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Journal of Biomedical Optics • Open Access

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging
Author(s): Alisha V. DSouza; Huiyun Lin; Eric R. Henderson; Kimberley S. Samkoe; Brian W. Pogue

Paper Abstract

There is growing interest in using fluorescence imaging instruments to guide surgery, and the leading options for open-field imaging are reviewed here. While the clinical fluorescence-guided surgery (FGS) field has been focused predominantly on indocyanine green (ICG) imaging, there is accelerated development of more specific molecular tracers. These agents should help advance new indications for which FGS presents a paradigm shift in how molecular information is provided for resection decisions. There has been a steady growth in commercially marketed FGS systems, each with their own differentiated performance characteristics and specifications. A set of desirable criteria is presented to guide the evaluation of instruments, including: (i) real-time overlay of white-light and fluorescence images, (ii) operation within ambient room lighting, (iii) nanomolar-level sensitivity, (iv) quantitative capabilities, (v) simultaneous multiple fluorophore imaging, and (vi) ergonomic utility for open surgery. In this review, United States Food and Drug Administration 510(k) cleared commercial systems and some leading premarket FGS research systems were evaluated to illustrate the continual increase in this performance feature base. Generally, the systems designed for ICG-only imaging have sufficient sensitivity to ICG, but a fraction of the other desired features listed above, with both lower sensitivity and dynamic range. In comparison, the emerging research systems targeted for use with molecular agents have unique capabilities that will be essential for successful clinical imaging studies with low-concentration agents or where superior rejection of ambient light is needed. There is no perfect imaging system, but the feature differences among them are important differentiators in their utility, as outlined in the data and tables here.

Paper Details

Date Published: 16 August 2016
PDF: 15 pages
J. Biomed. Opt. 21(8) 080901 doi: 10.1117/1.JBO.21.8.080901
Published in: Journal of Biomedical Optics Volume 21, Issue 8
Show Author Affiliations
Alisha V. DSouza, Thayer School of Engineering at Dartmouth (United States)
Huiyun Lin, Thayer School of Engineering at Dartmouth (United States)
Fujian Normal Univ. (China)
Eric R. Henderson, Dartmouth Hitchcock Medical Ctr. (United States)
Kimberley S. Samkoe, Geisel School of Medicine (United States)
Thayer School of Engineering at Dartmouth (United States)
Brian W. Pogue, Thayer School of Engineering at Dartmouth (United States)
Geisel School of Medicine (United States)


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