Method and system for differentiating stone from tissue using laser

Abstract

This disclosure provides a method and system for distinguishing stones from tissue based on fluorescence from the stone or tissue. Multiple reference beams are projected onto the target to determine the distance to the target. The intensity of the fluorescent excitation beam is measured in conjunction with the determined distance to calculate the emission of the target, and thus, its effective target for a therapeutic laser. If an effective target for the therapeutic laser is detected and a switch is actuated, the therapeutic laser is enabled. If no effective target for the therapeutic laser is detected and the switch is actuated, the therapeutic laser is immediately disabled. The fluorescent excitation beam is pulsed with high intensity and a low duty cycle to avoid blinding the endoscopic imager used during the procedure.

Description

[0001] Cross-references to related applications

[0002] This application claims priority to U.S. Provisional Patent Application Serial No. 63 / 602,122, filed November 22, 2023, the disclosure of which is incorporated herein by reference. Technical Field

[0003] This disclosure generally relates to optical systems and optical fibers for medical or therapeutic laser treatment. In particular, but not exclusively, this disclosure relates to methods and systems for separating urinary tract stones from surrounding tissues. Background Technology

[0004] The introduction of lasers into the medical field and the development of fiber optic technology that utilizes lasers have opened up numerous applications in treatment, diagnosis, therapy, and the like. These applications range from invasive and non-invasive treatments to endoscopic surgery and imaging diagnostics. For example, in the treatment of urinary tract stones, the stones need to be broken into smaller fragments. A technique called laser lithotripsy can be used for this breaking-up process, in which, for small to medium-sized urinary tract stones, a rigid or flexible ureteroscope is placed through the urethra for illumination and imaging. Simultaneously, an optical fiber is inserted through the working channel of the ureteroscope to the target location (e.g., the location of the stone in the bladder, ureter, or kidney). The laser is then activated to break the stone into smaller fragments or grind it into powder. In another instance, laser and fiber optic technology are used in coagulation or ablation treatments. During ablation, a laser is delivered to the tissue to vaporize it. During coagulation, the laser is used to induce thermal damage within the tissue. This type of ablation therapy can be used to treat a variety of clinical conditions, such as benign prostatic hyperplasia (BPH), cancers (such as prostate cancer, liver cancer, lung cancer, etc.), and heart disease by ablating and / or coagulating a portion of the heart.

[0005] These treatments using laser and fiber optic technologies require high precision to ensure the laser is aimed at the correct target (stones, tissue, tumors, etc.) to achieve clinical goals such as tissue ablation, coagulation, stone fragmentation, and pulverization. However, visibility is often reduced during laser lithotripsy procedures due to turbid water conditions. This lack of visibility in the treatment environment can cause doctors to mistakenly aim the laser at (or activate) tissue instead of the stone, resulting in unnecessary damage to the patient's tissues. Therefore, it is essential to distinguish between tissue and stones.

[0006] Techniques for distinguishing tissue from stones include using an excitation beam at a wavelength in which the stone fluoresces more than the surrounding tissue. Summary of the Invention

[0007] This summary is provided to present selected concepts in a simplified form, which will be further described in the detailed description below. This summary is not intended to require identification of key or essential features of the claimed subject matter, nor is it intended to help determine the scope of the claimed subject matter.

[0008] This disclosure provides designs, materials, manufacturing methods, and alternatives for using medical devices and medical systems. In a first example, the system includes: a first laser source for generating a first reference laser beam at a first wavelength and a second reference laser beam at a second wavelength; a second laser source for generating a fluorescence-excited laser beam at a third wavelength; an optical fiber having a distal end and a proximal end, the optical fiber being configured to receive laser light from the first and second laser sources at the proximal end, emit laser light at the distal end, and receive reflected laser light into the distal end; a reference photodetector for measuring the intensity of reflected light at the first and second wavelengths; a fluorescence detector for measuring the intensity of light emitted as fluorescence from a target at a fourth wavelength in response to the emission of the fluorescence-excited laser beam; and a processor and a memory including instructions that, when executed by the processor, cause the processor to determine a distance from the distal end of the optical fiber to the target based on the measured intensity of reflected light at the first and second wavelengths, and to determine whether the fluorescence of the target is greater than or equal to a threshold fluorescence based on the determined distance and the measured intensity of fluorescence at the third wavelength.

[0009] As an alternative to or supplement to any of the above examples, the first wavelength may have a first water absorption coefficient that is higher than the second water absorption coefficient of the second wavelength.

[0010] As an alternative to or supplement to any of the above examples, the ratio of the first water absorption coefficient to the second water absorption coefficient may be at least 2 to 1.

[0011] As an alternative to or supplement to any of the above examples, the wavelength can be approximately 200 nm to 700 nm.

[0012] As an alternative to or supplement to any of the above examples, when executed by a processor, the instructions also cause the processor to calculate the ratio of the intensity of the first wavelength to the intensity of the second wavelength. The distance between the far end of the optical fiber and the target can be determined based on the ratio of the first intensity to the second intensity.

[0013] As an alternative to or supplement to any of the above examples, the system includes a third laser source for generating a therapeutic laser beam of a fifth wavelength. When executed by the processor, the instructions also cause the processor to generate the therapeutic laser beam of the fifth wavelength from the third laser source and to stop the therapeutic laser beam based on determining that the fluorescence of the target is below a threshold.

[0014] As an alternative to or supplement to any of the above examples, the system includes a switch, and the processor generates a therapeutic laser beam in response to actuation of the switch. When executed by the processor, instructions also cause the processor to stop the therapeutic laser beam based on the release of the switch.

[0015] As an alternative to or supplement to any of the above examples, when executed by the processor, the instructions also cause the processor to compare the calculated distance with a threshold distance and stop the treatment laser beam based on determining that the calculated distance is greater than the threshold distance.

[0016] As an alternative to or supplement to any of the above examples, the second laser source has an activation and deactivation time of less than 10 seconds. A rapidly excitation laser source.

[0017] As an alternative to or supplement to any of the above examples, the system includes systems with switching times of less than 1 High-speed optical switch.

[0018] As an alternative to or supplement to any of the above examples, the system includes an optical chopper configured to block the aiming beam for more than 99% of the time during system operation.

[0019] In another example, a method includes the following steps: determining a first intensity value based on a first reflected laser corresponding to a first wavelength of laser light, wherein the first wavelength of laser light exits from the distal end of an optical fiber, and the first reflected laser light is reflected by a target and enters the distal end of the optical fiber; determining a second intensity value based on a second reflected laser corresponding to a second wavelength of laser light, wherein the second wavelength of laser light exits from the distal end of an optical fiber, and the second reflected laser light is reflected by a target and enters the distal end of the optical fiber; determining a third intensity value of a corresponding fluorescent laser light corresponding to a fourth wavelength of laser light, wherein the third wavelength of laser light exits from the distal end of an optical fiber, and the fluorescent laser light is excited by the third wavelength of light from a target and enters the distal end of the optical fiber; calculating a ratio of the first intensity value to the second intensity value; determining a distance between the distal end of the optical fiber and the target based on the calculated ratio; and determining whether the calculated emission of light from the target is greater than a threshold emission based on the determined distance and the third intensity value.

[0020] As an alternative to or supplement to any of the above examples, the method further includes the step of stopping the fifth wavelength therapeutic laser in response to determining that the calculated emission of the target is less than a threshold emission.

[0021] As an alternative to or supplement to any of the above examples, a third wavelength of laser light can be emitted at less than 10 ms. The duration.

[0022] In another example, an endoscopic surgical system includes a LETD (Light Transmission and Detection) system having a first laser source for generating a first reference laser beam at a first wavelength and a second reference laser beam at a second wavelength, a second laser source for generating a fluorescence-excited laser beam at a third wavelength, a reference photodetector for measuring the intensity of reflected light at the first and second wavelengths, and a fluorescence detector for measuring the intensity of light emitted from the target in fluorescence at a fourth wavelength in response to the emission of the fluorescence-excited laser beam. The endoscopic surgical system also includes an endoscopic probe comprising an optical fiber and an imager, the optical fiber having a distal end and a proximal end, the optical fiber being configured to receive laser light from the first and second laser sources at the proximal end, emit laser light from the distal end, and receive reflected laser light into the distal end; and a processor and a memory including instructions that, when executed by the processor, cause the processor to determine a distance from the distal end of the optical fiber to the target based on the measured intensities of reflected light at the first and second wavelengths, and to determine whether the fluorescence of the target is greater than or equal to a threshold fluorescence based on the determined distance and the measured fluorescence intensity at the fourth wavelength.

[0023] These and other features and advantages of this disclosure will become apparent from the following detailed description, the scope of which is set forth in the appended claims. Attached Figure Description

[0024] To facilitate identification of any discussion of an element or action, one or more of the most significant digits in the reference number refer to the figure number in which the element was first introduced.

[0025] Figure 1 A system according to at least one embodiment is shown.

[0026] Figure 2 The illustration shows an embodiment according to at least one of the embodiments. Figure 1 It is part of the system.

[0027] Figure 3A and Figure 3B A LETD according to at least one embodiment is shown.

[0028] Figure 4 It is a flowchart depicting a process for distinguishing stones from tissue according to at least one embodiment.

[0029] Figure 5 It is a flowchart depicting a process for automatically adjusting the parameters of a medical laser console based on an evaluation target, according to at least one embodiment.

[0030] Figure 6 It is a flowchart depicting a process for automatically stopping laser emission according to at least one embodiment.

[0031] Figure 7 It is a flowchart depicting a process for automatically initiating laser emission according to at least one embodiment.

[0032] Figure 8 Another system according to at least one embodiment is shown.

[0033] Figure 9 Another system according to at least one embodiment is shown.

[0034] Figure 10 A computer-readable storage medium according to at least one embodiment is shown.

[0035] Figure 11 A computing system according to at least one embodiment is shown. Detailed Implementation

[0036] This disclosure provides a method and system for distinguishing stones from tissue based on reflected light from the stone or tissue. It should be understood that the efficiency of laser treatment generally depends on the relative position and orientation of the fiber tip relative to the target. Furthermore, patient safety typically depends on the accurate aiming of the distal end of the fiber at the intended target. For example, when a stone is the intended target, unintentional activation of the laser while aiming at tissue can damage the tissue. This can lead to unnecessary complications, and in some cases, it can cause permanent tissue damage, potentially causing dysfunction in certain parts of the subject's body. Additional negative effects may occur when therapeutic laser energy is released off-target, including damage to one or more surgical instruments and / or unnecessarily increasing the temperature of the surgical environment.

[0037] This method involves illuminating a target with lasers of different wavelengths, having low and high water absorption coefficients, using different laser sources via a Light Emitting Transmission and Detection (LETD) system. The wavelengths are chosen such that they are close to each other and belong to the same "nm scale." Furthermore, the LETD system receives return signals corresponding to the different wavelengths of incident laser light. The return signals consist of the beams reflected from the target after illumination. One or more photodetectors configured within the LETD system can detect the return signals to measure the intensity value of the return signal at a specific wavelength. Using the measured intensity value, a controller can determine the distance to the target.

[0038] The LETD system also utilizes a fluorescent excitation beam to illuminate the target. This beam has a shorter wavelength, resulting in significantly higher fluorescence excitation at this wavelength compared to surrounding tissue, and consequently, significantly higher detectable luminescence in the target (such as urinary tract stones). Based on the measured luminescence and the determined distance, the controller can distinguish between tissue and a stone.

[0039] This disclosure utilizes the described LETD system in various configurations, including different arrangements of various optical components such as beam combiners, beam splitters, polarizers, collimators, wavelength division multiplexers (WDM), photodetectors, and similar devices. This disclosure also enables accurate determination of whether the laser is incident on a stone or tissue and is compatible with different types of targets. Furthermore, this disclosure can be used for the purpose of controlling and / or adjusting one or more operating parameters. For example, during treatment, the target may move back and forth or otherwise, or its shape, size, composition, pigment, and color may change. Therefore, preset laser source parameters before initiating laser emission onto the target may become ineffective. Traditionally, these preset parameters are changed manually, which can be error-prone and time-consuming, or in some cases, the preset parameters may remain unchanged, potentially leading to scenarios where the fiber is too close or too far from the target. Therefore, this disclosure allows for automatic and real-time monitoring of the distance between the fiber tip and the target, regardless of whether the laser is incident on a stone or tissue, and also enables automatic adjustment of preset laser parameters based on the target's shape, position, etc., to adjust laser emission and provide a greater likelihood of achieving the desired or therapeutic outcome.

[0040] The foregoing has provided a general overview of the features and technical advantages of this disclosure in order to better understand the following detailed description. Those skilled in the art will understand that the disclosed embodiments can be readily used as the basis for modifications or the design of other structures to achieve the same objectives of this disclosure. The novel features of this disclosure, in both its organization and manner of operation, along with further objectives and advantages, can be better understood from the following description when considered in conjunction with the accompanying drawings. However, it should be clearly understood that each drawing is provided for illustrative and descriptive purposes only and is not intended to be a definition of limitation of this disclosure.

[0041] Figure 1 An exemplary system 100 for estimating the distance between an optical fiber tip and a target and / or distinguishing tissue from stones, according to some embodiments of the present disclosure, is illustrated. In some embodiments, the exemplary system 100 includes an endoscope probe 102 having an imager 104 and an optical fiber 106, a controller 108, a light transmission detection (LETD) system 110, and a display device 112.

[0042] like Figure 2 As depicted more fully in the figure, optical fiber 106 includes a proximal end 202 and a distal end 204. The proximal end 202 is the end of optical fiber 106 through which the light beam 206 enters, while the distal end 204 is the end of optical fiber 106 through which the light beam 206 is emitted and can be guided to the target 208. For example, the figure depicts the light beam 206 entering optical fiber 106 at the proximal end 202, propagating along the length of optical fiber 106, exiting optical fiber 106 at the distal end 204, and incident on the target 208 from the distal end 204 of optical fiber 106.

[0043] The beam can be a beam guided from a light source (e.g., included in LETD system 110 or a similar system). The light source can be a laser source. As an example, such a laser source can include, but is not limited to, solid-state lasers, gas lasers, diode lasers, and fiber lasers. The beam can include one or more of the following: a targeting beam, a treatment beam, a fluorescence excitation beam, a distance measurement beam, and any other beam transmitted via fiber optic cable 106.

[0044] In various embodiments, the fluorescence excitation beam may include a low-intensity beam transmitted through optical fiber 106 to excite target fluorescence radiation to estimate the target type. In some embodiments, the fluorescence excitation beam may be a laser beam with wavelengths in the visible light range. As a specific example, the fluorescence excitation beam may be a "green" laser, such as a laser emitting light with wavelengths of 520 nm, 500 nm to 580 nm, or similar wavelengths. In such embodiments, the fluorescence excited by the light from the fluorescence excitation beam in soft tissue is significantly lower (e.g., at least in part due to differences in chemical composition and molecular structure between soft tissue and urinary tract stones). Therefore, the luminescence of soft tissue will be significantly lower than that of stones.

[0045] In several embodiments, the treatment beam may include a high-intensity light beam transmitted through optical fiber 106 to treat target 208. In some embodiments, different beams may be generated by one or more laser sources. As a specific example, a fluorescence-excited beam may be generated by one laser source, and the treatment beam may be generated by another laser source. In another example, both the fluorescence-excited beam and the treatment beam may be generated by a single laser source. As yet another example, different laser sources may be used to generate beams with different wavelengths, characteristics, and similar properties. This will be described in more detail below (e.g., referring to Figure 3).

[0046] like Figure 1 As shown, optical fiber 106 can communicate optically with LETD system 110 and is arranged to receive a light beam to aim at target 206 and transmit reflected light beams reflected from the surface and surrounding area of ​​target 208. In some embodiments, optical fiber 106 can be optically, mechanically, and / or electrically coupled to LETD system 110 via a port (as shown in other figures herein).

[0047] In some embodiments, the LETD system 110 includes optical components, which may include, but are not limited to, one or more of laser sources, polarizers, beam splitters, beam combiners, photodetectors, wavelength division multiplexers, collimators, and circulators configured in various combinations, as explained in detail in other parts of this disclosure.

[0048] In many embodiments, the laser source is configured to generate laser beams, such as a low-intensity aiming beam for aiming beam 206 at target 206 and a high-intensity treatment beam for treating target 206, and / or beams with different characteristics (e.g., intensity, wavelength, etc.) based on the application. Each laser source can be configured to generate lasers with different wavelengths, wherein each different wavelength may have a different water absorption coefficient. Furthermore, each laser source may have the same aperture or different apertures. In some embodiments, each laser source may be designated for a different purpose; for example, a laser source may be configured to generate an aiming beam and / or a fluorescence-excited beam of a specific intensity, and a laser source may be configured to generate a treatment beam of a specific intensity, and one or more laser sources may be configured to generate beams of a specific wavelength with a specific water absorption coefficient. Additionally, each laser source may be configured to generate polarized laser or unpolarized / depolarized light.

[0049] A polarizer may include optical components that act as filters. For example, a polarizer may be configured to allow beams of specific polarization to pass through while blocking beams of different polarizations. Thus, when an undefined beam of light (or a beam of mixed polarities) is supplied as input to a polarizer, the polarizer provides a well-defined, single-polarized beam as output.

[0050] A beam splitter may include optical components for splitting incident light into two separate beams at a specified ratio. Furthermore, the beam splitter may be arranged to manipulate the light to be incident at a desired angle of incidence (AOI). Therefore, in many embodiments, the beam splitter may be configured primarily with two parameters: the separation ratio and the AOI. The separation ratio includes the ratio of reflection to transmission of the beam splitter (reflection / transmission (R / T) ratio). Thus, as used herein, if the beam splitter's separation ratio is expressed as 50:50, it means that the beam splitter separates the incident beam with a 50:50 R / T ratio. In other words, the beam splitter separates the incident beam by altering the incident light by reflecting 50% and transmitting the other 50%. Furthermore, as an example, if the beam splitter's AOI is indicated as 45 degrees, it means that the beam splitter ensures the beam is incident at a 45-degree angle. Beam splitters may include, but are not limited to, polarized beam splitters and unpolarized beam splitters. Polarizing beam splitters can separate incident light based on S-polarization and P-polarization components, such as by passing the S-polarization component of reflected light and the P-polarization component of transmitted light (or vice versa). In some embodiments, non-polarizing beam splitters can separate incident beams based on a specific R / T ratio while preserving the original polarization state of the incident beam.

[0051] Beam combiners may include partial reflectors, such as those used to combine two or more wavelengths of light by employing the principles of transmission and reflection as explained above. In many embodiments, a beam combiner may be a combination of a beam splitter and a mirror, which perform the function of combining two or more wavelengths of light.

[0052] A photodetector may include a device that detects and / or measures the characteristics of a light beam and encodes the detected and / or measured characteristics into an electrical signal. For example, a photodetector may detect a specific type of light beam (such as a pre-configured one) and convert the light energy associated with the detected light beam into an electrical signal.

[0053] Collimators can include devices that narrow a light beam. To narrow the beam, a collimator can be configured to make the direction of motion more aligned in a particular direction (e.g., parallel rays), or to make the spatial cross-section of the beam smaller. In many embodiments, a collimator can be used to convert diverging light from a point source into a parallel beam.

[0054] A circulator may include a multi-port optics device configured to receive and emit light via a predetermined sequence of multiple ports. For example, a circulator may include a three-port (or four-port, or five-port, etc.) optics device designed such that light entering any one port exits from the next port. In such an example, light entering the first port may exit from the second port, light entering the second port may exit from the third port, and light entering the third port may exit from the first port. Typically, a circulator can be used to allow a light beam to propagate in only one direction.

[0055] It should be noted that when specific parameters are listed for optical components described herein, such as a beam splitter with an R / T ratio of 50:50 and an AOI of 45 degrees, these parameters are provided for a general understanding of the disclosed concepts and are not intended to be limiting. As specific examples, beam splitters with different R / T ratios and / or AOIs than those specified herein may be provided in various embodiments described herein without departing from the scope of this disclosure and claims. In one such example, an AOI of 40 degrees may be employed. In another such example, an R / T ratio of 47:53 may be employed.

[0056] The LETD system 110 is also associated with a controller 108 and / or a communication network (not shown). In some embodiments, the communication network may be a wired communication network or a wireless communication network. The controller 108 may be configured to receive measurements from the LETD system 110 and estimate the distance between the distal end 204 of the fiber optic cable 106 and the target 208 based on the measurements. The controller 108 may also be configured to receive measurements from the LETD system 110 and estimate the type of the target 208 based on the measurements. In some embodiments, the controller 108 may be a separate device with the processing capabilities required for distance estimation and target type estimation. For example, the controller 108 may include circuitry arranged to determine the distance and target type based on electrical signals received from the LETD system 110. As another example, the controller 108 may include circuitry and a memory containing instructions that, when executed by the circuitry, cause the circuitry to determine the distance and target type based on electrical signals received from the LETD system 110. However, in some other embodiments, the controller 108 may be a computing device (such as a laptop, desktop, mobile phone, tablet, and similar computing device) configured to use its processing power to perform distance and target type estimation.

[0057] The controller 108 also receives signals from any number of user interface devices, represented by switches 112. Switches 112 can be any mechanical or electrical interface, such as buttons, pedals, toggle switches, or the like. In some embodiments, switch 112 can be a foot pedal used by the operator of device 100 to release the therapeutic laser. As described herein, multiple pieces of information can be processed by the controller 108 in determining whether and when to activate the therapeutic laser source; whether switch 112 is actuated can be one of these signals.

[0058] Various exemplary configurations for estimating the distance between the fiber optic tip and the target and / or distinguishing stones from tissue are explained in detail below. However, the values ​​and parameters associated with the different optical components used in each configuration explained below should be considered purely exemplary and should not be construed as limiting this disclosure.

[0059] Figure 3A and Figure 3BA LETD system 300 is illustrated, which can be implemented as a LETD system 110 of system 100. According to some embodiments of this disclosure, the LETD system 300 can be configured to estimate the distance between the fiber optic end and a target and / or distinguish between stones or tissue. As depicted, the LETD system 300 includes three laser sources: a reference laser source 302a, a fluorescence-excited laser source 302b, and a therapeutic laser source 302c. In some embodiments, laser sources 302a and 302b can be polarized laser sources. In some embodiments, the multiple beams described herein can be generated by the same laser source; for example, the reference laser source can also generate a fluorescence-excited beam, or the therapeutic laser source can also generate a fluorescence-excited beam.

[0060] The various components of the LETD system 300 (and in particular the laser sources 302a-c) are controlled by a controller 108, which uses the methods described herein to determine when each laser source discharges, the duration of the discharge, and the intensity and frequency of the discharge.

[0061] like Figure 3A As shown, beam 304a emitted by reference laser source 302a is received at wavelength division multiplexing coupler 306 and passes through collimator 308. Beam 304a is split at beam splitter 310; the first branch is processed by attenuator 312 and then enters reference detector 314a. Another branch of beam 304a passes through first dichroic mirror 316a, enters beam combiner 318, and passes through port 320 into fiber 106 and strikes target 208. Figure 3B As shown, light 304a, with the same wavelength as the reference laser beam 304a, returns from the target, passing through fiber 106, port 320, combiner 318, dichroic mirror 316a, and beam splitter 310. The beam 304a is then guided by focusing lens 322a to the return signal detector 314b. The relative intensity measured between the reference detector 314a and the return signal detector 314b is used to calculate the distance between fiber 106 and target 208, as further described herein.

[0062] The reference laser source 302a may be one or more devices capable of emitting light at multiple frequencies to measure the relative intensities described herein. For example, the laser source 302a may generate a first frequency at 1340 nm, representing a higher water absorption rate, and a second frequency at 1310 nm, representing a lower water absorption rate. In the equations below, these are denoted as “HI” and “LO”, respectively.

[0063] Back Figure 3AThe beam 304b emitted by the fluorescently excited laser source 302b is reflected by two dichroic mirrors 318b and 316a before following the same path as the reference beam 304a: it enters the combiner 318, exits the port 320, and hits the target 208 through the fiber optic 106.

[0064] The light from the excitation laser beam 304b can be at least partially reflected from the target 208, while simultaneously exciting fluorescence at a second offset wavelength, so that both optical frequencies enter the optical fiber 106, such as... Figure 3B The reflected beam 304bʹ and the fluorescent beam 304bʹʹ are shown. Both beams 304bʹ and 304bʹʹ pass in opposite directions through fiber 106, port 320, combiner 318, and dichroic mirror 316a. Unlike the reference beam 304a, the reflected beam 304bʹ and the fluorescent beam 304bʹʹ are deflected to a second dichroic mirror 316b, which is selected to distinguish them. The second dichroic mirror 316b partially blocks the reflected wavelength of beam 304bʹ (the same wavelength as the excitation laser beam 304b) and allows the fluorescent wavelength of beam 304bʹʹ to pass through. A long-pass filter 324 can be employed along the return paths of the returning beams 304bʹ and 304bʹʹ to ensure that only the fluorescent wavelength is guided through focusing lens 322b to the fluorescent beam detector 314c.

[0065] The therapeutic laser source 302c emits a beam 304c that passes through combiner 318, port 320, and fiber optic 106 to be directed to target 208 for ablation, fragmentation, or similar operations. As further explained, when and whether the therapeutic laser source 302c is activated depends on the assessment of the beam received by detectors 314a-314c.

[0066] In some implementations, the relative intensities of the signals from detectors 314a and 314b can be used to determine the distance between the fiber optic cable 106 and the target 208. The controller 108 can estimate the distance between the distal end 204 of the fiber optic cable 106 and the target 208 based on the measured intensity of the returned signal. In some embodiments, the controller 108 can substitute the measured intensity into Equation 1, as follows:

[0067]

[0068] In Equation 1 above, “R” refers to the target reflectance coefficient, which is affected by the target composition, target color / pigment, target angle, target surface and similar factors; “λ” refers to the water absorption coefficient at a specific wavelength; and “X” refers to the distance between the distal end 204 of the optical fiber 106 and the target 208.

[0069] In Equation 1 above, "X" and "R" are unknown parameters that need to be determined by the controller 108. Therefore, in order to determine the values ​​of "X" and "R", the controller 108 can substitute the two measured intensity values ​​into Equation 1 above to obtain two equations with the substituted measured intensity values ​​and the water absorption coefficients of the corresponding wavelengths. For example, the two equations with the substituted values ​​can be as follows.

[0070]

[0071]

[0072] The controller 108 can further simplify the above-substituted equations 1.1 and 1.2 as follows: use equation 2.1 to calculate the ratio of the measured intensity values ​​obtained for the return signals of two different wavelengths; and use the natural logarithm to determine the distance value as shown in equation 2.2.

[0073]

[0074]

[0075] Therefore, controller 108 can estimate the distance X between the distal end 204 of fiber optic 106 and target 208 by simplifying equations 1.1 and 1.2 as shown above. In equation 2.2 above, "ln" refers to the natural logarithm. In some embodiments, distance X can be measured in millimeters. In some embodiments, when the selected wavelengths are close to each other on the "nm scale," X is the same distance for both wavelengths, and R (target reflection) is almost the same for both wavelengths. In some embodiments, wavelengths can be considered close to each other on the "nm scale" when they are within 250 nm (e.g., 1310 nm and 1340 nm or 1310 nm and 1550 nm). However, in many embodiments, wavelengths with a closer R value can be selected. Thus, 1310 nm and 1340 nm can be selected instead of 1310 nm and 1550 nm. According to some examples of this disclosure, two wavelengths of reference laser source 302a can be arranged to emit light with a wavelength difference of less than 100 nm from each other.

[0076] When using the fluorescence excitation beam 304b to evaluate the fluorescence of target 208, the distance X calculated above can be taken into account. In some embodiments, the measured fluorescence intensity can be corrected by a distance factor as described in Equation 3:

[0077]

[0078] In this equation, NA is the effective numerical aperture of the laser fiber 106, and d is the fiber core diameter. When the distance-corrected fluorescence intensity measured by detector 314c exceeds a threshold, target 208 is identified as a stone, and therapeutic laser 302c can be used. When the intensity is below the threshold, target 208 is identified as a target unsuitable for laser operation, such as patient tissue.

[0079] Figure 4 Flowchart 400 is shown, illustrating an exemplary process for evaluating a target according to this disclosure. The marked steps should be interpreted broadly; for example, deactivation step 416 would also include not stimulating the laser source if it is not already activated. Similarly, activation step 418 would also include maintaining the beam if it is already activated.

[0080] The laser source emits a reference and a fluorescence excitation beam (step 402), and the detector measures the light from these beams and reflected from the target (step 404). The intensity of the reference beam is used to calculate the distance between the laser fiber tip and the target (step 406).

[0081] If the calculated distance is below a certain threshold (the "Yes" branch of decision step 408), the distance value is combined with the intensity of the detected fluorescence frequency to calculate the target's luminescence value (step 410). The distance threshold may depend on factors such as the type of target identified, the imaging capabilities of the endoscope, and surgical parameters. If the calculated distance is greater than the threshold (the "No" branch of decision step 408), the controller 108 will not activate the treatment laser source or will deactivate the source (step 416).

[0082] In some implementations, the controller 108 may also consider calculated distances when determining the intensity of the treatment beam 304c. For example, if the tip of the fiber 106 is calculated to be in contact with the target 208, the treatment laser source 302c may be activated at full power, while if the tip of the fiber 106 is calculated to be considerably far from the target 208, the laser source 302c may be activated at only partial power. These values ​​may be preset based on the target and procedure type, but may also be set by the operator of the device 100.

[0083] At decision step 412, the system compares the calculated target luminescence with a predetermined threshold. This threshold itself can be determined by one or more factors, such as device calibration data and measurement conditions within the patient. If the target luminescence is determined to be consistent with a kidney stone or other valid target ("Yes" branch at decision step 412), and the switch is pressed or otherwise activated ("Yes" branch at decision step 412), the therapeutic laser is activated or maintained (step 418). If any of these conditions are not met, causing the adjusted luminescence to fall below the threshold ("No" branch at decision step 412) or the switch to the off position ("No" branch at decision step 414), the laser source cannot be activated or, if already activated, is cut off (step 416).

[0084] In some implementations, when the emission value is inconsistent with the effective target, but the switch is activated, the operator may see an indication, such as through display 112. In some implementations, processor 108 may lock or otherwise restrict the activation capability of the therapeutic laser until the measured emission exceeds a threshold. In other implementations, while one or more warning indications or safety alarms may be provided to the operator, the system may still allow the deployment of the therapeutic laser based on the operator's judgment.

[0085] The initial intensity of the fluorescent excitation beam 304b is directly related to the signal intensity of the target's luminescence measurement results. Unfortunately, since the fluorescent excitation beam 304b can be visible light, it may negatively affect the operator's ability to observe optical fibers and stones on the imager 104. To address this issue, the fluorescent excitation beam 304b can be pulsed intermittently and with a very low average intensity (the average intensity detected by the human eye and endoscopic cameras).

[0086] In some implementations, the laser source 302b can be rapidly excited, so that the source itself can be activated within a set duration (such as 10...). (or similar duration) Activation and deactivation. Strong pulses greater than 5mW with low duty cycles can be used; for example, for duty cycles below 1%, source 302b can be excited for 10... And disable it for 1ms.

[0087] Figure 5 Flowchart 500 is shown, illustrating an exemplary process for automatically adjusting parameters of a medical laser console based on evaluation objectives, according to this disclosure. In some examples, the process shown in flowchart 500 may correspond to the operations performed by controller 108 in steps 416 and / or 418. For example, 108 may implement logic from flowchart 500 to perform the deactivation and activation steps of 416 and 418.

[0088] Flowchart 500 may include step 502 to determine or measure distance and / or fluorescence as described herein. For example, controller 108 may implement a portion of flowchart 400 to determine distance and / or fluorescence as described herein.

[0089] Flowchart 500 may also include step 504 to determine whether to automatically adjust laser emission parameters (e.g., power, repetition rate, pulse width, etc.) based on the determined distance and fluorescence (e.g., as determined in flowchart 400, etc., or similar), and to adjust the laser emission parameters if adjustment is required (e.g., based on distance and / or fluorescence) (e.g., at step 506). Conversely, if laser parameter adjustment is not required, flowchart 500 may return to step 502. That is, flowchart 500 is designed to be executed iteratively during medical procedures.

[0090] Figure 6 The diagram shows a flowchart 600, which illustrates an exemplary process for automatically stopping laser emission based on an evaluation objective according to this disclosure. In some examples, the process shown in flowchart 600 may correspond to the operation performed by controller 108 in step 416 to deactivate laser emission via a medical laser console.

[0091] Flowchart 600 may include step 602 to determine or measure distance and / or fluorescence as described herein. For example, controller 108 may implement a portion of flowchart 400 to determine distance and / or fluorescence as described herein.

[0092] Flowchart 600 may also include step 604 to determine whether target 208 is aligned with the longitudinal axis of the distal end 204 of fiber 106. Or in other words, controller 108 may determine whether target 208 is "in front" of the distal end 204 of fiber 106.

[0093] With the target aligned with the vertical axis of the distal end 204 of fiber 106, the flowchart continues to step 606, where it is determined whether the distance is above a threshold (e.g., similar to step 408).

[0094] If the distance is higher than a threshold or the target is not aligned with the far end of the fiber, the controller 108 may deactivate the laser (e.g., step 416).

[0095] Conversely, if the target is aligned with the vertical axis of the far end of the fiber and the distance is no greater than a threshold, flowchart 600 can return to step 602. In other words, flowchart 600 is designed to be executed iteratively during medical procedures.

[0096] Figure 7The diagram shows a flowchart 700, which illustrates an exemplary process for automatically initiating laser emission based on an evaluation objective according to this disclosure. In some examples, the process shown in flowchart 700 may correspond to the operation performed by controller 108 at step 418 to activate laser emission via a medical laser console.

[0097] Flowchart 700 may include step 702 to determine or measure distance and / or fluorescence as described herein. For example, controller 108 may implement a portion of flowchart 400 to determine distance and / or fluorescence as described herein.

[0098] Flowchart 700 may also include step 704 to determine whether a foot switch (e.g., switch 112 or the like) is active. If the foot switch is active, flowchart 700 may proceed to step 706 and determine whether target 208 is aligned with the longitudinal axis of the distal end 204 of fiber optic cable 106. Alternatively, controller 108 may determine whether target 208 is "in front" of the distal end 204 of fiber optic cable 106.

[0099] If the foot switch is not activated or the target is not "ahead" at the far end of the fiber, flowchart 700 can return to step 702. That is, flowchart 600 is designed to be executed iteratively during medical procedures.

[0100] With the foot switch active and the target located "in front" of the far end of the optical fiber, flowchart 700 may include step 708 to determine if the distance is within the recommended operating range (e.g., 0 to 1 mm or a similar range). If the distance is within the recommended operating range, flowchart 700 may proceed to step 710 to activate laser emission using user-established or user-set parameters (e.g., power, frequency, etc.).

[0101] If the distance is outside the recommended operating range, flowchart 700 can proceed to step 712 to determine if the distance is within the "upper end" of the operating range (e.g., 1 to 2 mm, or a similar range). If the distance is within the upper end of the operating range, flowchart 700 can proceed to step 714 to activate laser emission at a lower power and / or lower frequency than defined by the established user parameters, thereby preventing backscatter. Then, as the distal end 204 of fiber 106 approaches the target 208, the controller can gradually increase the power and / or frequency until the established user-defined parameters are reached.

[0102] like Figure 8 As shown, an optical high-speed switch 802 can be added to the LETD 300 between the laser source 302b and the dichroic mirror 318b. In this embodiment, the laser source 302b itself can remain excited, but the switch operates at a speed of less than 10 ms. The operation is performed based on the conduction time. To fully control the pulse period, the activation time of switch 502 can be less than 1 second. .

[0103] like Figure 9 As shown, an optical chopper 902 can be added to the LETD to replace a high-speed switch. The optical chopper can be, for example, a linear chopper or a wheel chopper known in the art. The chopper can be configured to block the beam 99% of the time, such that the beam can only pass through mirror 318b for 10 seconds per millisecond. .

[0104] In some embodiments, the fluorescence excitation beam duty cycle can be synchronized with the imager 104 of the endoscope probe 102. For example, if the imager 104 is a camera with a frame rate of 60 frames per second, the processor 108 can control LETD to reserve a 1ms window every 16.667ms during which no pulses are received. In other embodiments, the fluorescence excitation beam duty cycle can be independent of the imager timing, but a low duty cycle can reduce the presence of the fluorescence excitation beam in the image to an acceptable level.

[0105] Figure 10 A computer-readable storage medium 1000 is illustrated. The computer-readable storage medium 1000 may include any non-transitory computer-readable storage medium or machine-readable storage medium, such as optical, magnetic, or semiconductor storage media. In various embodiments, the computer-readable storage medium 1000 may include articles of manufacture. In some embodiments, the computer-readable storage medium 1000 may store computer-executable instructions 1002 that are executable by circuitry (e.g., controller 108 or the like). For example, the computer-executable instructions 1002 may include instructions for implementing operations described with respect to the logic flow of flowchart 400, the logic flow of flowchart 500, the logic flow of flowchart 600, and / or the logic flow of flowchart 700. Examples of computer-readable storage medium 1000 or machine-readable storage media may include any tangible medium capable of storing electronic data, including volatile or non-volatile memory, removable or non-removable memory, erasable or non-erasable memory, and writable or rewritable memory, etc. Examples of computer-readable instructions 1002 may include code of any suitable type, such as source code, compiled code, interpreted code, executable code, static code, dynamic code, object-oriented code, visual code, and similar code.

[0106] Figure 11This is a block diagram of a computing environment 1100 including a computer system 1102 for implementing embodiments consistent with this disclosure. In some embodiments, the computing environment 1100 or a portion thereof (e.g., computer system 1102) may include or be included in a laser system (e.g., system 100, LETD 300, controller 108, etc.). Thus, in various embodiments, the computer system 1102 may be used to determine distance and / or fluorescence as described above, and automatically adjust laser parameters and / or start or stop laser emission based on distance and / or fluorescence.

[0107] Computer system 1102 may include a central processing unit (“CPU” or “processor”) 1104. Processor 1104 may include at least one data processor for executing instructions and / or program components to perform user- or system-generated processes. A user may include a person, a person using a device such as those included in this disclosure, or another device. Processor 1104 may include dedicated processing units such as an integrated system (bus) controller, a memory management control unit, a floating-point unit, a graphics processing unit, a neural processing unit, a digital signal processing unit, etc. Processor 1104 may be configured to communicate with input devices 1114 and output devices 1116 via I / O interface 1112. I / O interface 1112 may employ communication protocols / methods such as, but not limited to, audio, analog, digital, stereo, IEEE-1394, serial bus, Universal Serial Bus (USB), infrared, PS / 2, BNC, coaxial, component, composite, digital video interface (DVI), high-definition multimedia interface (HDMI), radio frequency (RF) antenna, S-Video, video graphics array (VGA), IEEE 802.n / b / g / n / x, Bluetooth, cellular (e.g., Code Division Multiple Access (CDMA), High-Speed ​​Packet Access (HSPA+), Global System for Mobile Communications (GSM), Long Term Evolution (LTE), WiMAX, or the like).

[0108] Using I / O interface 1112, computer system 1102 can communicate with input device 1114 and output device 1116. In some embodiments, processor 1104 may be configured to communicate with communication network 1120 via network interface 1110. In various embodiments, communication network 1120 may be used to communicate with remote memory storage device 1106, such as for accessing lookup tables, performing updates, or utilizing external resources. Network interface 1110 can communicate with communication network 1120. Network interface 1110 may employ connectivity protocols, including but not limited to direct connection, Ethernet (e.g., twisted pair 10 / 100 / 1000 Base T), Transmission Control Protocol / Internet Protocol (TCP / IP), Token Ring, IEEE 802.11a / b / g / n / x, etc.

[0109] Communication network 1120 can be implemented as one of different types of networks, such as an intranet or local area network (LAN), a closed area network (CAN), etc. Communication network 826 can be a private network or a shared network, representing a combination of different types of networks that communicate with each other using various protocols, such as Hypertext Transfer Protocol (HTTP), CAN protocol, Transmission Control Protocol / Internet Protocol (TCP / IP), Wireless Application Protocol (WAP), etc. Furthermore, communication network 1120 can include various network devices, including routers, bridges, servers, computing devices, storage devices, etc. In some embodiments, processor 1104 can be configured to communicate with memory storage device 1106 via storage interface 1108. Storage interface 1108 can be connected to memory storage device 1106, including but not limited to memory drives, removable disk drives, etc., using connection protocols such as Serial Advanced Technology Attachment (SATA), Integrated Drive Electronics (IDE), IEEE-1394, Universal Serial Bus (USB), Fibre Channel, Small Computer System Interface (SCSI), etc. Memory drives may also include magnetic drums, disk drives, magneto-optical drives, optical disc drives, redundant arrays of independent disks (RAID), solid-state storage devices, solid-state drives, etc.

[0110] Furthermore, memory storage device 1106 may include one or more computer-readable storage media used in embodiments consistent with this disclosure. Generally, a computer-readable storage medium refers to any type of physical memory where information or data readable by a processor can be stored. Therefore, a computer-readable storage medium may store instructions executable by one or more processors, including instructions for causing one or more processors to perform steps or stages consistent with the embodiments described herein. The term "computer-readable medium" should be understood to include tangible articles and exclude carrier waves and transient signals, i.e., non-transient signals. Examples include random access memory (RAM), read-only memory (ROM), volatile memory, non-volatile memory, hard disk drives, optical disc (CD) ROMs, digital video discs (DVDs), flash drives, magnetic disks, and any other known physical storage media.

[0111] Storage device 1106 can store a collection of program or database components, including but not limited to operating system 1122, application instructions 1124, and user interface elements 1126. In various embodiments, operating system 1122 can facilitate resource management and operation of computer system 1102. Examples of operating systems include, but are not limited to, APPLE® MACINTOSH® OS X®, UNIX®, UNIX-like system distributions (e.g., BERKELEY SOFTWARE DISTRIBUTION® (BSD), FREEBSD®, NETBSD®, OPENBSD, etc.), LINUX® distributions (e.g., RED HAT®, UBUNTU®, KUBUNTU®, etc.), IBM® OS / 2®, MICROSOFT® WINDOWS® (XP®, VISTA® / 7 / 8, 10, etc.), APPLE® iOS®, GOOGLE. TM ANDROID TM BLACKBERRY® OS or similar operating systems.

[0112] Application instructions 1124 may include instructions that, when executed by processor 1104, cause processor 1104 to perform one or more techniques, steps, procedures, and / or methods described herein, such as flushing a location and irradiating a location as outlined herein. For example, when executed by processor 1104, application instructions 1124 may cause processor 1104 to perform method 400, logic flow 500, method 800, and / or method 900.

[0113] User interface element 1126 can facilitate the display, execution, interaction, manipulation, or operation of program components using text or graphical tools. For example, the user interface can provide computer interaction interface elements, such as cursors, icons, checkboxes, menus, scroll bars, windows, widgets, etc., on a display system operatively connected to computer system 1102. User interface element 1126 can be employed by application instructions 1124 and / or operating system 1122 to provide, for example, a user interface that allows a user to interact with computer system 1102. In some embodiments, user interface element 1126 can be integrated with a display (not shown).

[0114] The terms used in this document shall have their common meaning in the relevant field, or the meaning indicated by the context in which they are used, unless otherwise specified.

[0115] References to “one embodiment” or “embodiment” herein do not necessarily refer to the same embodiment, although they may be identical. Unless the context explicitly requires otherwise, throughout the specification and claims, the words “comprising,” “including,” and similar terms should be interpreted in an inclusive sense, rather than an exclusive or exhaustive sense; that is, they mean “including, but not limited to.” Use of singular or plural terms also includes both singular and plural, unless explicitly limited to one or more. Furthermore, the terms “this article,” “above,” “below,” and similar terms as used herein refer to the entire application and not any part thereof. When the word “or” is used in a claim to refer to a list of two or more items, the word covers all of the following interpretations: any one item in the list, all items in the list, and any combination of items in the list, unless explicitly limited to one or the other. Any term not explicitly defined herein has one or more conventional meanings commonly understood by one or more people skilled in the art.

Claims

1. A system comprising: A first laser source is used to generate a first reference laser beam at a first wavelength and a second reference laser beam at a second wavelength. The second laser source is used to generate a fluorescence-excited laser beam of the third wavelength; An optical fiber having a far end and a near end, the optical fiber being configured to receive laser light from a first laser source and a second laser source at the near end, emit the laser light from the far end, and receive reflected laser light at the far end; A reference photodetector is used to measure the intensity of reflected light at the first wavelength and the second wavelength; A fluorescence detector is used to measure the intensity of light emitted from the target in fluorescence at a fourth wavelength in response to the emission of the fluorescence-excited laser beam; and A processor and memory, the memory including instructions that, when executed by the processor, cause the processor to: The distance from the far end of the optical fiber to the target is determined based on the measured intensity of reflected light at the first wavelength and the second wavelength. as well as Based on the determined distance and the measured intensity of fluorescence at the fourth wavelength, it is determined whether the fluorescence of the target is greater than or equal to the threshold fluorescence.

2. The system according to claim 1, wherein, The first wavelength has a first water absorption coefficient that is higher than the second wavelength's second water absorption coefficient.

3. The system according to claim 2, wherein, The ratio of the first water absorption coefficient to the second water absorption coefficient is at least 2 to 1.

4. The system according to any one of claims 1 to 3, wherein, The third wavelength is approximately 200 nm to 700 nm.

5. The system according to any one of claims 1 to 4, wherein, When executed by the processor, the instruction also causes the processor to calculate the ratio of the intensity of the first wavelength to the intensity of the second wavelength. Furthermore, the distance between the distal end of the optical fiber and the target is determined based on the ratio of the first strength to the second strength.

6. The system according to any one of claims 1 to 5, wherein the system further comprises a third laser source for generating a therapeutic laser beam of a fifth wavelength; in, When executed by the processor, the instructions also cause the processor to: The fifth wavelength therapeutic laser beam is generated from the third laser source, and The therapeutic laser beam is stopped based on determining that the fluorescence of the target is below the threshold.

7. The system according to claim 6, further comprising a switch; in, The processor generates the therapeutic laser beam in response to the actuation of the switch, and When executed by the processor, the instruction also causes the processor to stop the therapeutic laser beam based on the release of the switch.

8. The system according to claim 6 or 7, wherein, When executed by the processor, the instructions also cause the processor to: The calculated distance is compared with the threshold distance, and The treatment laser beam is stopped based on the determination that the calculated distance is greater than the threshold distance.

9. The system according to any one of claims 1 to 8, in, The second laser source has an emission intensity greater than 5mW. Furthermore, when executed by the processor, the instruction also causes the optical fiber to receive less than 10 fluorescently excited laser beams per millisecond. .

10. The system according to claim 9, wherein, The second laser source has a value of less than 10. A rapidly excitation laser source with fast activation and deactivation times.

11. The system according to claim 9 or 10, further comprising a switching time of less than 1... High-speed optical switch.

12. The system according to any one of claims 9 to 11, further comprising an optical chopper configured to block the aiming beam for more than 99% of the time during system operation.

13. A method, the method comprising: A first intensity value is determined based on a first reflected laser corresponding to a first wavelength of laser light, wherein the first wavelength of laser light is emitted from the far end of the optical fiber, and the first reflected laser light is reflected by the target and enters the far end of the optical fiber. A second intensity value is determined based on a second reflected laser corresponding to a second wavelength laser, wherein the second wavelength laser is emitted from the far end of the optical fiber, and the second reflected laser is reflected by the target and enters the far end of the optical fiber; A third intensity value of a corresponding fluorescent laser corresponding to a fourth wavelength is determined, wherein the third wavelength laser is emitted from the far end of the optical fiber, and the fluorescent laser is excited from the target by the third wavelength light and enters the far end of the optical fiber. Calculate the ratio of the first strength value to the second strength value; The distance between the distal end of the optical fiber and the target is determined based on the calculated ratio; and Based on the determined distance and the third intensity value, it is determined whether the calculated fluorescence of the target is greater than the threshold fluorescence.

14. The method according to claim 13, wherein the method comprises: In response to determining that the calculated fluorescence of the target is below the threshold fluorescence, the fifth wavelength of the therapeutic laser is stopped.

15. The method according to any one of claims 13 or 14, wherein the method comprises emitting less than 10 lasing wavelengths of the third wavelength per millisecond. The duration.

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