Recent Advances in Smart Epidural Spinal Needles.

Lumbar puncture is a minimally invasive procedure that utilizes a spinal needle to puncture the lumbar epidural space to take a sample from the cerebrospinal fluid or inject drugs for diagnostic and therapeutic purposes. Physicians rely on their expertise to localize epidural space. Due to its critical procedure, the failure rate can reach up to 28%. Hence, a high level of experience and caution is required to correctly insert the needle without puncturing the dura mater, which is a fibrous layer protecting the spinal cord. Failure of spinal anesthesia is, in some cases, related to faulty needle placement techniques since it is blindly inserted. Therefore, advanced techniques for localization of the epidural space are essential to avoid any possible side effects. As for epidural space localization, various ideas were carried out over recent years to provide accurate identification of the epidural space. Subsequently, several methodologies based on mechanical and optical schemes have been proposed. Several research groups worked from different aspects of the problem, namely, the clinical and engineering sides. Hence, the main goal of this paper is to review this research with the aim of remedying the gap between the clinical side of the problem and the engineering side by examining the main techniques in building sensors for such purposes. This manuscript provides an understanding of the clinical needs of spinal needles from an anatomical point of view. Most importantly, it discusses the mechanical and optical approaches in designing and building sensors to guide spinal needles. Finally, the standards that must be followed in building smart spinal needles for approval procedures are also presented, along with some insight into future directions.

Estimation of the Differential Pathlength Factor for Human Skin Using Monte Carlo Simulations.

Near-infrared technology is an emerging non-invasive technique utilized for various medical applications. Recently, there have been many attempts to utilize NIR technology for the continues monitoring of blood glucose levels through the skin. Different approaches and designs have been proposed for non-invasive blood glucose measurements. Light photons penetrating the skin can undergo multiple scattering events, and the actual optical pathlength becomes larger than the source-to-detector separation (optode spacing) in the reflection-mode configuration. Thus, the differential pathlength factor (DPF) must be incorporated into the modified Beer-Lambert law. The accurate estimation of the DPF values will lead to an accurate quantification of the physiological variations within the tissue. In this work, the aim was to systematically estimate the DPF for human skin for a range of source-to-detector separations and wavelengths. The Monte Carlo (MC) method was utilized to mimic the different layers of human skin with different optical properties and blood and water volume fractions. This work could help improve the accuracy of the near-infrared technique in the measurement of physiological variations within skin tissue.

In Silico Investigation of SNR and Dermis Sensitivity for Optimum Dual-Channel Near-Infrared Glucose Sensor Designs for Different Skin Colors.

Diabetes is a serious health condition that requires patients to regularly monitor their blood glucose level, making the development of practical, compact, and non-invasive techniques essential. Optical glucose sensors-and, specifically, NIR sensors-have the advantages of being non-invasive, compact, inexpensive, and user-friendly devices. However, these sensors have low accuracy and are yet to be adopted by healthcare providers. In our previous work, we introduced a non-invasive dual-channel technique for NIR sensors, in which a long channel is utilized to measure the glucose level in the inner skin (dermis) layer, while a short channel is used to measure the noise signal of the superficial skin (epidermis) layer. In this work, we investigated the use of dual-NIR channels for patients with different skin colors (i.e., having different melanin concentrations). We also adopted a Monte Carlo simulation model that takes into consideration the differences between different skin layers, in terms of blood content, water content, melanin concentration in the epidermis layer, and skin optical proprieties. On the basis of the signal-to-noise ratio, as well as the sensitivities of both the epidermis and dermis layers, we suggest the selection of wavelengths and source-to-detector separation for optimal NIR channels under different skin melanin concentrations. This work facilitates the improved design of a compact and non-invasive NIR glucose sensor that can be utilized by patients with different skin colors.

Observation and motor imagery balance tasks evaluation: An fNIRS feasibility study.

In this study, we aimed at exploring the feasibility of functional near-infrared spectroscopy (fNIRS) for studying the observation and/or motor imagination of various postural tasks. Thirteen healthy adult subjects followed five trials of static and dynamic standing balance tasks, throughout three different experimental setups of action observation (AO), a combination of action observation and motor imagery (AO+MI), and motor imagery (MI). During static and dynamic standing tasks, both the AO+MI and MI experiments revealed that many channels in prefrontal or motor regions are significantly activated while the AO experiment showed almost no significant increase in activations in most of the channels. The contrast between static and dynamic standing tasks showed that with more demanding balance tasks, relative higher activation patterns were observed, particularly during AO and in AO+MI experiments in the frontopolar area. Moreover, the AO+MI experiment revealed a significant difference in premotor and supplementary motor cortices that are related to balance control. Furthermore, it has been observed that the AO+MI experiment induced relatively higher activation patterns in comparison to AO or MI alone. Remarkably, the results of this work match its counterpart from previous functional magnetic resonance imaging studies. Therefore, they may pave the way for using the fNIRS as a diagnostic tool for evaluating the performance of the non-physical balance training during the rehabilitation period of temporally immobilized patients.

A Review of Non-Invasive Optical Systems for Continuous Blood Glucose Monitoring.

The prevalence of diabetes is increasing globally. More than 690 million cases of diabetes are expected worldwide by 2045. Continuous blood glucose monitoring is essential to control the disease and avoid long-term complications. Diabetics suffer on a daily basis with the traditional glucose monitors currently in use, which are invasive, painful, and cost-intensive. Therefore, the demand for non-invasive, painless, economical, and reliable approaches to monitor glucose levels is increasing. Since the last decades, many glucose sensing technologies have been developed. Researchers and scientists have been working on the enhancement of these technologies to achieve better results. This paper provides an updated review of some of the pioneering non-invasive optical techniques for monitoring blood glucose levels that have been proposed in the last six years, including a summary of state-of-the-art error analysis and validation techniques.

Hemodynamic responses during standing and sitting activities: a study toward fNIRS-BCI.

In this paper, we utilized functional near-infrared spectroscopy (fNIRS) technology to examine the hemodynamic responses in the motor cortex for two conditions, namely standing and sitting tasks. Nine subjects performed five trials of standing and sitting (SAS) tasks with both real movements and imagery thinking of SAS. A group level of statistical parametric mapping (SPM) analysis during these tasks showed bilateral activation of oxy-hemoglobin for both real movements and imagery experiments. Interestingly, the SPM analysis clearly revealed that the sitting tasks induced a higher oxy-hemoglobin level activation compared to the standing task. Remarkably, this finding is persistent across the 22 measured channels at the individual and group levels for both experiments. Furthermore, six features were extracted from pre-processed HbO signals and the performance of four different classifiers was examined in order to test the viability of using SAS tasks in future fNIRS-brain-computer interface (fNIRS-BCI) systems. In particular, two features-combination tests revealed that the signal slope with signal variance represents one of the three best two-combined features for its consistency in providing high accuracy results for both real and imagery experiments. This study shows the potential of implementing such tasks into the fNIRS-BCI system. In the future, the results of this work could pave the way towards the application of fNIRS-BCI in lower limb rehabilitation.

An Automated Preprocessing Method for Diffuse Optical Tomography to Improve Breast Cancer Diagnosis.

The ultrasound-guided diffuse optical tomography is a noninvasive imaging technique for breast cancer diagnosis and treatment monitoring. The technique uses a handheld probe capable of providing measurements of multiple wavelengths in a few seconds. These measurements are used to estimate optical absorptions of lesions and calculate the total hemoglobin concentration. Any measurement errors caused by low signal to noise ratio data and/or movements during data acquisition would reduce the accuracy of reconstructed total hemoglobin concentration. In this article, we introduce an automated preprocessing method that combines data collected from multiple sets of lesion measurements of 4 optical wavelengths to detect and correct outliers in the perturbation. Two new measures of correlation between each pair of wavelength measurements and a wavelength consistency index of all reconstructed absorption maps are introduced. For phantom and patients' data without evidence of measurement errors, the correlation coefficient between each pair of wavelength measurements was above 0.6. However, for patients with measurement errors, the correlation coefficient was much lower. After applying the correction method to 18 patients' data with measurement errors, the correlation has improved and the wavelength consistency index is in the same range as the cases without wavelength-dependent measurement errors. The results show an improvement in classification of malignant and benign lesions.

Compact ultrasound-guided diffuse optical tomography system for breast cancer imaging.

Near-infrared diffuse optical tomography (DOT) has demonstrated a great potential as an adjunct modality for differentiation of malignant and benign breast lesions and for monitoring treatment response in patients with locally advanced breast cancers. The path toward commercialization of DOT techniques depends upon the improvement of robustness and user-friendliness of this technique in hardware and software. In this study, we introduce our recently developed ultrasound-guided DOT system, which has been improved in system compactness, robustness, and user-friendliness by custom-designed electronics, automated data preprocessing, and implementation of a new two-step reconstruction algorithm. The system performance has been tested with several sets of solid and blood phantoms and the results show accuracy in reconstructed absorption coefficients as well as blood oxygen saturation. A clinical example of a breast cancer patient, who was undergoing neoadjuvant chemotherapy, is given to demonstrate the system performance.

Diffuse optical tomography reconstruction method using ultrasound images as prior for regularization matrix.

Ultrasound-guided diffuse optical tomography (DOT) is a promising imaging technique that maps hemoglobin concentrations of breast lesions to assist ultrasound (US) for cancer diagnosis and treatment monitoring. The accurate recovery of breast lesion optical properties requires an effective image reconstruction method. We introduce a reconstruction approach in which US images are encoded as prior information for regularization of the inversion matrix. The framework of this approach is based on image reconstruction package "NIRFAST." We compare this approach to the US-guided dual-zone mesh reconstruction method, which is based on Born approximation and conjugate gradient optimization developed in our laboratory. Results were evaluated using phantoms and clinical data. This method improves classification of malignant and benign lesions by increasing malignant to benign lesion absorption contrast. The results also show improvements in reconstructed lesion shapes and the spatial distribution of absorption maps.