Malignant gliomas are a devastating brain tumor disease with very poor prognosis. Stereotactic biopsy sampling is routinely used in larger neurosurgical centers to confirm the diagnosis of a suspected brain tumor. This procedure is associated with risk of blood vessel rupture as well as false-negative results. Recent investigations suggest a potential of light-based techniques to improve both therapy and diagnosis of GBM. Optical guidance can be utilized to improve the biopsy sampling procedure in terms of safety, reliability, and efficacy. Recording of optical signals (transmission, remission, fluorescence) can be potentially integrated into a biopsy needle for providing optical detection of tumor tissue and blood vessel recognition during the biopsy sampling. Optical signals can also be used for monitoring purposes during photodynamic therapy. Here, fluorescence signals recorded before the treatment indicate the presence and accumulation level of photosensitizer, while photobleaching of the photosensitizer fluorescence during the treatment can be used as a measure of the effectiveness of the therapy. Finally, transmitted light can reveal problematic tissue-optical conditions as well as changes of the optical properties of the treated tissue, which may be relevant with regard to treatment prognosis and strategy. Different optical concepts for interstitial PDT monitoring and optical tissue property assessment are presented.
Objective: Improvement of the clinical outcome of glioblastoma (GBM) patients by employment of fluorescence and
photosensitization on the basis of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX).
Methods: In this report the focus is laid on the use of tumor selective PpIX fluorescence for stereotactic biopsy
sampling and intra-operative treatment monitoring. In addition, our current concept for treatment planning is presented.
For stereotactic interstitial photodynamic therapy (iPDT), radial diffusers were implanted into the contrast enhancing
tumor volume. Spectroscopic measurements of laser light transmission and fluorescence between adjacent fibers were
performed prior, during and post PDT.
Results: PpIX concentrations in primary glioblastoma tissue show high intra- and inter-patient variability, but are
usually sufficient for an effective PDT. During individual treatment attempts with 5-ALA based GBM-iPDT,
transmission and fluorescence measurements between radial diffusers gave the following results: 1. In some cases,
transmission after PDT is considerably reduced compared to the value before PDT, which may be attributable to a
depletion of oxygenated hemoglobin and/or diffuse bleeding. 2. PpIX fluorescence is efficiently photobleached during
PDT in all cases.
Conclusion: iPDT with assessment of PpIX fluorescence and photobleaching is a promising treatment option.
Individualization of treatment parameters appears to bear a potential to further improve clinical outcomes.
Objective: During laser assisted laparoscopic intervention smoke occurs reducing the clear vision to the target. Simply
smoke suction is not possible with respect to deflating / enflating capabilities of the belly. Thus the clinical question arise
if the use of different wavelength may show similar smoke development or whether is it possible to reduce the smoke
development by wavelength selection.
Materials and Methods: Tissue test model was “Bavarian Leberkäse”. A special container set-up was created to collect
the laser induced smoke. Smoke was suctioned through a capillary. The amount of light scattered by the smoke particles
when flowing through this capillary was measured. Ablation parameter was continuous mode and10W at the end of a
400μm bare fibre for the wavelengths 980nm, 1350nm and 1470nm. Additional the optical transmission was measured.
The vaporized tissue volume was measured.
Results: Light scattering, optical parameters and vaporized tissue volume were correlated. Measurement showed
reproducible results. While the time to get first signal of scattered light in case of 1470nm is shorter compared the other
wavelength, the ratio of scatter-signal to ablation rate showed only a trend increase when longer wavelength were used.
Conclusion: Tissue absorbers and carbonized tissue properties are relevant for smoke development resulting in an
increased SI / AR ratio trend. Thus the expert physician in laparoscopic intervention should also be an expert in lasertissue
interaction. Cutting without carbonization gained advantages.
Objective: When a stereotactic biopsy is taken to enable histopathological diagnosis of a suspected brain tumor, it is
essential to i) do this safely, that is not injure a major blood vessel and ii) to obtain relevant vital material from the
tumor. We are investigating the suitability of Indocyanine Green (ICG) fluorescence for blood vessel recognition and 5-
Aminolevulinic acid (5-ALA) induced Protoporphyrin IX (PpIX) fluorescence for identification of proliferative brain
tumor tissue.
Methods: A fiber-optic endoscopic approach was studied to generate and detect both fluorescence signals. PpIX
concentrations in brain tumors have been measured by chemical extraction. Preliminary equipment was studied in a
mouse model.
Results: PpIX-concentrations in glioblastoma tissue showed high inner- and inter-patient variability, but each patient
out of 15 with interpretable data showed at least one sample with a PpIX-concentration exceeding 2.4 μmol/l, which is
easily detectable by state-of-the-art fiberoptic fluorescence spectroscopy and imaging. The imaging fluoroscope with
30,000 pixels resolution could be introduced through a position controlled stereotactic needle. ICG-fluorescence from
vessels with diameters ≥ 0.1 mm can be detected with a contrast of 2-2.5 against surrounding tissue.
Conclusion: Fluorescence detection during stereotactic biopsy might increase safety and precision of the procedure
significantly.
PpIX induced by administration of ALA is being successfully employed for tissue diagnosis and photodynamic therapy (PDT) of, for example, brain malignancies. To guide tissue biopsy by fluorescence during stereotaxy, correct quantification of the PpIX accumulation is required. However, the detected fluorescence intensity and spectral shape are influenced and distorted by the varying optical properties of tissue. Quantitative PpIX measurements thus need to disentangle these effects in order to provide the undistorted, intrinsic fluorescence. Numerous methods for obtaining the intrinsic fluorescence have been developed and optimized for certain fluorochromes. PpIX poses a particular case where excitation and fluorescence are spectrally well separated. Furthermore, the fluorescence appears within the red wavelength region where absorption in tissue is relatively weak.
Here, three experimental approaches towards assessing the intrinsic fluorescence for PpIX in homogeneous phantom materials for four subsets at tissue-like conditions, were tested and compared; 1) single-fiber with diameters 200-800 μm, 2) a two-fiber probe with evaluation based on an empirical ratio between fluorescence and reflectance signals or 3) a multi-fiber probe for combined fluorescence and reflectance measurements with evaluation based on a theoretical model of light propagation. All methods could be realized with an outer probe diameter of less than 1.5 mm, thus applicable during stereotaxy. Method 3 could quantify the PpIX concentration best, regarding all four subsets and thus covering a broad, physiologically relevant range of optical parameters. With accuracies between ± 3.2 % and ± 24.8 % for different subsets it was overall a great improvement to the accuracies resulting from calculations based on a plane wave geometry, which vary from ± 4.6 % to ± 84.3 %.
Protoporphyrin IX (PpIX) displays high tumour-selective uptake following oral administration of 5-aminolaevulinic acid
(ALA), a fact that is being exploited for the fluorescence-guided resection (FGR) and photodynamic therapy (PDT) of
human brain malignancies. A clinical procedure for interstitial PDT (iPDT) has been established including pre-treatment
planning, optical fiber insertion under stereotactic guidance and therapeutic irradiation at non-thermal fluence rates. We
have previously reported on median survival in the range of 15 months and the existence of some intriguing long-term
survivors (>5 years) following iPDT. Such successful treatments rely on for example sufficient light, PpIX and oxygen
levels. We have investigated the absolute PpIX concentration as well as the PDT-induced photobleaching kinetics in
brain tissues. Tissue samples acquired during FGR contained PpIX concentrations up to 28 μM. This observation implies
that ALA-induced PpIX levels are sufficient for inducing PDT effects in viable tumour tissue upon therapeutic
irradiation. However, regions of pre-existing necrosis were characterised by significantly lower photosensitiser levels.
Fluorescence spectroscopy was implemented in parallel to iPDT with the aim to employ PpIX photobleaching as a tool
for realtime treatment supervision and early treatment prognosis.
Bladder cancer (BC) is among the most expensive oncological diseases. Any improvement in diagnosis or therapy
carries a high potential for reducing costs. Fluorescence cystoscopy relies on a selective formation of Protoporphyrin IX
(PpIX) or more general photoactive porphyrins (PAP) in malignant urothelium upon instillation of 5-aminolevulinic acid
(5-ALA) or its hexyl-derivative h-ALA. Fluorescence cystoscopy equipment has been developed with the aim to
compensate for the undesired distortion caused by the tissue optical properties by displaying the red fluorescence
simultaneously with the backscattered blue light. Many clinical studies proved a high sensitivity in detecting flat
carcinoma in situ and small papillary malignant tumours. As a result, recurrence rates were significantly decreased in
most studies. The limitation lies in a low specificity, caused by false positive findings at inflamed bladder wall. Optical
coherence tomography (OCT) is currently being investigated as a promising tool to overcome this limitation.
H-ALA-PDT (8 or 16 mM h-ALA in 50 ml instillation for 1-2 h, white light source, catheter applicator) has recently
been investigated in a phase I study. 17 patients were applied 100 J/cm2 (3 patients received incrementing doses of 25 -
50 - 100 J/cm2) during approx. 1 hour irradiation time in 3 sessions, 6 weeks apart. PDT was performed without any
technical complications. Complete photobleaching of the PpIX-fluorescence, as intended, could be achieved in 43 of 45
PDT-sessions receiving 100 J/cm2. The most prominent side effects were postoperative urgency and bladder pain, all
symptoms being more severe after 16 mM h-ALA. Preliminary evaluation shows complete response assessed at 3
months after the third PDT-session (i.e. 6 months after first treatment) in 9 of 12 patients. 2 of these patients were free of
recurrence until final follow-up at 84 weeks.
A summary of clinical trials employing photodynamic diagnosis (PDD) and photodynamic therapy (PDT) for
the diagnosis and treatment of brain malignancies is presented. Intra-cavity PDT has been performed within
the surgical cavity following FGR, employing oral administration of 5-aminolevulinic acid (5-ALA), either targeting
fluorescing tissue regions that were not removed during FGR due to safety reasons (referred to as focal
PDT, n=20) or illuminating the entire resection cavity (referred to as integral PDT, n=9). Both approaches
proved technically feasible and safe. Spectroscopic measurements performed pre-, during and post-PDT revealed
Protoporphyrin IX (PpIX)-photobleaching of more than 95% after the delivery of 200 J/cm2. This light dose
did not induce any side effects. Furthermore, interstitial PDT (iPDT) has been employed within one feasibility
trial (n=10) and one Phase I/II trial (n=15). Here, three to six cylindrical light diffusors (20-30 mm length,
200 mW/cm, 720 J/cm) were positioned within the target tissue under stereotactic guidance. Pre-treatment
planning was performed with the intent to target the entire tumour volume with a sufficient light dose while
also minimising the risk of any light-induced temperature increase. For the feasibility trial patients with small,
recurrent gliomas were included, resulting in a median survival of 15 months as well as some unexpected longterm
survivals (up to 5 years). The Phase I/II trial employed the same clinical procedures. Here, the 12-month
survival was 35% and the median progression-free survival was 6 months. In summary, stereotactic iPDT in
combination with treatment-planning could be shown to be a safe and feasible treatment modality. These trials
are presently being extended to also include on-line monitoring of PpIX fluorescence and photobleaching kinetics.
Preliminary data has revealed dramatically different PpIX levels and photobleaching kinetics. Such data
could possibly be employed for realtime treatment monitoring and as an early prognostic marker for the PDT
response.
An ex-vivo model was developed for experimental evaluation of endoluminal thermal procedures for the occlusion of saphenous veins. The model consists of the subcutaneous foot vein from freshly slaughtered cows. Using this model primary and acute effects and initial mechanisms on vein vessel could be studied. In this study different energy sources (laser and radiofrequency generator), different energy application parameters (velocity, fluence, fluence rate, temperature) were compared. The dependency of using bare fibre and cylindrical diffusors could be investigated with
respect to the induced effects on the vessels wall. Contraction of the vessels were measured and investigated macroscopically and microscopically as well as by means of optical coherence tomography. As a result an optimized treatment protocol could be developed and discussed with respect to the induced effects.
Motivation: Photodynamic Therapy (PDT) with interstitial light delivery by multiple fibers for the treatment of large tissue volumes requires measurement of sensitizer distribution for dosimetric considerations. For stereotactic interstitial PDT of malignant glioma, for instance, a pre-irradiation comparison of the contrast enhancing tissue volume in MR-imaging with the photosensitized volume as assessed by fluorescence detection is desirable. For PDT of prostate cancer, the quantitative measurement of the selectivity of sensitizer uptake in cancer versus normal prostate parenchyma is important. Methods: It has previously been shown by others that the fluorescence intensity measured by a thin single optical fiber for excitation and detection is largely independent on optical parameters of the tissue that contains the fluorochrome. However, the investigators assumed similar values for excitation and emission wavelengths. This study concerned liquid phantom measurements (absorber: ink or hemoglobin, fluorochrome: Na-fluorescein) and Monte Carlo calculations, with extended conditions, where the absorption differs by a factor of 10 between excitation (426 nm) and emission (530 nm) wavelengths. The absorption coefficient (μa') was varied between 0.01 - 0.3 mm-1 (@ 426 nm), the effective scattering coefficient (μs') between 0.6 - 2.5 mm-1. A 200 μm and a 1000 μm core fiber were used. Results: Fluorescence intensity measured at 530 nm via a thin optical fiber (core diameter small compared to light penetration depth) depends minimally on optical tissue parameters. This result is valid for ink as absorber (μa identical at excitation and emission) as well as for hemoglobin (μa different). Fluorochrome concentration measurements seem possible with a 200 μm core fiber, but not with the 1000 μm core fiber.
Oral application of 20 mg/kg bw of 5-aminolevulinic acid results in a highly specific accumulation of fluorescent and phototoxic Protoporphyrin IX in malignant glioma tissue. Surgical removal with fluorescence guidance is studied in a phase III clinical trial, adjuvant Photodynamic Therapy (PDT) to the surgical cavity is in phase II and for interstitial PDT of recurrent gliomas, a phase I/II study has started. Fluorescence guided resections have been shown to be safe and effective in augmenting neurosurgical removal of malignant gliomas in 52 consecutive patients. Intra-operative fluorescence spectroscopy showed statistically significant higher sensitizer accumulation in vital brain tumor versus the infiltration zone and in the infiltration zone versus adjacent normal brain, which contained very little PPIX. This is promisingly exploited for PDT - both to the surgical cavity by surface irradiation and for stereotactically guided interstitial irradiation.
We report on clinical experiences with photodynamic therapy in patients with recurrent, multifocal superficial transitional cell carcinoma of the urinary bladder. PDT is performed by intravesically applied 5-aminolevulinic acid and a Xe arc lamp as a light source delivering more than 5 Watt white light for activation of 5-ALA induced Protoporphyrin IX. For whole bladder wall irradiation a special irrigation catheter system has been developed. Based on that technology we determined whether this treatment modality was effective in destroying urothelial carcinoma and preventing recurrent disease. The study should help defining the optimal target group of patients and is considered as basis for a long term and multicenter clinical trial.
The initial clinical results indicate that white light photodynamic therapy with 5-ALA is an effective organ-preserving procedure for treating multifocal superficial transitional cell carcinoma of the bladder, even in patients with refractory urothelial carcinoma and is effective in selectively destroying flat neoplastic lesions like carcinoma in situ. None of the patients showed phototoxic skin reactions or loss of bladder capacity.
KEYWORDS: Tissue optics, Tissues, In vivo imaging, Bladder, Diffuse reflectance spectroscopy, Brain, Reflectivity, Monte Carlo methods, Optical properties, Tumors
For many clinical light applications, such as photodynamic therapy (PDT), the therapeutic effect strongly depends on the light dose in a certain tissue depth. A measure for the attenuation and penetration of light in tissue is the optical penetration depth, which is derived from the tissue’s optical properties at a certain wavelength.
Therefore, in vivo measurements to determine the optical properties were performed of the bladder wall (n = 12) and brain tissue (n = 11) on patients undergoing photodynamic therapy. The tip of a 400 μm bare fiber was placed in contact with the investigated tissue, either during open surgery (brain) or through the working channel of a cystoscope (bladder wall). Light of the wavelengths 420-450 nm, 532 nm, and 635 nm was coupled alternately into the fiber. The diffuse backscattered light was detected spatially resolved by means of a CCD camera. Additionally, the total diffuse reflectance of the tissue site was determined, by relating the white light spectra remitted from the tissue to that of a reflectance standard. These two independent measurements were fitted with Monte Carlo simulations. Thus, the reduced scattering and absorption coefficient could be obtained and the optical penetration depth was derived. The presented investigations showed that spatially resolved diffuse reflectance in combination with total diffuse remission provides a valuable method to determine tissue optical properties in vivo. Two human organs were analyzed with this technique and both, bladder wall tissue and brain
tissue showed reproducible results.
The administration of low-level-laserlight for irradiation of the inner ear could represented a new therapeutic model for complex diseases of the inner ear. However, successful therapy requires a well-defined light dosimetry based on a dosimetric analysis of the human cochlea that represents a complex anatomy. The light distribution inside the cochlear windings, produced by an irradiation of the tympanic membrane, was quantitatively measured ex vivo for HeNe laser wavelengths of 593 nm and 633 nm. To obtain the space irradiance within an intact cochlea a correction factor of about 6 has been determined by Monte Carlo calculations. It follows from 3 contributions, first the backscattering of light in the bony parts removed during the preparation procedure of the specimen, second the change of index of refraction from the bony parts to air and third some geometrical factors due to the angular distribution of the radiation. The transmission of light across the tympanic cavity and the promontory depends strongly on the wavelength. Due to the observed spatial intensity variations of a factor 10 and more inside the cochlear windings the optimum external light dose has to be chosen with regard to the tonotopy of the ear.
Photodynamic therapy (PDT) may provide a new approach for treatment of patients with superficial transitional carcinoma and carcinoma in situ of the bladder. The light applicator for the bladder wall (Rusch) is constructed as a balloon catheter with two concentric balloons. A new PDT applicator (Rusch) was assessed for the homogeneity and accuracy of irradiation during PDT. In an in-vitro experiment with 17 freshly harvested porcine bladders the fluence rate was measured locally with isotropic detectors. The results were compared to the light fluence detected by the PDT applicator. The increase of the fluence rate (beta) inside the bladders due to back scattering ranged between 5.3 and 7.0 with an average of 6.2. Local variations of the fluence rate in the spherical bladders were also smaller than 15%. Therefore it is concluded, that a homogeneous and accurate irradiation during PDT is possible. Blood between the outer balloon and the bladder wall reduces the local fluence rate strongly and should to be avoided. Also larger air bubbles in the applicator can lead to an inhomogeneous light distribution. In regular application the presented new catheter system provides accurate and easy light dosimetry during PDT of the bladder. Attention had to be paid to a continuous flushing of the space between balloon and bladder wall in order to prevent the accumulation of urine and blood. To avoid a malfunction of the system and large errors in light dosimetry and application, it is advisable to monitor the measured light dosage and the shape of the balloon using ultrasonography during PDT.
In a clinical pilot study performed on 104 patients suffering from bladder cancer it could be shown that intravesical instillation of a solution of 5-aminolevulinic acid (5-ALA) induces a tumorselective accumulation of Protoporphyrin IX (PPIX). Malignant lesions could be detected with a sensitivity of 97% and a specificity of 67%. The Kr+-laser as excitation light source could successfully be replaced by a filtered short arc Xe-lamp. Its emission wavelength band (375 nm - 440 nm) leads to an efficiency of 58% for PPIX- excitation compared to the laser. Two-hundred-sixty mW of output power at the distal end of a slightly modified cystoscope could be obtained. This is sufficient for recording fluorescence images with a target integrating color CCD-camera. Red fluorescence and blue remitted light are displayed simultaneously. Standard white light observation is possible with the same instrumentation. Pharmacokinetic measurements were performed on 18 patients after different routes of 5-ALA application (oral, inhalation and intravesical instillation). PPIX-fluorescence measurements were made on the skin and on the blood plasma. Pharmacokinetic of 5-ALA could be performed on blood plasma. Endoscopical florescence spectroscopy showed the high fluorescence contrast between tumor and normal tissue with a mean value of 10.7. Forthcoming clinical multicenter studies require an objective measure of the fluorescence intensity. Monte Carlo computer simulations showed that artifacts due to observation geometry and varying absorption can largely be reduced by ratioing fluorescence (red channel of camera) to remission (blue channel). Real time image ratioing provides false color images with a reliable fluorescence information.
Photodynamic therapy (PDT) and photodynamic diagnosis (PDD) add support to efficient treatment modalities of superficial and early stage cancer. Recently 5-aminolevulinic acid (5-ALA), a precursor of hemoglobin in the hem biosynthetic pathway, was used to stimulate endogenous porphyrin production. The time dependency of 5-ALA induced porphyrin fluorescence has been investigated on several normal tissues as well as on a tumor in an in-vivo tumor model (human gastrointestinal adenocarcinoma Grade II, UICC IIa). 5-ALA has been administered intravenously at a concentration of 50 mg/(kg bw). With respect to a certain time schedule the animals were sacrificed and 12 different organs as well as the tumor were removed. Using laser-induced fluorescence techniques the emission spectra in the range of (lambda) equals (550-750) nm were detected from the tissues after excitation with light of the wavelength (lambda) equals (411 +/- 4) nm. For quantitative evaluation the integral fluorescence intensity at (lambda) equals (635 +/- 2) nm of the porphyrin specific spectra has been determined. All tissues showed porphyrin fluorescence, while brightest fluorescence has been detected from the tumor. With respect to the other tissues the relative tumor selectivity showed a maximum ratio at 406 h post injection. The kinetics of the porphyrin fluorescence intensity of the organs follow different time dependencies. Simple mathematical pharmacokinetic models are developed and discussed.
Instillation of a solution of 5-aminolevulinic acid (5-ALA) into the urinary bladder leads to a tumorselective accumulation of fluorescing Protoporphyrin IX (PpIX) within hours. Upon fluorescence excitation using a Kr+- laser, cystoscopy provides high contrast images even of early stage tumors, that are invisible or hardly detectable by routine white light cystoscopy. Fluorescence can simply be judged by naked eyes or recorded with a target integrating camera in real color. Histological and fluorescence data of 91 patients were evaluated statistically, showing a sensitivity of 97% and a specificity of 68% for the detection of dysplastic lesions or malignant tumors. The detectability of a sufficient fluorescence contrast of suspicious versus normal tissue is not affected significantly by either short incubation times of less than 1 hour or prolonged retention times without 5-ALA in the instillation liquid of up to about 6 hours. The fluorescence intensity detected from the tissue surface is not only dependent on PpIX concentration. The additional influence of optical parameters of tissue and fluorochrome distribution on the fluorescence signal was determined using Monte Carlo computer simulations. Results show that 5-ALA induced fluorochrome detection is superior to the detection of fluorochromes that do not exclusively stain the epithelium. Using the ratio of fluorescence intensity to backscattered excitation light corrects for geometrical and absorption effects but would introduce a dependence on the scattering coefficient.
Photodynamic therapy (PDT) of tumors in the urinary bladder requires a homogeneous light distribution on the whole organ wall. The light applicator recently developed consists of a catheter-supported isotropic emitter and a concentric outer balloon, which guarantees a centric position. For dosimetry a detector fiber with conical end is axially placed half way between center and bladder outlet. It detects the light backscattered from the bladder wall. It has been tested by means of a bladder phantom model with variable backscattering properties. To study the limits of this irradiation and dosimetry concept in case of nonspherical bladder shapes the light distributions in hollow ellipsoids with backscattering surface have been investigated by computer simulation. It shows that the ratio of the largest to the smallest fluence rate and the ratio of the largest to the smallest diameter of the bladder are nearly equal.
We developed a Monte Carlo model to estimate the light distribution in tissue. The underlying assumption of the calculation is the knowledge of the microscopic tissue optical parameters. In the simulation we start with a single point illumination in a 3-D multi-layer tissue model. To get the light distribution for extensive irradiation we convolve the `single point solution' with the expanded irradiance profile. The aim of our simulation is the development and design of diverse PDT-applicators for dosimetry reasons and as an inverse method, the calculation of microscopic tissue optical parameters for different tumor samples from ex vivo measurements.
Photodynamic diagnosis (PDD) and therapy (PDT) require light application devices which enable homogeneous illumination of tissue in hollow organs. Three techniques based on modification of the aperture of single fibers are presented mainly for use in urology and pneumology in combination with rigid and flexible endoscopes. All illumination systems allow for nearly entire illumination of the endoscope's viewing field. A microlens system is used for fluorescence diagnostic purposes in the lung. The system, consisting of two plano convex lenses in a condenser configuration, is attached directly to the fiber. The beam profile is optimized by ray tracing calculations. For fluorescence excitation of the tumormarker Photofrin II in the urinary bladder a 500 micrometers plastic fiber is used. The tip of the fiber is polished to a double cone with angles of 12 degree(s) and 7 degree(s). With this modification the aperture is increased by a factor of two. Photodynamic treatment of confined superficial tumors in the lung was successfully performed with a fused silica fiber coupled to the endoscope in a special adaptive device. In this procedure laserlight at 630 nm is guided through the optics channel of rigid endoscopes. A homogeneous circular illumination pattern is obtained following exactly the deflection angle of the endoscope.
In the medical field of laser light application detector systems are required for measuring the light
power applied to the tissue and monitoring instabilities caused by the delivery system during the
application of the laser light.
An isotropic detector was developed consisting of a fiber tip molded to a sphere and covered with
diffuse backscattering layers. The homogeneity of the isotropic detection is 85-90% in an angular field
of
Additionally a monitoring device has been developed which consists of a darkened chamber holding a
part of the fiber bent to a curve. Integrated photodiodes detect the photons "stepping" out of the fiber.
Defects of the fiber, the fiber tip, changes in the medium around the fiber tip, and variations of the
laser output have influences on the detector signal.
Both devices could be useful in evaluating an exact dosimetry for light.
Four ways of optimizing laser-assisted treatments in hollow organs are proposed in this paper: 1 . For
coagulation in axial direction at small irradiation distances fiber tips with enhanced divergence increase
the coagulation volume and reduce vaporization. 2. Circumferentially complete coagulation of
cylindrical organs can be achieved by using a radially radiating probe. 3. Radiators for photodynamic
therapy in cylindrical organs can be constructed and optimized by means of a theoretical scattering
model. 4. Isotropic radiators based on conical fiber tips improve the radiation into the rear hemisphere.
The uniform distribution of light over the area to be photodynamically treated is one of the
prerequisites for a successful tumor therapy. For homogenization of laser light distributions especially in
hollow organs a new method has been developed. It applies fiber coupled emitters in combination with
a highly backscattering layer deposited on the inner wall of the organ to be irradiated. The effect of
homogenization by means of this layer has been calculated for spherical and cylindrical hollow organs
and compared with experimental results. This method also seems to be applicable for organs with
irregular geometry. Laser light applications for different medical fields will be described.
Applying the same method, isotropic light detectors with diameters of less than 1 mm have been
developed for irradiation control during photodynamic treatment or for determination of light
distributions in tissue.
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