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Photonics: Capillary Blood Flow Imaging Within Human Finger Cuticle Using Optical Microangiography
Photonics: Capillary Blood Flow Imaging Within Human Finger Cuticle Using Optical Microangiography
Photonics: Capillary Blood Flow Imaging Within Human Finger Cuticle Using Optical Microangiography
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BIOPHOTONICS
FULL ARTICLE
Capillary blood flow imaging within human finger cuticle
using optical microangiography
Utku Baran 1 , Lei Shi 2 , and Ruikang K. Wang*; 2; 3
1
Department of Electrical Engineering, University of Washington, Seattle, WA, USA
2
Department of Bioengineering, University of Washington, Seattle, WA, USA
3
Department of Ophthalmology, University of Washington, Seattle, WA, USA
Key words: optical coherence tomography, Doppler optical microangiography, ultra-high sensitive optical microangiography,
skin microcirculation, capillary blood flow
BIOPHOTONICS
2 U. Baran, L. Shi, and R. K. Wang: Capillary blood flow imaging within human finger
and connective tissue diseases, e.g., Scleroderma Doppler optical coherence tomography (DOCT)
spectrum disorder (SSD) [4] and systemic sclerosis [19] is based upon OCT combined with LDF. It per-
(SSc) [5]. Typically, capillary abnormalities such as mits the quantitative imaging of fluid flow in highly
dilated vessel loops and/or change in RBC velocity scattering media, for example blood flow beneath
occur as symptoms of these diseases. Hence, an abil- the skin. Doppler optical microangiography (DO-
ity to quantify these abnormalities and their inter-re- MAG) [20] is a technological extension to DOCT, in
lationship would be essential in the clinical studies of which DOCT is combined with OMAG technique to
these conditions. provide highly sensitive velocity mapping of blood
Microvascular changes in morphology and func- flows within tissue beds in vivo. Phase-resolved tech-
tion have been monitored in the skin, particularly in nique [21] is commonly used to calculate the axial
the finger nail-fold area. Laser Doppler imaging flow velocity of the RBC,
(LDI) [6], Laser Doppler flowmetry (LDF) [7], nail- lj
fold capillaroscopy (NC) [8] and nail-fold video ca- Vaxial ¼ ð1Þ
pillaroscopy (NVC) [9] are the main techniques, the 4 pnT
use of which in clinical situation has accumulated a where l is the center wavelength of light source, n is
vast amount of data of dysfunctional cutaneous the tissue refractive index, and j and T are the phase
blood flow responses in patients. However, there are difference and time interval between adjacent A-
still several limitations and disadvantages of these scans, respectively. The maximal and minimal detect-
methods. LDI and LDF techniques are capable of able velocities are determined by the time interval T,
obtaining averaged changes in blood flow within a the p-ambiguity and the system phase noise level
large tissue volume but cannot measure the velocity [21]. Mapping of RBC velocities in human finger cu-
in absolute values [6]. On the other hand, NC and ticle capillaries, which are typically from ~0.3 mm/s
NVC methods can visualize only some of the capil- to 1 mm/s [22], requires relatively long T, i.e. very
laries under the nail-fold, and they fail to provide a slow imaging speed (>20 min. for one 3D scan),
comprehensive outlook of the microvasculature un- which is not practical in actual clinical studies with
der the skin [8, 9]. Additionally, melanin absorbs patients. Moreover, using very slow imaging speed
light strongly in the visible spectrum making highly makes inevitable bulk tissue motion artifacts more
pigmented skin difficult to image with capillaroscopy apparent in the final image, leading to difficulty in
[8]. The recording takes ~2 min or longer depending interpreting the results. Hence, RBC velocity map-
on the patient’s condition [8], and only a limited ping in human finger cuticle capillaries using DO-
number of capillaries can be examined. These lead MAG remains as an important and challenging task.
to subjectivity and make it difficult to measure the Lately, Shi et al. have developed a wide velocity
same set of capillaries of patients at each visit, which range DOMAG technique [23] which is capable of
is crucial for treatment of connective tissue diseases. measuring multiple velocity ranges without requiring
Optical coherence tomography (OCT) has be- a long scanning time by skipping A-scans for DOCT
come a popular technique in determining the micro- processing [24] and benefiting from step-scan strat-
structural composition of biological tissues in vivo egy [25]. However, this technique is currently opti-
and in real time since its introduction in the early mized for mouse cerebral blood flow imaging where
1990s [10]. It provides cross-sectional images of RBC velocity in capillaries is nearly an order of
structure below the tissue surface with axial resolu- magnitude larger than the typical cutaneous capil-
tions of 1–15 mm [11]. The maximum imaging depth laries in human finger.
is limited by optical attenuation and scattering to ap- This work presents a scanning protocol specifi-
proximately 1–3 mm in most cases. cally devised for measuring the directional RBC ve-
Optical micro-angiography (OMAG) is a label- locity in human finger cuticle capillaries by utilizing
free noninvasive imaging and processing method a wide velocity range DOMAG technique [23]. To
used to obtain 3-D blood perfusion map in microcir- the best of authors’ knowledge, this is the first time
culatory tissue beds in vivo using Fourier domain RBC velocity mapping is demonstrated in human
OCT (FD-OCT) [12]. Ultrahigh-sensitive OMAG finger cuticle capillaries using optical microangiogra-
(UHS-OMAG) is a variation of OMAG technique, phy. Moreover, UHS-OMAG with ED algorithm
capable of imaging microvasculature down to capil- [15] is engineered to visualize the volumetric micro-
lary level by separating structural tissue from dy- vasculature in human finger cuticle with a resolution
namic scatters (e.g., moving red blood cells within high enough to delineate capillary loops.
patent vessels) using magnitude subtraction, phase- The proposed imaging modality provides several
compensated subtraction [13, 14] or eigendecomposi- advantages over alternative methods. Ability to im-
tion (ED) based [15] OMAG algorithms. It has been age large number of capillaries in one 3D scan helps
applied to visualize micro-vasculature in various liv- decrease subjectivity and locate the same set of ca-
ing tissue samples such as retina [14], cerebral [16], pillaries of patients at each visit. Additionally, it en-
renal microcirculation [17] and skin [18]. ables imaging cutaneous microcirculation at different
J. Biophotonics (2013) 3
depths up to 1.5 mm within human finger nail-fold metric scanner (Thorlabs Inc.) is characterized to
area, independent of patient’s skin characteristics, find the most stable operation region by calculating
which is not possible with other methods. The pro- the CD between the A-lines for various time points
posed approach is promising to facilitate clinical [23]. For the system used, the most stable time peri-
trials of treatment for various diseases that lead to od is found to be between 0.25–1.2 seconds after
capillary abnormalities, which have so far relied on moving to a next step, and the camera is triggered
inaccurate and/or limited outcome measures. only in this time frame of each step to capture A-
scans. Each B scan had 1.5 mm span over the sample
consisting of 5000 A-lines by acquiring 25 A-lines at
each 200 discrete steps. In the elevational direction,
2. System and methods there were 200 B scans along ~1.2 mm. Hence the
data cube of each 3D image (C scan) was composed
A fiber-based SD-OCT system similar to previously of 1024 by 5000 by 200 (z–x–y) voxels, which took
described in [11] is used for the experiments. The ~6.7 min to acquire, capturing 200 B-frames with
system used an extended broadband superlumines- 0.5 fps imaging speed. During this time, the volun-
cent diode (Thorlabs Inc.) as the light source, which teer sit on a chair with his elbow supported on the
has the central wavelength of 1340 nm and band- imaging table and his finger is gently fixed in a
width of 110 nm that provided a ~7 mm axial resolu- holder arranged to fit. The stage is tilted 20 with
tion in the air. In the sample arm, a 10X objective respect to table to have detectable axial component
lens with 18 mm focal length was used to achieve lat- (relative to top view) of the RBC velocity. Images
eral resolution of ~7 mm. The output light from the are obtained by Doppler processing of complex sig-
interferometer was routed to a home-built spectro- nals among A-lines. Phase variance mask is used to
meter, which had a designed spectral resolution of separate Doppler flow signals from noisy phase
~0.141 nm that provided a detectable depth range of background. Post-processing time took ~15 minutes
~3 mm on each side of the zero delay line. The line using commercial software MATLAB.
rate of the InGaAs linescan camera (Goodrich Inc.) Furthermore, UHS-OMAG technique [14] is en-
was 92 kHz. The system had a measured dynamic gineered with a separate scanning protocol to visua-
range of 105 dB with the light power of 3.5 mW at lize the volumetric microvasculature in the same
sample surface. The operations for probe beam scan- area. For UHS-OMAG, each frame (B scan) consists
ning, data acquisition, data storage and hand-shaking of 300 A-lines over 1.5 mm span with imaging rate
between them were controlled by a custom software of 240 fps. In the elevational direction, there were
package written in Labview. total number of 1920 B scans along ~1.2 mm with
Wide velocity range DOMAG method relies on a 8 repetition in each location. Hence the data cube of
step-scanning protocol with repeated A-scans at each 3D image was composed of 1024 by 300 by 240
each step [23]. Performing DOCT processing be- (z–x–y) voxels, which took ~8 s to acquire. More-
tween adjacent A-scans in the data set provides axial over, ~7 mm lateral and axial resolutions are good
velocity mapping of blood flows within tissue bed in enough to differentiate the arteriole-end capillary
vivo. In addition, selected numbers of A-scans can from venule-end capillary. ED-based clutter filtering
be skipped during processing to increase the time in- algorithm [15] is implemented in MATLAB to sup-
terval, T, between processed A-scans. This enables press the effect of tissue motion and reveal micro-
to obtain multiple velocity ranges without a signifi- vasculature, which took ~3 minutes to post-process.
cant impact on the scanning time (Eq. (1)). Slower
velocity ranges can be acquired by skipping larger
number of A-scans. However correlation degree
(CD) between A-scans, which should be high for ac- 3. Results and discussion
curate imaging, diminishes as skipped A-scan num-
ber increases [23]. Considering this trade-off, skip- Human finger cuticle with 1.5 1.2 mm2 area, de-
ping three A-scans is decided to be the most picted in Figure 1(a), is imaged to obtain RBC velo-
effective strategy to speed up the imaging without city mapping. The majority of the microvasculature in
sacrificing from high correlation degree between A- the skin resides in the papillary dermis 1–2 mm below
scans. The imaging rate was adjusted at 0.5 frames the surface of the skin where capillaries range in
(B-scan) per second (fps) which gives long enough T diameter from 10 mm to 35 mm [26]. The cuticle, which
for capturing RBC axial velocities in capillaries with is also called the eponychium, is a barrier layer be-
a corresponding axial velocity range of 0.9 mm/s tween the skin and the nail plate fusing these struc-
and 0.3 mm/s when one and three A-lines are tures together. Its supply and waste disposal is carried
skipped, respectively (Eq. (1)). out by RBCs travelling within loop-shaped capillaries.
CD is also affected by the mechanical stability of Imaging this area is favorable because of thin epider-
the scanner used in B-scan. Hence, the galvano- mis layer compared to other areas in nail-fold region.
BIOPHOTONICS
4 U. Baran, L. Shi, and R. K. Wang: Capillary blood flow imaging within human finger
J. Biophotonics (2013) 5
BIOPHOTONICS
6 U. Baran, L. Shi, and R. K. Wang: Capillary blood flow imaging within human finger