A fiber optoacoustic guide with augmented reality for precision breast-conserving surgery

Abstract

Lumpectomy, also called breast-conserving surgery, has become the standard surgical treatment for early-stage breast cancer. However, accurately locating the tumor during a lumpectomy, especially when the lesion is small and nonpalpable, is a challenge. Such difficulty can lead to either incomplete tumor removal or prolonged surgical time, which result in high re-operation rates (~25%) and increased surgical costs. Here, we report a fiber optoacoustic guide (FOG) with augmented reality (AR) for sub-millimeter tumor localization and intuitive surgical guidance with minimal interference. The FOG is preoperatively implanted in the tumor. Under external pulsed light excitation, the FOG omnidirectionally broadcasts acoustic waves through the optoacoustic effect by a specially designed nano-composite layer at its tip. By capturing the acoustic wave, three ultrasound sensors on the breast skin triangulate the FOG tip’s position with 0.25-mm accuracy. An AR system with a tablet measures the coordinates of the ultrasound sensors and transforms the FOG tip’s position into visual feedback with <1-mm accuracy, thus aiding surgeons in directly visualizing the tumor location and performing fast and accurate tumor removal. We further show the use of a head-mounted display to visualize the same information in the surgeons’ first-person view and achieve hands-free guidance. Towards clinical application, a surgeon successfully deployed the FOG to excise a “pseudo tumor” in a female human cadaver. With the high-accuracy tumor localization by FOG and the intuitive surgical guidance by AR, the surgeon performed accurate and fast tumor removal, which will significantly reduce re-operation rates and shorten the surgery time.

Optoacoustic brain stimulation at submillimeter spatial precision

“…Beyond imaging, recent advances in developing optoacoustic materials have enabled highly efficient optoacoustic conversion 27 . Pulsed light excitation of these optoacoustic materials generates ultrasound waves at high amplitude, which allowed for all-optical ultrasound imaging 28,29 , tissue cavitation 30,31 , and precision surgical guidance of lumpectomy 32 .…”

A fiber optoacoustic emitter with controlled ultrasound frequency for cell membrane sonoporation at submillimeter spatial resolution

“…Similarly, Noimark et al [ 30 ] and Poduval et al [ 31 ] coated CNTs and subsequently PDMS on the tip of an optical fiber and showed peak frequency of 20 MHz and 30 MHz, with bandwidth of 23∼40 MHz and 29 MHz, respectively. In our previous work, an optical fiber coated with ZnO/Epoxy and Graphite/Epoxy was developed, serving as an optoacoustic guide for sub-millimeter tumor localization and intuitive surgical guidance [ 32 ]. To study the involvement of cochlear pathway in the ultrasound induced brain stimulation, the fiber based optoacoustic emitter was used for spatially confined neuron stimulation of mouse brain in vivo [ 33 ], showing powerful capability of understanding the bio-interface mechanism.…”

Ultraefficient thermoacoustic conversion through a split ring resonator

“…2 With advances in laser, instrumentation, and algorithms, PA imaging has become a multiscale imaging tool from microscopic to macroscopic domains. [3][4][5] Apart from numerous imaging applications, the PA effect has been recently utilized as a versatile ultrasonic source for ultrasound (US) imaging, 6 tissue localization, 7 ablation, 8 and neuromodulation. 9 Nevertheless, the dissipation limit of photons in a tissue fundamentally prevents PA applications over 7 cm in depth, at which photons are diminished to none by the strong tissue scattering.…”