We review the current state-of-the-art of diffuse optical imaging, which is an emerging technique for functional imaging of biological tissue. It involves generating images using measurements of visible or near-infrared light scattered across large (greater than several centimetres) thicknesses of tissue. We discuss recent advances in experimental methods and instrumentation, and examine new theoretical techniques applied to modelling and image reconstruction. We review recent work on in vivo applications including imaging the breast and brain, and examine future challenges.

The desire for a diagnostic optical imaging modality has motivated the development of image reconstruction procedures involving solution of the inverse problem. This approach is based on the assumption that, given a set of measurements of transmitted light between pairs of points on the surface of an object, there exists a unique three-dimensional distribution of internal scatterers and absorbers which would yield that set. Thus imaging becomes a task of solving an inverse problem using an appropriate model of photon transport. In this paper we examine the models that have been developed for this task, and review current approaches to image reconstruction. Specifically, we consider models based on radiative transfer theory and its derivatives, which are either stochastic in nature (random walk, Monte Carlo, and Markov processes) or deterministic (partial differential equation models and their solutions). Image reconstruction algorithms are discussed which are based on either direct backprojection, perturbation methods, nonlinear optimization, or Jacobian calculation. Finally we discuss some of the fundamental problems that must be addressed before optical tomography can be considered to be an understood problem, and before its full potential can be realized.

The overwhelming scatter which occurs when optical radiation propagates through tissue severely limits the ability to image internal structure using measurements of transmitted intensity. A broad range of methods has been proposed during the past decade or so in order to improve imaging performance. Direct methods involve isolating an unscattered or least-scattered component of transmitted scattered light. Indirect methods generally involve measuring some characteristic of the temporal distribution of transmitted light, or an equivalent in the frequency domain, and obtaining a computational solution to the inverse problem. In this paper, we review the experimental techniques which have been proposed in order to explore both direct and indirect imaging. The relative merits and limitations of the various experimental methods are discussed, and we consider the future directions and likelihood of success of optical imaging in medicine.

For the first time, three-dimensional images of the newborn infant brain have been generated using measurements of transmitted light. A 32-channel time-resolved imaging system was employed, and data were acquired using custom-made helmets which couple source fibres and detector bundles to the infant head. Images have been reconstructed using measurements of mean flight time relative to those acquired on a homogeneous reference phantom, and using a head-shaped 3D finite-element-based forward model with an external boundary constrained to match the measured positions of the sources and detectors. Results are presented for a premature infant with a cerebral haemorrhage predominantly located within the left ventricle. Images representing the distribution of absorption at 780 nm and 815 nm reveal an asymmetry consistent with the haemorrhage, and corresponding maps of blood volume and fractional oxygen saturation are generally within expected physiological values.

A prototype multichannel time-resolved medical optical tomography system is presented, and various instrumental aspects and performance issues are discussed. The instrument has been designed primarily as a continuous bedside monitor for obtaining functional images of premature infants’ brains that are at an increased risk of injury due to dysfunction in cerebral oxygenation or hemodynamics. Separate maps of the internal absorption and scattering properties can be reconstructed from purely temporal measurements of photons transmitted diffusely through the tissue, and without recourse to reference or baseline measurements. The instrument employs 32 source fibers that sequentially deliver near-infrared pulsed laser radiation of picosecond duration. Transit time measurements of very high temporal resolution and stability are made between these sources and 32 detector optodes that are located on the surface. The effectiveness of this instrument is demonstrated by successfully imaging a tissue-equivalent phantom.