Fiber optics applications in

medicine

Chapter 8

PHYS 3616E, Winter 2017 Dr. Bassam Aharmim

1) Introduction

As optical fibers transformed communication, they also made a revolution in imaging,

diagnosis and therapy in medicine.

The first application of transmitting light through optical fibers in medicine was the
development of endoscopes that were based on optical fibers.

This led to other developments:

 The development of fiber optic sensors, which are ideally suited for diagnosis inside the
human body
 Improved fibers that were capable of transmitting high power laser beams, opening up
the possibility of performing laser surgery and therapy inside the body (chapter 9).

The front picture shows an endoscope (called

arthroscope) utilized to examine a knee.

An arthroscope is a straight and cylinder-like tool

with a series of lens and bundles of fibers which
has a size of 2 - 5 mm.

It will be inserted into the joint through a tiny

incision and will do all the examinations.
A light is then transmitted through the fiber
optics to illuminate the joints which will help
the physician to examine the joint thoroughly.

Endoscopes can be rigid or flexible

Rigid endoscopes are based on a rigid image

conduit.
Flexible endoscopes, on the other hand, incorporate
flexible bundles.
The figure bellow shows an examination of the lining
of the esophagus, stomach, and upper duodenum
with a flexible endoscope.

Fiber optics in dentistry

2) The fiberscope
The fiberscope as an imaging instrument became
possible with the perfection of illuminating and
imaging optical fiber bundles.
An objec­tive lens is attached to the distal end of
the coherent bundle.
An image of the object is formed on the distal
end face of the ordered bundle and is
transmitted through the bundle to the proximal
end.
Another compound lens system (an eyepiece) is
used to fa­cilitate viewing of the image at the
proximal end.
Light guide bundles are often positioned at the
side of the image bundle for illumination.
Individual fibers at the distal end of the non-
ordered bundle may be ordered in a circle around
the imaging bundle (saves space + more uniform
illumination of the object).

The fiberoptic endoscope is a medical system that makes use of the fiberscope for imaging
inside the body.
In addition, this system contains several ancillary channels that are used for the
introduction of thin mechanical tools or for the introduction of liquids inside the body.
3) Endoscopy
An endoscopy is a special test that involves
examining the inside of a person's body using
an endoscope.
The name endoscope is based on two Greek
words : endon (within) and skopein (view).
It's being used to describe optical instruments
that facilitate visual inspection and imaging of
internal organs.
In addition, an endoscope may include ancillary
channels through which the physician can
perform other tasks.
The endoscopic system consists of several
subsystems: the endoscope itself; subsystems
that provide, irrigation, and suction; and auxiliary
medi­cal subsystems such as electrocautery and
biopsy forceps
Endoscopes may be inserted into the body
through natural openings (mouth, rectum, etc.)
or through small incision in the skin.

A view of the inside of the colon as it normally appears when

viewed through an endoscope
 distal
end

flexible
shaft

proximal
end

Example 8-1: An optical fiber has core with an index of refraction ncore=1.40 and a diameter d= 80 μm.
It is surrounded by a cladding with an index of refraction ncladding=1.34.
Light is sent into the fiber along its axis. Calculate the smallest outside radius R min permitted for a bent
in the fiber if no light is to escape.
The distal end of the endoscope houses the distal tips of several of the optical and
mechanical components.
These are the tip of the light guides, which provide illumination; the distal tip of the imaging
bundle; and a miniature objec­tive lens (or a complex lens system), which is attached to the tip
of this bundle.
A thin, flat protective window that is easy to clean may cover the tip to protect it from
contamination by blood or debris.
The distal end of the endoscope is often immersed in fluids, secretions, or blood, which tend to
hinder viewing. A flushing port is supplied through which a stream of water can be sprayed
on the distal tip of the imaging system to keep it clean.
The distal end may also contain one or several outlets that are used for irrigation, as­piration,
suction, or insertion of thin instruments.

The flexible shaft holds the light guide, imaging bundle, and ancillary tubes together.
The shaft is connected at one side to the distal end and at the other side to the proximal end
of the endoscope.
This shaft is often constructed of steel mesh and can be strengthened further by a steel spiral.
This construction serves two purposes. It stiffens the endoscope, giving it mechanical
support, and protects the delicate optical and mechanical components inside from being
crushed or kinked.
The flexible shaft is sheathed by a plastic jacket that is biologically inert and that forms a
hermetic seal. It protects the inner parts of the endoscope from interaction with water, blood, or
other biological fluids.
The proximal end of the endoscope includes viewing optics, controls, and several ports.
These are often housed in a handpiece held by the physician. All the control knobs, buttons,
levers, and the photographic equipment are connected to this handpiece
For large enough endoscopes, a tiny video camera can be attached to the tip of the
endoscope for what is called direct imaging.
The same integrated circuit chips as the imaging elements in commercial cameras are used
in these endoscopes.
The resulting image can be viewed directly on a monitor and stored for future reference.
New endoscopes have digital capabilities for manipulating and enhancing the video images.

Ultrathin endoscopes
In some applications it is desirable to have endoscopes whose diameter is smaller than that
of thin endoscopes.
Ultrathin endoscopes have been developed with outer diameters of less than 1 mm.
The imaging bundle of such an endoscope consists of less than 3000 fibers each of diameter
of roughly 2-5 μm.
The outer diameter of the imaging bundle is often less than 0.3 mm and the optical resolution
is lower than that of a thin endoscope. This endoscope is too thin to include a practical
ancillary channel.
Ultrathin endoscopes have been used clinically for imaging of peripheral and coronary
arteries.
Because the body's organs naturally settle compactly together, leaving no clear air-filled
spaces, a gas channel is usually included and used to inflate the region to be examined
with inert carbon dioxide gas to lift and separate the tissues.

Similarly, another insert is used for injecting water and suctioning off fluid and debris.

Other common tools include forceps for manipulating and removing tissue for
examination, tiny scalpels, miniaturized staple guns, tools for making sutures, and snares
for both cutting and heating tissue.

The snare works by being looped around a region of tissue while an electric current is
passed through the wire.

This heats the wire, causing the tissue to heat up as well, and destroy tissue and seal off
blood vessels at the same time, an effect called cauterization.
Medical endoscopes go by specific names that are determined by which part of the body
each scope is used to image.

Many different types exist, each designed for a specific application.

In principle, the various endoscopes are similar to each other, although distinct differences
were introduced to make the endoscopes more suited to each particular discipline.
Endoscopes, like other optical systems, are designed and built to perform specific goals.

Some of the features that can be specified are as follows:

(i) Transmission range: 0.4-0.9 μm. (imaging and illumination)

(ii) Resolution: 3-5 lines/mm. This number determines the ability of the optical system to
discriminate details in the image.
(iii) Magnification: 4 - 40 X
(iv) Depth of focus: The distance over which a clear image is obtained.
(v) Field of view (FOV): The angular field which can be imaged through the endoscope.
(vi) Minimum bending radius: The minimum ra­dius over which the endoscope can be bent
without danger of damage due to breaking of optical fibers.
(vii) Bending angle: The maximum angle over which the distal tip may be bent.
Time sequence showing the removal of a precancerous growth (or polyp).

The first image shows, at left, a polyp growing within the colon, as seen through an
endoscope.

In the middle two images, a snare is used to hook and remove the polyp.

The final picture shows the site after the removal.

No bleeding occurs during the procedure.

4) Fiber optics for medical diagnostics

Diagnostic medical techniques can be divided into two classes: invasive and noninvasive.
The noninvasive methods, do not cause pain to the patient and are potentially safe.
The invasive methods, which require penetration into the body, are still necessary because
they provide­information that cannot be obtained otherwise.
Optical fibers are the basis for a relatively new family of "least invasive" diagnostic tools
called optical fiber sensors.

Optical fiber sensors make use of electronic devices that perform chemical/physical
analysis inside the body (They collect measurement information over fiber optics).
They rely on the fact that alterations in a specific physical/chemical property of the medium
being probed would cause a predictable change in light transmission characteristics of the
optical fiber.

The requirements of a good sensor system are:

 Specificity: The measurement of only one parameter at a time without being affected by
other parameters.
 Sensitivity: The ability to measure small changes in a given parameter.
 Accuracy: The ability to give an accurate and stable measurement over a long period.
 Cost: A low cost would enable the sensor to be disposable.
In principle, fiberoptic biomedical sensors have all these attributes, including the following
advantages:

 Miniaturization: very thin fibers can easily be inserted into various places in the body (in
vivo and in real time measurements).
 Biocompatibility: All the materials from which the fibers and trans­ducers are made are
nontoxic and compatible with biological tissue.
 Accuracy: Fiberoptic sensors may be in principle fast, stable, and accurate.
 Safety: No electrical wires and circuits are introduced into the body.

At present, blood samples are generally sent to a laboratory for a chemical analysis of one or
more of their constituents.

An alternative is the use of miniaturized sensors that can be inserted into the body of the
patient.

It is possible to make a sensor small enough to fit into blood vessels without interfering too
much with the blood flow.

The sensor should be able to perform chemical analysis in real time and should be
disposable to avoid transmissible diseases.

In a typical sensor, a thin optical fiber is part of a complex optical system. The fiber is placed
in a location and is used to measure some parameter such as temperature, or pressure.
A typical fiber optic sensor is shown schematically in the figures bellow.

The fiber optic sensors fall into two categories : direct and indirect.

In direct sensors, the end of the fiber is bare simply inserted into the sampling region.
Indirect sensors incorporate some transducer (called optrode) at the end of the fiber.

In both cases, the optical fibers are the vehicles for transmitting the light into the body and
back again. The major advantage of optical fibers is that they enable measurements to be
made inside the human body (even inside the heart or other major organs).
Fiber optic sensors can be broadly divided into physical and chemical.
Physical sensors respond to some physical change in the sample such as temperature,
pressure, or flow
Chemical sensors respond to changes that are chemical in nature such as pH or
pCO2,pO2, or glucose content in the blood
4-1) Direct sensors

Direct physical sensors

In conventional diagnostics, several optical methods are useful:

Photometry

Monochromatic light is directed onto tis­sue or blood and the absorption or reflection at this
wavelength is mea­sured.
If this is performed at many wavelengths, the spectral absorption or the spectral reflection of
the sample is obtained.
Such spectra are "fingerprints" of specific compounds in tissue (or in blood).

Fluorometric method

Excitation of luminescence in the sample.

By measuring the excitation spectrum or emission spectrum of the sample, important
information is provided.
Temperature Measurement
Objects
  at temperatures higher than absolute zero emit radiation known as blackbody
radiation.
Emission increases as the temperature increases.
Bodies at room temperature emit mainly in the far infrared.
As the temperature rises, more and more emission appears in the near infrared and finally
in the visible.
For biological tissue, the total emission is dependent only on the temperature T.
If the IR emission is measured, the temperature of the tissue can be determined.

Radiometer systems used for measuring tempera­ture by way of IR emission depend on a

line of sight between the warm surface and the IR detector.
Sometimes no such line of sight exists
transmit the IR emission from a warm body to a detector via an infrared-transmitting
fiber.

The fiberoptic radiometry system consists of an infrared detector and a flex­ible IR fiber.

Fiber­optic radiometer is capable of measuring temperature with a resolution greater than

0.1°C.
With fiberoptic radiometry the fibers can be introduced through an endo­scope, in order to
monitor and control tissue temperature during endoscopic laser surgery or laser welding.
 Laser Doppler Velocimetry (LDV)

Cardiologists need to measure blood supply to the heart in order to know if the coronary
arteries are blocked and to what degree.
Flow: volume of fluid that passes through the end of the tube per unit time. (cm 3/s).
According to the Doppler effect, the change in frequency of the reflected radiation is a
function of the targeted object's relative velocity.
the velocity of the object can be obtained by measuring the change in frequency of the
reflected laser light.
LDV can be used with fiberoptic systems.
The only difference is that the incident and reflected laser beams are sent through optical
fibers, rather than through air.
The method is then called fiberoptic LDV or FOLDV.
 A fiber is inserted into a blood vessel.
 The laser beam interacts with a small volume of blood near the distal end of the fibers.
 The light scattered back from the flowing blood cells is collected and transmitted back.
 This scattered light is shifted in frequency (with respect to the regular frequency of the
laser) because of the Doppler effect.
 The frequency shift is proportional to the velocity.
If a cardiologist is interested in determining the blood flow in a diseased coronary artery, an
ultrathin angioscope can be threaded into the artery and positioned next to the blockage
under observation.
Direct chemical sensors
Oximetry
Oxygen in the blood is carried by the hemoglobin in red blood cells.
Oxygen saturation is the ratio (in percent) between the oxygen content in a blood sample
and the maximum carrying capacity.
The blood in the arteries should be more than 95% saturated and that in veins about 75%
saturated.
Optical methods can be used to monitor the oxygen saturation, based on different optical
properties of saturated and desaturated hemoglobin.
The optical absorption spectrum and the optical re­flection spectrum are different for each.

There is a large difference between deoxyhemoglobin and oxyhemoglobin in reflection of light

in the red part of the spectra, in particular at λ = 660 nm.
On the other hand, there is little difference at 805 nm.

Light at 660 nm and 805 nm (from a diode laser) is

sent through an optical fiber.

The intensity of light scattered back from blood is

measured for the two wavelengths.

The ratio I660/I805 is used to determine the oxygen

saturation in blood.
Fiberoptic Laser-Induced Fluorescence
By studying the complete spectrum (the excitation and emission spectra) of a tissue, it is
possible to obtain information about the pathology of the tissue

Cancer:

The auto-fluorescence emitted by healthy tissue is different from that of cancerous tissue in
both the spectral emission and the temporal behavior.
Such differences may be used to detect cancer endoscopically.

Cardiology:
In order to deal with plaque blockages inside the arteries, the plaque must be identified
during endoscopic imaging.
The intrinsic auto-fluo­rescence spectrum of plaque can be compared to that of the normal
blood ves­sel wall.

Dentistry:
The luminescent emission from a healthy tooth is different from that emitted by a tooth with
caries.
When excited at 480 nm, the carious areas absorb more than non-carious areas and
also emit more red light.
Analysis of the emitted light signal can thus reveal whether the tooth is healthy or not.
Similar fiberoptic methods have been applied inside the tooth to determine the state of the
root canals
4-2) Indirect sensors
For indirect sensors, a miniature transducer is attached to the distal tip of one or two
fibers (a miniature chemical/physics laboratory).
The optical trans­ducer is called an optrode
The input light sent through the fiber actuates the transducer, which in turn inter­acts with
the sample.
The output light sent back from the transducer is ana­lyzed by an optical processing
system.

If the optrode is physical in nature, the parameters that can be measured are physical,
such as temperature or pressure.
If it is chemical, the parameters are chemical, such as pH or glucose content in the
blood.

Indirect physical sensors

Various indirect sensors have been developed for measuring :

 fluid pres­sure (P),

 tissue temperature (T),
 blood velocity,
 blood flow.
 Pressure Sensors
Fiberoptic pressure sensors are suitable for pressure
measurement inside the body.

Most of these sensors are based on the simple principle

shown sche­matically in the front figure

A mechanical optrode is attached to the distal tip of a

fiber(or a bundle of fibers).

The optrode is inserted in a liquid, whose pressure is P.

Light is sent through a fiber and reflected from the

optrode.

When the optrode is exposed to higher pressure, the

membrane is displaced or curved and a different amount
of light is reflected back.

There is a correlation between the amount of light

reflected through the fiber and the pressure Ρ of the
liquid.

The reflected light can be measured by a photodetector

and this value is then related to the pressure.
Temperature Sensors

 Fiberoptic indirect temperature sensors are based on optrodes in which some physical
property changes as a function of temperature.

Liquid crystal optrodes

Liquid crystals (LSs) show a dramatic change in color in response to a temperature change.
LCs are used in inexpensive (or disposable) thermometers, in which the temperature is
shown by colored digits.
These LCs were attached to the distal end of an optical fiber and used in the same manner
for measuring temperatures.

Luminescent probe

The luminescence of many materials depends strongly on temperature.

By measuring the lumines­cence emission intensity, temperature can be determined.
The luminescent material is attached to the distal tip of a optical fiber.
UV radiation (pulsed) is sent through the fiber to excite luminescence.
The luminescent material emits visible light that decays with a characteristic time constant .
The emitted luminescent light is transmitted back through the same fiber
 
can be measured and temperature determined.
Indirect chemical sensors
In this case, the miniature transducers, are sensitive to chemical changes (pH, pO 2 -partial
oxygen pressure-) in the sample of interest (blood).

pH Sensors

In fiberoptic pH probes, an optrode is attached to the distal tip of the fiber and is coated
with a thin protective coating.

The coating permits small ions, such as hydrogen ions, to penetrate and interact with the
optrode but keeps larger ions out.
When the whole tip is inserted into blood, the interaction with the optrode, through the
coating, gives rise to optical changes which are measured through the fiber.
A common technique for determining pH is based on substances called indi­cators, which
are used to indicate the acidity or alkalinity of a solution by chang­ing color.

The indi­cator changes color depending on the pH, in the phys­iological range of interest
(pH between 7.0 and 7.4).

This effect can be quantified by measuring the optical absorption of the indi­cator (through
an optical fiber).
Light sent through the input fiber is scattered by
the indi­cator.
Part is absorbed by the indi­cator and the rest is
transmitted back through the output fiber.
The amount of light transmitted back depends
on the ab­sorption in the indi­cator.
Two irradiating colors, red (600 nm) and green
(550 nm), from two LEDs are used alternately.

The green light is absorbed by the indi­cator and the amount transmitted is measured by a
small semiconductor photodetector.
This amount depends on the pH.
The red light is not pH depen­dent, serving only to calibrate the system.
The ratio (green)/(red) is a direct measure of the pH.