Publications by authors named "Philipp Arens"

16 Publications

  • Page 1 of 1

Real-time gait metric estimation for everyday gait training with wearable devices in people poststroke.

Wearable Technol 2021 25;2. Epub 2021 Mar 25.

John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA.

Hemiparetic walking after stroke is typically slow, asymmetric, and inefficient, significantly impacting activities of daily living. Extensive research shows that functional, intensive, and task-specific gait training is instrumental for effective gait rehabilitation, characteristics that our group aims to encourage with soft robotic exosuits. However, standard clinical assessments may lack the precision and frequency to detect subtle changes in intervention efficacy during both conventional and exosuit-assisted gait training, potentially impeding targeted therapy regimes. In this paper, we use exosuit-integrated inertial sensors to reconstruct three clinically meaningful gait metrics related to circumduction, foot clearance, and stride length. Our method corrects sensor drift using instantaneous information from both sides of the body. This approach makes our method robust to irregular walking conditions poststroke as well as usable in real-time applications, such as real-time movement monitoring, exosuit assistance control, and biofeedback. We validate our algorithm in eight people poststroke in comparison to lab-based optical motion capture. Mean errors were below 0.2 cm (9.9%) for circumduction, -0.6 cm (-3.5%) for foot clearance, and 3.8 cm (3.6%) for stride length. A single-participant case study shows our technique's promise in daily-living environments by detecting exosuit-induced changes in gait while walking in a busy outdoor plaza.
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http://dx.doi.org/10.1017/wtc.2020.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360352PMC
March 2021

Classifying and Predicting Surgical Complications After Laryngectomy: A Novel Approach to Diagnosing and Treating Patients.

Ear Nose Throat J 2021 Jul 30:1455613211029749. Epub 2021 Jul 30.

Department of Otolaryngology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Objectives: The total laryngectomy is one of the most standardized major surgical procedures in otolaryngology. Several studies have proposed the Clavien-Dindo classification (CDC) as a solution to classifying postoperative complications into 5 grades from less severe to severe. Yet more data on classifying larger patient populations undergoing major otolaryngologic surgery according to the CDC are needed. Predicting postoperative complications in clinical practice is often subject to generalized clinical scoring systems with uncertain predictive abilities for otolaryngologic surgery. Machine learning offers methods to predict postoperative complications based on data obtained prior to surgery.

Methods: We included all patients (N = 148) who underwent a total laryngectomy after diagnosis of squamous cell carcinoma at our institution. A univariate and multivariate logistic regression analysis of multiple complex risk factors was performed, and patients were grouped into severe postoperative complications (CDC ≥ 4) and less severe complications. Four different commonly used machine learning algorithms were trained on the dataset. The best model was selected to predict postoperative complications on the complete dataset.

Results: Univariate analysis showed that the most significant predictors for postoperative complications were the Charlson Comorbidity Index (CCI) and whether reconstruction was performed intraoperatively. A multivariate analysis showed that the CCI and reconstruction remained significant. The commonly used AdaBoost algorithm achieved the highest area under the curve with 0.77 with high positive and negative predictive values in subsequent analysis.

Conclusions: This study shows that postoperative complications can be classified according to the CDC with the CCI being a useful screening tool to predict patients at risk for postoperative complications. We provide evidence that could help identify single patients at risk for complications and customize treatment accordingly which could finally lead to a custom approach for every patient. We also suggest that there is no increase in complications with patients of higher age.
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http://dx.doi.org/10.1177/01455613211029749DOI Listing
July 2021

Ultrasound Shear Wave Elastography of the Tongue during Selective Hypoglossal Nerve Stimulation in Patients with Obstructive Sleep Apnea Syndrome.

Ultrasound Med Biol 2021 Oct 21;47(10):2869-2879. Epub 2021 Jul 21.

Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Radiology, Berlin Institute of Health, Berlin, Germany.

Currently, there is no established technique to directly measure extrinsic tongue muscle activation during selective hypoglossal stimulation therapy (sHNS) in patients with obstructive sleep apnea syndrome (OSAS) in a simple, non-invasive clinical setting. Ultrasound shear-wave elastography (US-SWE) enables quantitative measurement of tissue stiffness. We investigated whether US-SWE is able to detect changes in muscle stiffness of the tongue during sHNS. Patients with OSAS treated with sHNS were prospectively enrolled. A standardized US-SWE protocol was used to selectively measure tissue stiffness of the geniohyoid muscle (GH) and genioglossus (GG) muscles on the side of stimulator implantation (sGH, sGG) and on the contralateral side (nGH, nGG) without and with sHNS. Eighteen patients were included (median age = 62 years, interquartile range: 56-65, 83.3% male). Median shear-wave velocity (SWV) increased during contraction with each patient's clinically prescribed therapeutic regimen in the sGH (+19%, p = 0.020) and sGG (+81%, p < 0.001) and decreased during contraction in the nGH (-8%, p = 0.107) and nGG (-8%, p = 0.396). Differences in SWV during contraction were significant only on the side of stimulation (sGG +81%, sGH +19%). SWE measurements had excellent reliability as reflected by a Cronbach α value ≥0.9 for all target muscles pre- and post-contraction and an item-total correlation ≥0.5. US-SWE allows reliable measurement of SWV as an indicator of muscle stiffness of extrinsic tongue muscles. This non-invasive method provides new possibilities to distinguish and characterize responders from non-responders in hypoglossal stimulation therapy. Compared with the regular visual assessment of tongue movement, US-SWE of individual muscle groups provides a new non-invasive imaging tool in patients with OSAS.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2021.06.009DOI Listing
October 2021

The Diagnostic Yield of Excisional Biopsy in Cervical Lymphadenopathy: A Retrospective Analysis of 158 Biopsies in Adults.

Ear Nose Throat J 2021 Jun 7:1455613211023009. Epub 2021 Jun 7.

Department of Otorhinolaryngology, 14903Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Objectives: Cervical lymph nodes are the most common site of peripheral lymphadenopathy. The underlying etiologies are usually benign and self-limiting but may include malignancies or other severe life-threatening diseases. The aim of the current study was to investigate the various underlying pathologies of cervical lymphadenopathy as assessed by the diagnostic yield of excisional lymph node biopsies of the neck in a tertiary adult practice. The evaluation was performed in light of previous literature and regional epidemiological patterns.

Methods: Retrospective analysis of hospital charts of 158 adult patients who underwent an excisional biopsy for suspected cervical lymphadenopathy at a tertiary referral head and neck service between January 2017 and December 2019.

Results: The most common underlying pathology was unspecific and/or reactive lymphadenitis in 44.5% of specimens, followed by malignant disease in 38.6% of cases. An age above 40 years was significantly correlated with an increased likelihood of malignant disease. Lower jugular and posterior triangle lymph nodes showed higher malignancy rates than other groups (100% and 66.7%, respectively). The overall surgical complication rate was 2.5%.

Conclusions: The results of the current study serve as an indicator of the variety of etiologies causing cervical lymphadenopathy. In particular, given the increasing incidence of malignant diseases in recent decades, the findings should alert physicians to the importance of lymph node biopsy for excluding malignancy in persistent cervical lymphadenopathy especially in older adults. The findings emphasize the value of excisional lymph node biopsy of the neck as a useful diagnostic tool in adult patients with peripheral lymphadenopathy.
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http://dx.doi.org/10.1177/01455613211023009DOI Listing
June 2021

[The Use of Intraoperative Nerve Monitoring in Head and Neck Surgery].

Laryngorhinootologie 2020 Dec 3;99(12):e3. Epub 2021 Mar 3.

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Hals-Nasen-Ohrenheilkunde, Campus Charité-Mitte, 10117 Berlin, Germany.

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http://dx.doi.org/10.1055/a-1402-6689DOI Listing
December 2020

Bilateral Hearing Loss Due to Metastatic Gastric Signet Cell Adenocarcinoma Involving the Internal Auditory Canal and Cerebellopontine Angle.

J Int Adv Otol 2021 Jan;17(1):87-90

Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Intracranial metastases of stomach cancers are very rare and are associated with a poor prognosis. Of those, metastases of gastric cancers in the internal auditory canal and cerebellopontine angle represent an extremely rare subgroup. Such metastatic lesions may be indistinguishable from vestibular schwannomas in imaging studies and clinical presentation. In this report, we describe a case of gastric signet cell adenocarcinoma metastasizing to the internal auditory canal and cerebellopontine angle bilaterally and causing bilateral hearing loss, including a unilateral sudden deafness. Due to the co-detection of multiple other intracranial masses in the magnetic resonance imaging scan, the suspected diagnosis of leptomeningeal metastatic disease was clear, and the patient was referred to palliative whole brain radiotherapy. The case further highlights the importance of prompt diagnosis and treatment of metastatic cerebellopontine angle lesions to prevent permanent neurological sequelae. Metastatic tumors should therefore be considered in the differential diagnosis of cerebellopontine angle lesions, especially in patients with a known history of malignant disease.
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http://dx.doi.org/10.5152/iao.2020.8415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901424PMC
January 2021

Incidence and survival of HNSCC patients living with HIV compared with HIV-negative HNSCC patients.

Eur Arch Otorhinolaryngol 2021 Oct 25;278(10):3941-3953. Epub 2021 Jan 25.

Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany.

Purpose: The aim was to analyze the incidence and survival of patients living with HIV (PLWH) with head and neck squamous cell carcinoma (HNSCC) and to compare with a control group of HIV-negative HNSCC patients.

Methods: Clinicopathological data and predictors for overall survival (OS) and disease-free survival (DFS) were investigated (2009-2019).

Results: 50 of 5151 HNSCC patients (0.97%) were PLWH, and 76% were smokers. Age ≤ 60 years, HIV-PCR ≤ 50 copies, CD4 cells ≤ 200/mm, cART treatment, T and UICC classification, oral cavity and nasal/paranasal sinuses, and therapy were significantly associated with OS in univariate analysis. In the multivariate analysis, only age and HIV-PCR independently predicted OS. The OS of the 50 PLWH was not significantly altered compared with the 5101 HIV-negative controls. However, OS and DFS were significantly inferior in advanced tumor stages of PLWH compared with an age-matched control group of 150 HIV-negative patients.

Conclusions: PLWH were diagnosed with HNSCC at a significantly younger age compared to HIV-negative patients. Taking into account patient age at initial diagnosis, both OS and DFS rates in PLWH are significantly worse compared with a matched control group of HIV-negative patients in advanced tumor stages UICC III/IV. The prognosis (OS) is improved when taking cART treatment, the HIV viral load is undetectable and CD4 count is high.
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http://dx.doi.org/10.1007/s00405-020-06573-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8382606PMC
October 2021

[The Use of Intraoperative Nerve Monitoring in Head and Neck Surgery].

Laryngorhinootologie 2020 12 11;99(12):850-852. Epub 2020 Dec 11.

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Hals-Nasen-Ohrenheilkunde, Campus Charité-Mitte, 10117 Berlin, Germany.

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http://dx.doi.org/10.1055/a-1215-7228DOI Listing
December 2020

Validation of two techniques for intraoperative hyperspectral human tissue determination.

J Med Imaging (Bellingham) 2020 Nov 19;7(6):065001. Epub 2020 Nov 19.

Fraunhofer Heinrich Hertz Institute, Computer Vision and Graphics Group, Berlin, Germany.

Hyperspectral imaging (HSI) is a non-contact optical imaging technique with the potential to serve as an intraoperative computer-aided diagnostic tool. Our work analyzes the optical properties of visible structures in the surgical field for automatic tissue categorization. Building an HSI-based computer-aided tissue analysis system requires accurate ground truth and validation of optical soft tissue properties as these show large variability. We introduce and validate two different hyperspectral intraoperative imaging setups and their use for the analysis of optical tissue properties. First, we present an improved multispectral filter-wheel setup integrated into a fully digital microscope. Second, we present a novel setup of two hyperspectral snapshot cameras for intraoperative usage. Both setups are operating in the spectral range of 400 up to 975 nm. They are calibrated and validated using the same database and calibration set. For validation, a color chart with 18 well-defined color spectra in the visual range is analyzed. Thus the results acquired with both settings become transferable and comparable to each other as well as between different interventions. On patient data of two different otorhinolaryngology procedures, we analyze the optical behaviors of different soft tissues and show a visualization of such different spectral information. The introduced calibration pipeline for different HSI setups allows comparison between all acquired spectral information. Clinical data underline the potential of HSI as an intraoperative diagnostic tool and the clinical usability of both introduced setups. Thereby, we demonstrate their feasibility for the analysis and categorization of different human soft tissues.
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http://dx.doi.org/10.1117/1.JMI.7.6.065001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675006PMC
November 2020

Supraklavikulärer Insellappen.

Laryngorhinootologie 2020 10 28;99(10):680-681. Epub 2020 Sep 28.

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http://dx.doi.org/10.1055/a-1123-4514DOI Listing
October 2020

Safety and effectiveness in explantation and re-implantation of hypoglossal nerve stimulation devices.

Eur Arch Otorhinolaryngol 2021 Feb 26;278(2):477-483. Epub 2020 Jun 26.

Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.

Purpose: Since 2001, hypoglossal nerve stimulators have been implanted in patients with obstructive sleep apnea around the world, initially in trial situations but more recently also in regular care settings. Medium term data indicate effectiveness and tolerability of treatment. However, when assessing the safety of the procedure, the safe feasibility of explantation or reimplantation must also be considered.

Patients And Methods: Nine patients with an implanted respiratory-driven hypoglossal nerve stimulator. We have evaluated the feasibility and safety of explantation or re-implantation with another stimulation system.

Results: In 2012, nine patients were implanted with a respiratory-driven hypoglossal nerve stimulator as part of the Apnex Medical Pivotal Study. The study was ended in 2013. For a variety of reasons, the system was explanted from all nine patients by the year 2019. Three of these patients were re-implanted with a different system with respiratory sensing during the same session (mean incision to closure time for explantation 88.2 ± 35.01 min., mean incision to closure time for re-implantation 221.75 ± 52.73 min.). Due to extensive scar tissue formation, all procedures were technically challenging. Complication rate was significantly higher when re-implantation was performed or attempted in the same surgical session (0 of 5 patients with explantation versus 3 of 4 patients with attempted re-implantation; p = 0.018). There was no significant difference between the AHI values before and after implantation in patients with re-implantation.

Conclusion: Explantation and re-implantation are technically challenging though possible procedures. The single-staged equilateral reimplantation of another hypoglossal nerve stimulation system can, but need not, be successful.
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http://dx.doi.org/10.1007/s00405-020-06170-wDOI Listing
February 2021

Determination of the optical properties of cholesteatoma in the spectral range of 250 to 800 nm.

Biomed Opt Express 2020 Mar 20;11(3):1489-1500. Epub 2020 Feb 20.

Charité - Universitätsmedizin Berlin, Department of Otorhinolaryngology, Berlin, Germany.

Cholesteatoma of the ear can lead to life-threatening complications and its only treatment is surgery. The smallest remnants of cholesteatoma can lead to recurrence of this disease. Therefore, the optical properties of this tissue are of high importance to identify and remove all cholesteatoma during therapy. In this paper, we determine the absorption coefficient and scattering coefficient ' of cholesteatoma and bone samples in the wavelength range of 250 nm to 800 nm obtained during five surgeries. These values are determined by high precision integrating sphere measurements in combination with an optimized inverse Monte Carlo simulation (iMCS). To conserve the optical behavior of living tissues, the optical spectroscopy measurements are performed immediately after tissue removal and preparation. It is shown that in the near-UV and visible spectrum clear differences exist between cholesteatoma and bone tissue. While is decreasing homogeneously for cholesteatoma, it retains at the high level for bone in the region of 350 nm to 580 nm. Further, the results for the cholesteatoma measurements correspond to published healthy epidermis data. These differences in the optical parameters reveal the future possibility to detect and identify, automatically or semi-automatically, cholesteatoma tissue for active treatment decisions during image-guided surgery leading to a better surgical outcome.
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http://dx.doi.org/10.1364/BOE.384742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075596PMC
March 2020

Determination of optical properties of human tissues obtained from parotidectomy in the spectral range of 250 to 800 nm.

J Biomed Opt 2019 12;24(12):1-7

Charité-Universitätsmedizin Berlin, Department of Otorhinolaryngology, Berlin, Germany.

The optical properties of human tissues are an important parameter in medical diagnostics and therapy. The knowledge of these parameters can encourage the development of automated, computer-driven optical tissue analysis methods. We determine the absorption coefficient μ and scattering coefficient of different tissue types obtained during parotidectomy in the wavelength range of 250 to 800 nm. These values are determined by high precision integrating sphere measurements in combination with an optimized inverse Monte Carlo simulation. To conserve the optical behavior of living tissues, the optical spectroscopy measurements are performed immediately after tissue removal. Our study includes fresh samples of the ear, nose, and throat (ENT) region, as muscle tissue, nervous tissue, white adipose tissue, stromal tissue, parotid gland, and tumorous tissue of five patients. The measured behavior of adipose corresponds well with the literature, which sustains the applied method. It is shown that muscle is well supplied with blood as it features the same characteristic peaks at 430 and 555 nm in the absorption curve. The parameter decreases for all tissue types above 570 nm. The accuracy is adequate for the purposes of providing μ and of different human tissue types as muscle, fat, nerve, or gland tissue, which are embedded in large complex structures such as in the ENT area. It becomes possible for the first time to present reasonable results for the optical behavior of human soft tissue located in the ENT area and in the near-UV, visual, and near-infrared areas.
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http://dx.doi.org/10.1117/1.JBO.24.12.125001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890295PMC
December 2019

Extraoral Osseous Choristoma in the Head and Neck Region: Case Report and Literature Review.

Case Rep Otolaryngol 2019 28;2019:8532356. Epub 2019 May 28.

Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Otorhinolaryngology, Charitéplatz 1, 10117 Berlin, Germany.

An osseous choristoma is a benign tumor consisting of regular bone tissue in an irregular localization. Choristomas in the head and neck region are rare. Most frequently, they are found in the region of the tongue or oral mucosa. There are also very few reports on osseous choristomas in the submandibular region. We present the case of a woman with a large, caudal osseous choristoma within the lateral cervical triangle. Literature review is given about all of the reported cases in the region of the neck. The pathogenesis is yet unexplained. Our case supports the theory that the development of an osseous choristoma is a reaction to a former trauma. Cervical osseous choristomas are seldom, but they represent an important differential diagnosis when dealing with a cervical tumor.
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http://dx.doi.org/10.1155/2019/8532356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558603PMC
May 2019

Apnea and hypopnea characterization using esophageal pressure, respiratory inductance plethysmography, and suprasternal pressure: a comparative study.

Sleep Breath 2019 Dec 7;23(4):1169-1176. Epub 2019 Feb 7.

Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Objectives: To determine if recording of suprasternal pressure (SSP) can classify apneas and hypopneas as reliably as respiratory inductance plethysmography (RIP) belts and to compare the two methods to classification with esophageal pressure (Pes), the reference method for assessing respiratory effort.

Methods: In addition to polysomnographic recordings that included Pes, SSP was recorded. Recordings from 32 patients (25 males, mean age 66.7 ± 15.3 years, and mean BMI 30.1 ± 4.5 kg/m) were used to compare the classification of detected apneas and hypopneas by three methods of respiratory effort evaluation (Pes, RIP belts, and SSP). Signals were analyzed randomly and independently from each other. All recordings were analyzed according to AASM guidelines.

Results: Using Pes as a reference for apnea characterization, the Cohen kappa (κ) was 0.93 for SSP and 0.87 for the RIP. The sensitivity/specificity of SSP was 97.0%/96.9% for obstructive, 93.9%/98.3% for central, and 94.9%/97.9% for mixed apneas. The sensitivity/specificity of the RIP was 97.4%/91.9% for obstructive, 87.5%/97.9% for central, and 85.6%/96.6% for mixed apneas. For hypopnea characterization using the Pes as a reference, κ was 0.92 for SSP and 0.86 for the RIP. The sensitivity/specificity of SSP was 99.7%/97.6% for obstructive and 97.6%/99.7% for central. The sensitivity/specificity of the RIP was 99.8%/81.1% for obstructive and 81.1%/99.8% for central.

Conclusions: These results confirm the excellent agreement in the detection of respiratory effort between SSP, RIP belts, and Pes signals. Thus, we conclude that apnea and hypopnea characterization in adults with SSP is a reliable method.
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http://dx.doi.org/10.1007/s11325-019-01793-8DOI Listing
December 2019

Intraoperative hyperspectral determination of human tissue properties.

J Biomed Opt 2018 05;23(9):1-8

Fraunhofer-Institut für Nachrichtentechnik Heinrich-Hertz-Institut, Germany.

We address the automatic differentiation of human tissue using multispectral imaging with promising potential for automatic visualization during surgery. Currently, tissue types have to be continuously differentiated based on the surgeon's knowledge only. Further, automatic methods based on optical in vivo properties of human tissue do not yet exist, as these properties have not been sufficiently examined. To overcome this, we developed a hyperspectral camera setup to monitor the different optical behavior of tissue types in vivo. The aim of this work is to collect and analyze these behaviors to open up optical opportunities during surgery. Our setup uses a digital camera and several bandpass filters in front of the light source to illuminate different tissue types with 16 specific wavelength ranges. We analyzed the different intensities of eight healthy tissue types over the visible spectrum (400 to 700 nm). Using our setup and sophisticated postprocessing in order to handle motion during capturing, we are able to find tissue characteristics not visible for the human eye to differentiate tissue types in the 16-dimensional wavelength domain. Our analysis shows that this approach has the potential to support the surgeon's decisions during treatment.
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http://dx.doi.org/10.1117/1.JBO.23.9.091409DOI Listing
May 2018
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