Background. When locating the sentinel lymph node (SLN), surgeons use state-of-the-art imaging devices, such as a 1D gamma probe or less widely spread a 2D gamma camera. These devices project the 3D subspace onto a 1D respectively 2D space, hence loosing accuracy and the depth of the SLN which is very important, especially in the head and neck area with many critical structures in close vicinity. Recent methods which use a multi-pinhole collimator and a single gamma detector image try to gain a depth estimation of the SLN. The low intensity of the sources together with the computational cost of the optimization process make the reconstruction in real-time, however, very challenging. Results. In this paper, we use an optimal design approach to improve the classical pinhole design, resulting in a non-symmetric distribution of the pinholes of the collimator. This new design shows a great improvement of the accuracy when reconstructing the position and depth of the radioactive tracer. Then, we introduce our Sentinel lymph node fingerprinting (SLNF) algorithm, inspired by MR-fingerprinting, for fast and accurate reconstruction of the tracer distribution in 3D space using a single gamma detector image. As a further advantage, the method requires no pre-processing, i.e. filtering of the detector image. The method is very stable in its performance even for low exposure times. In our ex vivo experiments, we successfully located multiple Technetium 99m (Tc-99m) sources with an exposure time of only one second and still, with a very small L2-error. Conclusion. These promising results under short exposure time are very encouraging for SLN biopsy. Although, this device has not been tested on patients yet, we believe: that this approach will give the surgeon accurate 3D positions of the SLN and hence, can potentially reduce the trauma for the patient.

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We acknowledge the funding of the Werner Siemens Foundation through the MIRCALE (Minimally Invasive Robot-Assisted Computer-guided LaserosteotomE) project. ABSTRACT Today's mechanical tools for bone cutting (osteotomy) lead to mechanical trauma that prolong the healing process. Medical device manufacturers continuously strive to improve their tools to minimize such trauma. One example of such a new tool and procedure is minimally invasive surgery with laser as the cutting element. This setup allows for tissue ablation using laser light instead of mechanical tools, which reduces the post-surgery healing time. During surgery, a reliable feedback system is crucial to avoid collateral damage to the surrounding tissues. Therefore, we propose a tissue classification method that analyzes the acoustic waves produced during laser ablation and show its applicability in an ex-vivo experiment. The ablation process with a microsecond pulsed Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser produces acoustic waves that we captured with an air-coupled transducer. Consequently, we used these captured waves to classify five porcine tissue types: hard bone, soft bone, muscle, fat, and skin tissue. For automated tissue classification of the measured acoustic waves, we propose three Neural Network (NN) approaches: A Fully-connected Neural Network (FcNN), a one-dimensional Convolutional Neural Network (CNN), and a Recurrent Neural Network (RNN). The time-and the frequency-dependent parts of the measured waves' pressure variation were used as separate inputs to train and validate the designed NNs. In a final step, we used Grad-CAM to find the frequencies' activation map and conclude that the low frequencies are the most important ones for this classification task. In our experiments, we achieved an accuracy of 100 % for the five tissue types for all the proposed NNs. We tested the different classifiers for their robustness and concluded that using frequency-dependent data together with a FcNN is the most robust approach.

Background Squamous cell carcinoma in the head and neck region is one of the most widespread cancers with high morbidity. Classic treatment comprises the complete removal of the lymphatics together with the cancerous tissue. Recent studies have shown that such interventions are only required in 30% of the patients. Sentinel lymph node biopsy is an alternative method to stage the malignancy in a less invasive manner and to avoid overtreatment. In this paper, we present a novel approach that enables a future augmented reality device which improves the biopsy procedure by visual means. Methods We propose a co-calibration scheme for axis-aligned miniature cameras with pinholes of a gamma ray collimating and sensing device and show results gained by experiments, based on a calibration target visible for both modalities. Results Visual inspection and quantitative evaluation of the augmentation of optical camera images with gamma information are congruent with known gamma source landmarks. Conclusions Combining a multi-pinhole collimator with axis-aligned miniature cameras to augment optical images using gamma detector data is promising. As such, our approach might be applicable for breast cancer and melanoma staging as well, which are also based on sentinel lymph node biopsy.