accessible vein viewing system has been developed and is being introduced for clinical application. Although the concept of patient friendliness is already accepted, measurements need to show the effectiveness for particular groups of patients.

There can be a large variation in response between laser treatments of vascular malformations like port-wine stains even in one patient. This could be ascribed to variations in the skin properties like tint (melanin) and perfusion (redness) which will influence the effectiveness of the laser dosimetry. To obtain a better understanding of the relation between skin properties just before treatment, laser dosimetry and clinical response, a multi-spectral dermatoscope is applied. A sequence of calibrated images is captured from 400 to 720 nm. Images at the treatment laser wavelength (532 nm) show the absorbing structures during laser exposure. Images of different treatment sessions of one patient were matched with dedicated registration software to quantify the results of the laser treatment (change in blood vessels structure, effect on pigment). For feasibility, images were collected from 5 patients and used to determine the optimal wavelength combination strategies. The image matching software gives an objective impression of the improvement, e.g. the clearing of the port-wine stain over time or pigment reactions, which will facilitate the discussion with the patient about the end point of treatment. The multi-spectral dermatoscope and software developed enables the evaluation of large patient series which will result in objective data to advise the dermatologist on the optimal laser dosimetry in future in relation to the skin properties

A compact multi-spectral imaging system is presented as diagnostic tool in dermatology and neurosurgery. Using an electronically tunable filter, a sensitive high resolution digital camera, 140 spect ral images from 400 nm up to 720 nm are acquired in 40 s. Advanced image processing algorithms ar e used to enable interactiv e acquisition, viewing, image registration and image analysis. Experiments in the department of dermatology and neurosurgery show that multi-spectral imaging reveals much more detail than conventional medical photography or a surgical microscope, as images can be reprocessed to enhance the view on e.g. tumor boundaries. Using a hardware-based interactive registration algorithm, multi-spectral images can be aligned to correct for motion occurred during image acquisition or to compare acquisitions from different moments in time. The system shows to be a powerful diagnostics tool for medical imaging in the visual and near IR range. Keywords: Tumor demarcation, diagnostics, multi-spectral imaging, optical biopsy.

Multi-spectral images of human tissue taken in-vivo often contain image alignment problems as patients have difficulty in retaining their posture during the acquisition time of 20 seconds. Previously, it has been attempted to correct motion errors with image registration software developed for MR or CT data but these algorithms have been proven to be too slow and erroneous for practical use with multi-spectral images. A new software package has been developed which allows the user to play a decisive role in the registration process as the user can monitor the progress of the registration continuously and force it in the right direction when it starts to fail. The software efficiently exploits videocard hardware to gain speed and to provide a perfect subvoxel correspondence between registration field and display. An 8 bit graphic card was used to efficiently register and resample 12 bit images using the hardware interpolation modes present on the graphic card. To show the feasibility of this new registration process, the software was applied in clinical practice evaluating the dosimetry for psoriasis and KTP laser treatment. The microscopic differences between images of normal skin and skin exposed to UV light proved that an affine registration step including zooming and slanting is critical for a subsequent elastic match to have success. The combination of user interactive registration software with optimal addressing the potentials of PC video card hardware greatly improves the speed of multi spectral image registration.

Invading tumors like basal cell carcinoma have usually no distinct demarcation for the human eye. Therefore, during resection, an additional rim around the tumor is removed. However, extending sprouts can be missed since most lesions are not uniform. To improve the visualization of the tumor demarcation, we developed a multi-spectral imaging system especially adapted for dermatological applications based on tunable liquid crystal spectral tunable filter technology and LED illumination. Enhanced visualization of skin tumor demarcation was achieved using three strategies. The first strategy is based on creating false color images by combining narrow band spectral filtered images by placing them into the red, green and blue image components of a color image at three specific wavelengths. These specific wavelengths were determined using a trial on error tool to achieve the highest contrast between malignant and healthy tissue. The second strategy is to make ratio images of narrow band spectral filtered images at specific wavelengths. A trail on error tool was created which enables the user to try multiple wavelengths to obtain optimal contrast. This method could be applied in realtime. For the third strategy, on pixel spectral segmentation is applied by selecting the pixel spectra in the center of a tumor, surrounding tissue and healthy tissue far away from the tumor. The correlation between these specific spectra and all image pixels is calculated using a fast algorithm. The degree is correlation is graded by color coding and presented in a false color images showing a detailed demarcation of suspicious regions in the tissue. Although this strategy is expected to provide a higher specificity, it takes more time to calculate than the first strategy.

Laser systems of various wavelengths and pulse characteristics have been introduced in dentistry. At present, the range of applications for the different systems is being investigated mainly differentiating between soft and hard tissue applications. For the preparation of root canals both hard and soft tissues are involved. Ideally, one would like to use one laser system for the whole treatment. In this study, we studied the characteristics of the pulsed 2,78 Er,Cr:YSGG laser (Biolase, Waterlase Millenium), in view of root canal cleaning and desinfection. The laser energy was fiber delivered with fiber tip diameters from 400 mm down to 200 mm. Special thermal and high speed imaging techniques were applied in a transparent model of a tapered root canal and slices cut from human teeth. High speed imaging revealed the dynamics of an explosive vapor bubble at the tip of the Er laser in water and the root canal model. Typically for Erbium lasers, within a time span of several hundred ms, a longitudinal bubble expanded to maximum size of 5 mm length and 2 mm diameter at 100 mJ and imploded afterwards. In the root canal, the explosive bubble created turbulent high speed water streaming which resects soft tissue from the hard tissue. Thermal imaging showed the dynamics of all lasers heating of the canal wall up to several mm depending on the wavelength and energy settings. The mechanism of smear layer removal and sterilization in the root canal, is attributed to cavitation effects induced by the pulsed laser. The heat generation into the dentine wall was minimal.

In-vivo image-based multi-spectral images have typical problems in image acquisition, registration, visualization and analysis. As its spatial and spectral axes do not have the same unit, standard image algorithms often do not apply. The image size is often so large that it is hard to analyze them interactively. In a clinical setting, image motion will always occur during the acquisition times up to 30 seconds, since most (elderly) patients often have difficulty to retain their poses. In this paper, we discuss how the acquisition, registration, display and analysis can be optimized for in-vivo multi-spectral images.

A multi-spectral imaging system is presented consisting of a spatially and spectrally uniform light source, an electronically tuneable bandpass filter and a sensitive digital camera. When properly calibrated with a white reference, it can reproducibly grab the reflection spectrum of any accessible tissue surface. After a description of technical challenges, some examples are given for the application in dermatology.