Fluorescence imaging system using an operating room lighting device

Abstract

Fluorescence Imaging System Using an Operating Room Lighting Device. The fluorescence imaging system (10) comprises a fluorescence imaging device (14) for detecting fluorescence radiation, and an operating room lighting device (12), including at least one white light source (18) generating white light that includes in its spectrum a first endogenous fluorescence excitation wavelength. For each white light source (18), at least one first removable filtering element (20) is suitable for filtering wavelengths above a first predefined value between 675 and 725 nm, preferably 700 nm. The light source forms a first means for generating fluorescence excitation light. Figure for the abstract: Figure 1

Description

Title of the invention: Fluorescence imaging system using an operating room lighting device

[0001] The present invention relates to a fluorescence imaging system, particularly for surgical application.

[0002] In medicine, fluorescence imaging consists of exciting a substance at certain wavelengths by a light source, so that the substance emits fluorescence radiation which can be captured by a camera and visualized in real time.

[0003] Certain human tissues intrinsically emit (without added fluorescent markers) fluorescent radiation when excited at certain wavelengths; this is called tissue autofluorescence (also known as endogenous fluorescence). The major advantage of autofluorescence imaging is that it is completely non-invasive for the patient (no intravenous or subcutaneous injection of tracer).

[0004] In other cases, a fluorescent marker is injected or ingested, this fluorescent marker being excited to emit fluorescent radiation (this is referred to as exogenous fluorescence).

[0005] Endogenous fluorescence imaging and exogenous fluorescence imaging can provide useful additional information for clinical interpretation.

[0006] For example, during a thyroidectomy, the thyroid gland must be removed while preserving the parathyroid glands, which are generally very close to it. Locating the parathyroid glands is often difficult with the naked eye and requires considerable experience on the part of the surgeon. Autofluorescence of these glands facilitates their localization.

[0007] Thus, some surgeons have been able to demonstrate that the number of post-operative complications decreases when the surgeon secures his procedure using autofluorescence imaging.

[0008] However, autofluorescence imaging only provides information Contextual, namely the potential localization of the parathyroid glands. Indeed, false positives are common due to the fact that many substances are capable of autofluorescence. Autofluorescence imaging therefore primarily serves to limit the number of areas to be analyzed.

[0009] During thyroid dissection, the surgeon also needs functional information: 1) to identify the vessels supplying each of the parathyroid glands in order to avoid damaging them and preserve their function, 2) to verify that the parathyroid glands are well vascularized. Indeed, to ensure tissue viability, it is important to preserve the vessels that supply them. Imaging Autofluorescence alone does not allow observation of irrigating vessels or tissue perfusion. However, it is common practice to use the fluorescence of a marker such as indocyanine green (ICG) to visualize the vascular network that supplies the parathyroid glands.

[0010] It should be noted, however, that once the marker is injected, its powerful fluorescence often overwhelms the weaker autofluorescence of the parathyroid gland, so that the autofluorescence can no longer be seen and used to identify the parathyroid glands.

[0011] It should also be noted that other exogenous fluorescence markers can be used. For example, in nerve fluorescence imaging, there are ALM-488 markers, whose fluorescence is excited between 450 and 520 nm, and emitting between 500 and 600 nm, or ALM-594 markers, whose fluorescence is excited between 500 and 620 nm, and emitting between 600 and 700 nm.

[0012] The invention aims in particular to enable efficient visualization of autofluorescence, in a simple and economical manner.

[0013] To this end, the invention relates in particular to a fluorescence imaging system, comprising:

[0014] - a first means of generating excitation light emitting radiation excitation comprising a first endogenous fluorescence excitation wavelength, and

[0015] - a fluorescence imaging device suitable for detecting radiation of fluorescence,

[0016] characterized in that the imaging system comprises:

[0017] - an operating room lighting device, comprising at least one source of white light generating white light including in its spectrum the first excitation wavelength of endogenous fluorescence and,

[0018] - for each white light source, at least one first filtering element removable suitable for filtering wavelengths above a first predefined value between 675 and 725 nm, preferably equal to 700 nm, the first means of generating excitation light being formed by at least one light source.

[0019] The invention notably provides for the use of at least the white light from an operating room lighting device to excite an autofluorescent tissue. Thus, the fluorescence imaging system includes at least the operating room lighting device, and therefore does not require the imaging device to be equipped with a means for autofluorescence excitation.

[0020] According to other advantageous aspects of the invention, the imaging system comprises one or more of the following features, taken individually or in any technically possible combination:

[0021] - The fluorescence imaging device comprises: - a first means of bandpass filtering, preferably removable, allowing the visualization of wavelengths between a first lower bound and a first upper bound, the first lower bound being between 700 and 750 nm and the first upper bound being between approximately 750 and 900 nm, preferably between 750 and 810 nm, and - preferably, a second removable bandpass filtering means allowing the visualization of wavelengths between a second lower bound and a second upper bound, the second lower bound being between 750 and 810 nm and the second upper bound being between 775 and 900 nm, preferably between 810 and 900 nm.

[0022] - The imaging system includes a first means for generating a light of reinforcement of endogenous fluorescence excitation, for example a Laser or a Light Emitting Diode, emitting excitation radiation having a maximum intensity defined by an excitation wavelength between 600 and 700 nm, the first means of generating excitation reinforcement light preferably being integrated into the operating room lighting device.

[0023] - The white light generated by the white light source includes in its spectrum a second excitation wavelength of exogenous fluorescence.

[0024] - The imaging system includes a second means for generating light from reinforcement of exogenous fluorescence excitation, for example a Laser or a Light Emitting Diode, generating excitation radiation having a maximum intensity defined by an excitation wavelength between 680 and 850 nm, the fluorescence imaging device comprising a filter blocking the wavelength of the second generation means.

[0025] - The second means of generating light is integrated into a chosen device among: the imaging device; the operating room lighting device; or an external device different from the imaging device and the operating room lighting device.

[0026] - The operating room lighting system comprises, for each source of white light, at least one second removable filtering element capable of substantially filtering wavelengths above a second predefined value, the second predefined value being selected between 680 and 850 nm, for example equal to 750 nm, 775 nm, 785 nm or 808 nm.

[0027] - For each white light source, the first and second filtering elements are carried by a wheel, which rotates to bring the first element of filtration, the second filtration element, or at least a third element, opposite the white light source.

[0028] - The wheel is common to several white light sources, and comprises as many of first filtering element and second filtering element than of white light sources corresponding to this wheel, the wheel being sized to bring the same type of filtering element opposite each white light source.

[0029] - The imaging system has at least three operating configurations, namely: - a first operating configuration for the detection of endogenous fluorescence, using the white light source of the operating room lighting device as the first means of generating excitation light, each white light source being filtered by the corresponding first filtering element; - a second operating configuration for the detection of exogenous fluorescence, in particular for the detection of ICG fluorescence; and - a third operating configuration for color imaging.

[0030] - In the first configuration, the first means of generating a light of reinforcement of endogenous fluorescence excitation is activated.

[0031] - In the first configuration, the fluorescence imaging device is filtered to substantially block wavelengths out of the range between approximately a first lower bound and a first upper bound, the first lower bound being between approximately 700 and 750 nm, and the first upper bound being between approximately 775 nm and 900 nm, in particular between 775 nm and 825 nm.

[0032] - In the second operating configuration, each light source white is filtered by the corresponding second filtration element.

[0033] - In the second configuration, the second means of generating light exogenous fluorescence excitation is activated.

[0034] - In the second configuration, the fluorescence imaging device is filtered to block wavelengths above a second upper limit between 775 and 900 nm, preferably between 810 and 900 nm.

[0035] - In the third configuration, the white light sources are not substantially unfiltered, or only filtered using a cold filter to reduce radiant energy.

[0036] - The settings for the first, second and third configurations of The functions are automatically implemented in response to the selection of a first, second, or third operating mode.

[0037] - The adjustments are implemented by rotating at least one of the wheels carrying the filters.

[0038] - The settings are implemented by switching the first means of generation of reinforcement light and / or the second means of generating reinforcement light.

[0039] The invention also relates to a method for detecting endogenous fluorescence, comprising the excitation of an endogenously fluorescent substance by light at a first endogenous fluorescence excitation wavelength, and the detection of endogenous fluorescence by means of a fluorescence imaging device, characterized in that the excitation of the substance is carried out by means of an operating room lighting device, comprising at least one white light source generating white light including in its spectrum the first endogenous fluorescence excitation wavelength and, for each white light source, at least one first removable filtering element suitable for filtering wavelengths above a first predefined value between 675 and 725 nm, preferably equal to 700 nm.

[0040] The invention finally relates to the use of an operating room lighting device to excite a fluorescent substance, with a view to detecting the endogenous or exogenous fluorescence of this substance by means of a fluorescence imaging device.

[0041] Various aspects and advantages of the invention will be highlighted in the following description, given solely by way of non-limiting example, and made with reference to the drawings in which:

[0042] [Fig-1] [Fig.1] schematically represents an imaging set according to a first example of an embodiment of the invention;

[0043] [Fig.2] [Fig.2] schematically represents an imaging set according to a second example of an embodiment of the invention;

[0044] [Fig.3] [Fig.3] schematically represents an operating room lighting device equipping an imaging system according to a third embodiment of the invention.

[0045] Figure 1 shows an image set 10 according to a first embodiment. The image set 10 is intended to observe a region of interest 11.

[0046] The area of ​​interest 11 comprises, for example, a first substance intrinsically emitting fluorescent radiation (endogenous fluorescence) and a second substance emitting fluorescent radiation following the injection of a fluorescent marker (exogenous fluorescence). The fluorescent marker is, for example, indocyanine green.

[0047] The first substance exhibits a fluorescence emission spectrum with a first intensity maximum at a first emission wavelength (by For example, this is the autofluorescence of the parathyroid glands with a maximum intensity near 711 nm. The second substance exhibits a fluorescence emission spectrum with a second maximum intensity at a second emission wavelength (for example, this is the fluorescence of indocyanine green with a maximum intensity near 820 nm). The fluorescence spectra of the first and second substances are distinct. The first and second emission wavelengths are distinct. For example, the maximum fluorescence spectrum of the second substance has a longer wavelength than the maximum fluorescence spectrum of the first substance, for the same excitation wavelength used.

[0048] The imaging assembly 10 includes an operating room lighting device 12, an imaging device 14 and a viewing device 16 connected to the imaging device 14. The imaging assembly 10 also includes computing means 30, comprising one or more computers or servers, configured to perform various operations from the output signal or signals of the imaging device 14.

[0049] According to the first embodiment, shown in [Fig.1], the imaging device 14 is separate from the lighting device 12, and can be manipulated independently of this lighting device 12.

[0050] On the other hand, in the second embodiment, shown in [Fig.2], the imaging device 14 is carried by the lighting device 12, preferably in its center.

[0051] In the third embodiment, shown in [Fig.3], the imaging device is also carried by the lighting device 12. The third embodiment differs from the others by the arrangement of filters, which will be described later.

[0052] These three embodiments, however, operate similarly, so they will be described together. In the following description, unless otherwise specified, everything described will be common to all three embodiments.

[0053] The imaging device 14 is intended to detect fluorescence radiation emitted from the area of ​​interest 11. This fluorescence radiation can be endogenous or exogenous fluorescence radiation.

[0054] In order to enable the emission of fluorescence radiation, the imaging assembly 10 comprises a first means for generating a first excitation radiation having a first endogenous fluorescence excitation wavelength, and preferably a second means for generating a second excitation radiation having a second exogenous fluorescence excitation wavelength. second excitation means preferably has a maximum intensity at a wavelength greater than the wavelength corresponding to the maximum intensity of the first excitation means.

[0055] The operating room lighting device 12 includes at least one white light source 18.

[0056] The invention provides for using at least this white light source 18 to excite endogenous fluorescence by emitting the first excitation radiation having a maximum intensity defined by the first endogenous fluorescence excitation wavelength. For this purpose, the white light 18 includes, in its spectrum, said first endogenous fluorescence excitation wavelength. This first endogenous fluorescence excitation wavelength is generally between 600 and 700 nm, preferably between 650 and 700 nm. Thus, the white light source 18 constitutes said first means for generating the first excitation radiation.

[0057] It should be noted that the measured powers, in the wavelengths considered, of the white light emitted by the lighting device 12 are equivalent to those of the lights emitted by conventional devices. As an example, one can compare the illuminances, at the incision site, of a parathyroid visualization device by autofluorescence (Fluobeam® LX Red) and an operating room lighting device (Volista™ NIR) in the 600-700 nm band. The measurement was carried out:

[0058] - at 10 cm from the excitation light source (recommended working distance of the Fluobeam LX Red), and

[0059] - at 1m from the operating room lighting device (lighting distance recommended, the imaging device can be positioned 10cm from the incision).

[0060] The power measured for the LX Red is then 75 W / m2, and the power measured for the Volista NIR is 71.2 W / m2 (for the wavelength band [600-700] nm).

[0061] For each white light source 18, the lighting device 12 includes at least one first removable filtering element 20, suitable for filtering wavelengths above approximately a first predefined value between 675 and 725 nm, preferably equal to 700 nm. This first filtering element 20 is movable between an active position, in which it is positioned opposite the corresponding white light source 18 to filter wavelengths above the first predefined value, and a retracted position, in which the first filtering element 20 is held away from the white light source 18 so as not to filter the white light.

[0062] The first filter element 20 is put into active position when the imaging assembly 10 is in endogenous fluorescence observation configuration.

[0063] Advantageously, the invention also provides for using the white light source 18 to excite exogenous fluorescence by emitting a second excitation radiation having a maximum intensity defined by the second excitation wavelength of the exogenous fluorescence. For this purpose, the white light 18 includes, in its spectrum, said second excitation wavelength of the exogenous fluorescence. This second excitation wavelength of the exogenous fluorescence is generally between 680 and 850 nm, preferably between 750 and 850 nm. Thus, the white light source 18 also constitutes said second means for generating the second excitation radiation.

[0064] For each white light source 18, the lighting device 12 includes at least one second removable filtering element 22 capable of substantially filtering wavelengths above a second predefined value, the second predefined value being selected between 680 and 850 nm, preferably between 750 and 850 nm, for example equal to 750 nm, 775 nm, 785 nm or 808 nm.

[0065] Advantageously, the filtering of the second filtering element 22 is higher than the filtering of the first filtering element 20, in order to improve the colorimetric quality of the operating room lighting.

[0066] The second filtering element 22 is movable between an active position, in which it is in front of the corresponding white light source 18 to filter wavelengths above the second predefined value, and a retracted position, in which the second filtering element 22 is held away from the white light source 18 so as not to filter the white light.

[0067] The second filter element 22 is put in the active position when the imaging assembly 10 is in exogenous fluorescence observation configuration.

[0068] In the example of the third embodiment, shown in [Fig. 3], the first 20 and second 22 filtering elements are carried by a wheel 24. The wheel 24 is then rotatable to bring the first filtering element 20, the second filtering element 22, or preferably at least a third element 26, into alignment with the white light source 18. This third element 26 has no filter, or alternatively, includes a cold filter designed to reduce the radiant energy. This third element 26 is positioned opposite the white light 18 when used in color imaging. The third element 26 advantageously improves the colorimetry of the white light source 18.

[0069] For example, the wheel 24 is common to several light sources 18, and comprises as many first filtering elements 20, second filtering elements 22, and third elements 26 as there are light sources 18 corresponding to this wheel 24. The wheel 24 is dimensioned to bring the same type of element opposite each light source 18. In [Fig. 3], each wheel 24 is shown in a configuration where the second filtration elements 22 are opposite the corresponding light sources 18.

[0070] The imaging device 14 is intended to capture an image of the area of ​​interest 11, and to reproduce this image on the display device 16.

[0071] The imaging device 14 conventionally comprises a detector 15 equipped with a lens including at least one optical lens. The imaging device 14 also includes filtering means 28.

[0072] The filtering means 28 comprise a first bandpass filtering means 32, preferably removable, allowing the visualization of wavelengths between a first lower bound and a first upper bound, the first lower bound preferably being between 700 and 750 nm. This first filtering means 32 therefore blocks wavelengths shorter than the endogenous fluorescence wavelengths of interest, for example by blocking the wavelengths of ambient white lighting sources (ceiling light and window), white light sources 18 or excitation lighting.

[0073] Preferably, the first filtering means 32 blocks wavelengths above the first upper limit in the endogenous fluorescence imaging configuration, in order to block or substantially reduce exogenous fluorescence and thus not interfere with the detection of endogenous fluorescence, for example, to block the strongest ICG fluorescence during autofluorescence imaging of the parathyroid gland. The first upper limit is between approximately 750 and 900 nm, preferably between 750 and 810 nm.

[0074] Advantageously a second low-pass type filter is positioned between the first filtration means 32 and the sensor 15 to block wavelengths above approximately 750 and 900 nm, preferably between 750 and 810 nm.

[0075] Preferably, the filtering means 28 comprise a second removable bandpass filtering means 34 allowing the visualization of wavelengths between a second lower and a second upper limit. The second lower limit is, for example, between 750 and 810 nm. This second filtering means 34 therefore blocks wavelengths shorter than the exogenous fluorescence wavelengths of interest, for example, by blocking the wavelengths of ambient white light sources (ceiling lights and windows), white light sources 18, or excitation lighting. The second upper limit is between 775 and 900 nm, preferably between 810 and 900 nm.

[0076] It should be noted that the endogenous fluorescence and exogenous fluorescence wavelengths are both wavelength bands, and the lower limit of the endogenous fluorescence wavelengths is, in the example described, lower than the lower limit of the exogenous fluorescence wavelengths.

[0077] Alternatively, it is possible to provide for exogenous fluorescence with a wavelength shorter than that of endogenous fluorescence. This is particularly the case when using an exogenous marker of the CY5, ALM-488 or ALM-594 type.

[0078] Furthermore, it should be noted that exogenous and endogenous fluorescence may include certain wavelengths of light, generally at low intensities, beyond the selected endogenous and exogenous fluorescence wavelength bands that are detected and used for imaging in this system.

[0079] The filtering means 28 finally include a third removable means 36, for the use of the imaging device 14 in color imaging mode.

[0080] This third removable means 36 is, for example, a filter called IR-CUT. It is a low-pass filter, which has the effect of blocking wavelengths beyond a limit A, A being chosen in the range 650-800 nm. Its function is to improve the color rendering of the color image acquired by the sensor 15.

[0081] In the example of the third embodiment, the first filtration means 32, second filtration means 34 and third means 36 are carried by a wheel, configured to bring one of these means in relation to the sensor 15 according to the desired configuration.

[0082] Advantageously, in order to enhance the excitation of endogenous fluorescence, the imaging system 10 comprises at least one first means 38 for generating light to enhance the excitation of endogenous fluorescence, emitting excitation radiation having a maximum intensity defined by an excitation-enhancement wavelength between 600 and 700 nm. The first generation means 38 is, for example, a laser source, a light-emitting diode, or a VCSEL (Vertical Cavity Surface Emitting Laser) source.

[0083] The first means 38 excitation enhancement light generators are generally additional light sources separate from the white light sources 18, although the white lights 18 are also to be used to excite endogenous fluorescence.

[0084] In the third embodiment, the first means 38 for generating excitation reinforcement light is preferably integrated into the operating room lighting device 12, as shown in [Fig.3].

[0085] Alternatively, the first excitation-enhancement light-generating means 38 is carried by an external device separate from the lighting device 12 and the imaging device 14, as shown in Figures 1 and 2. It should be noted that these variants are compatible for all three embodiments, so that the first excitation-enhancement light-generating means 38 could be integrated into the operating room lighting device 12 in the first or second embodiment, or use an external device in the third embodiment.

[0086] The first means 38 for generating reinforcement light is activated in particular when it is desired to observe endogenous fluorescence in the area of ​​interest 11.

[0087] Advantageously, the first enhancement means 38 contributes to improving the color quality of the operating room lighting, provided its wavelength and optical power are appropriately chosen. More specifically, due to the first filtering element 20, the color quality of the operating room lighting is reduced, particularly in the red range. By adding the enhancement light 38 at red wavelengths, the effect of the filters on the color quality is diminished.

[0088] Advantageously, in order to enhance the excitation of exogenous fluorescence, the imaging assembly 10 includes at least one second means 40 for generating exogenous fluorescence excitation enhancement light, emitting excitation radiation having a maximum intensity defined by an excitation wavelength between 680 and 850 nm. The second generation means 40 is, for example, a laser source, a light-emitting diode, or a VCSEL (Vertical Cavity Surface Emitting Laser) source.

[0089] The second means 40 for generating strengthening light is activated when it is desired to observe exogenous fluorescence in the area of ​​interest 11.

[0090] Preferably, the imaging device 14 includes a filter at the wavelength of the second generation means 40, in order to prevent the reflection of this generated light from interfering with the observation of exogenous fluorescence.

[0091] In the third embodiment, the second means 40 for generating excitation reinforcement light is preferably integrated into the operating room lighting device 12, as shown in [Fig.3].

[0092] Advantageously, the second reinforcement means 40 contributes to improving the colorimetric quality of the operating room lighting, by having its wavelength and optical power appropriately chosen.

[0093] Alternatively, the second means 40 for generating reinforcement light is integrated into the imaging device 14, or, as shown in Figures 1 and 2, integrated into an external device different from the imaging device 14 and the operating room lighting device 12.

[0094] It should be noted that these variants are compatible for all three embodiments, so that the second means 40 for generating excitation-enhancing light could be integrated into the operating room lighting device 12 in the first or second embodiment, or use an external device in the third embodiment.

[0095] The imaging assembly 10 has at least three operating configurations, namely:

[0096] - a first operating configuration for fluorescence detection endogenous,

[0097] - a second operating configuration for fluorescence detection exogenous; and

[0098] - a third operating configuration for color imaging (i.e. the mode of visualizing tissues in the visible spectrum).

[0099] In the first configuration, the white light source 18 is used as the first source of endogenous fluorescence excitation light. Each white light source 18 is filtered by the corresponding first filtering element 20. To this end, each wheel 24 is rotated to bring the first filtering elements 20 opposite the corresponding white light sources 18.

[0100] Furthermore, in the first configuration, the fluorescence imaging device 14 is filtered to substantially block wavelengths outside the range between approximately the first lower limit and 900 nm, and preferably to block wavelengths above the first upper limit, which is, for example, between 750 nm and 810 nm. For this purpose, the first filtering means 32 is arranged in front of the sensor 15 of the imaging device 14, between the sensor 15 and the area of ​​interest 11.

[0101] The first filtration means 32 of the first configuration filter out the wavelengths of exogenous fluorescence (such as those of ICG) so that they do not reach the sensor 15, thus ensuring that only the endogenous fluorescence remains predominantly visible. The image then generated for display on the display means 16 shows essentially the endogenous fluorescence, particularly from one or more parathyroid glands.

[0102] Preferably, in the first configuration, the first means 38 for generating endogenous fluorescence excitation-enhancing light is activated.

[0103] Advantageously, all these elements are activated automatically, for example controlled by the calculation means 30.

[0104] In the second configuration, the white light source 18 is advantageously used as a second source of exogenous fluorescence excitation light. Each white light source 18 is filtered by the corresponding second filtering element 22. To this end, each wheel 24 is rotated to bring the second filtering elements 22 opposite the corresponding white light sources 18.

[0105] Furthermore, in the second configuration, the fluorescence imaging device 14 is filtered to substantially block wavelengths below the second lower limit (between 750 and 810 nm) and above the second upper limit (between 810 and 900 nm). For this purpose, the second filtering means 34 is arranged in front of the sensor 15 of the imaging device 14.

[0106] In the application of ICG and parathyroid autofluorescence, it is not essential to blocking parathyroid autofluorescence light during ICG imaging because the ICG fluorescence signal is generally much more intense.

[0107] Preferably, in the second configuration, the second means 40 for generating exogenous fluorescence excitation-enhancing light is activated.

[0108] Advantageously, all these elements are activated automatically, for example controlled by the calculation means 30.

[0109] In the third configuration, the white light source 18 is substantially unfiltered, or only filtered by a cold filter. For this purpose, the third element 26 is brought opposite the corresponding light source 18.

[0110] It should be recalled here that a cold filter is a light filter that preferentially blocks a red component of white light so that the radiant energy of the white light is reduced with minimal effect on the color temperature or other visible properties of the white light. This can be particularly useful for reducing the heat felt by medical personnel working under strong white light.

[0111] Similarly, the third means 36 is brought in relation to the sensor 15 of the imaging device 14.

[0112] Advantageously, all these elements are activated automatically, for example controlled by the computing means 30. More particularly, in each configuration, the white light filtering elements, the imaging device filtering means, and preferably the reinforcement lights, are activated automatically and simultaneously.

[0113] Thus, the settings for the first, second and third operating configurations are preferentially automatically implemented in response to the selection of the first, second or third operating mode.

[0114] Alternatively, these settings are made manually.

[0115] In some embodiments, endogenous fluorescence is excited by white lights 18 (first operating configuration), and exogenous fluorescence is further excited by at least a second additional light source 40 for boosting the excitation of exogenous fluorescence, which is preferably activated in the second operating configuration, but not in the first operating configuration. Optionally, the first means 38 light generation reinforcement is used to further excite endogenous fluorescence in the first operating configuration.

[0116] In some housings, the first removable filtering means 32 is configured to prevent light wavelengths shorter than the maximum endogenous fluorescence wavelengths from reaching the sensor 15, and the second removable filtering means 34 is configured to prevent light wavelengths shorter than the maximum exogenous fluorescence wavelengths from reaching the sensor 15. In some embodiments, the first removable filtering means 32 is configured to prevent light wavelengths shorter than the parathyroid gland autofluorescence wavelengths from reaching the sensor 15, and the second removable filtering means 34 is configured to prevent light wavelengths shorter than the maximum ICG fluorescence wavelengths from reaching the sensor 15.

[0117] In some embodiments, the autofluorescence wavelengths and the ICG wavelengths are both wavelength bands, and a lower limit of the autofluorescence wavelength band is lower than a lower limit of the ICG wavelength band. The system can detect light in the autofluorescence wavelength band in the first operating configuration, and can detect light in the ICG wavelength band in the second operating configuration, and can preferably create and present respective images in the first and second configurations.

[0118] In some embodiments, the imaging system is configured for alternating parathyroid gland autofluorescence and ICG fluorescence imaging. In particular, the fluorescence imaging device is preferably filtered to substantially block wavelengths above a wavelength A of the sensor 15 during parathyroid gland autofluorescence imaging in order to block or substantially reduce ICG fluorescence so that parathyroid gland autofluorescence can be detected, wavelength A preferably being a wavelength between approximately 750 and 810 nm.

[0119] In certain embodiments, in the second operating configuration, the second means 40 for generating reinforcement light generates excitation light at wavelengths that are normally removed from white light by the first removable filter element in the first operating configuration. For example, in the second operating configuration, the second means 40 for generating reinforcement light can generate excitation light at wavelengths greater than 700 nm that would be blocked by the first removable filter element in the first operating configuration. This has the advantage of improving color quality. operating room lighting by giving the surgeon better visibility of tissues, as well as further improving exogenous fluorescence, in the second configuration.

[0120] It should be noted that the invention is not limited to the embodiments described above, but could have various variants without departing from the scope of the claims.

[0121] In particular, the above embodiments have been described for use in exogenous fluorescence using ICG markers. The imaging system according to the invention could alternatively be adapted to other markers, such as:

[0122] - the ALM-488 (excitation between 450 and 520 nm, emission between 500 and 600 nm); or

[0123] - the ALM-594 (excitation in the 500-620 nm band, emission between 600 and 700 nm).

[0124] In this case, each source 18 would be equipped with a removable filtering element adapted to the fluorophore ALM-488 (respectively ALM-594), preferably of the bandpass type, which filters the wavelengths corresponding to the emission band of the ALM-488 (respectively ALM-594), and the filtering means 28 comprise a removable bandpass type filtering means allowing the wavelengths of the emission band of the ALM-488 (respectively ALM-594) to pass through.

[0125] In a preferred embodiment, these filtration elements and filtration means are added to those previously described, so that the imaging assembly 10 would further present a fourth operating configuration, called nerve imaging, adapted to the ALM-488 or ALM-594 marker.

[0126] In another embodiment, these filtration elements replace those intended for ICG fluorescence.

[0127] It will be understood that the invention can be adapted to any type of fluorescence marker, by adapting the filters appropriately.

[0128] The number of filters is not limited, so that an imaging set 10 can be planned to work with multiple different fluorescence markers.

Claims

1. Demands Fluorescence imaging kit (10), comprising - a first means for generating excitation light emitting excitation radiation comprising a first endogenous fluorescence excitation wavelength, and - a fluorescence imaging device (14) suitable for detecting fluorescence radiation, comprising a sensor (15), characterized in that the imaging assembly (10) comprises: - an operating room lighting device (12), comprising at least one white light source (18) generating white light comprising in its spectrum the first endogenous fluorescence excitation wavelength and, - for each white light source (18), at least one first removable filtering element (20) suitable for filtering wavelengths above a first predefined value of 700 nm, the first means for generating excitation light being formed by at least one light source, in that: - the imaging device (14) is supported by the lighting device (12), at its center, - the imaging system (10) includes a first means (38) for generating an excitation enhancement light of endogenous fluorescence, emitting excitation radiation having a maximum intensity defined by an excitation wavelength between 600 and 700 nm, the first means (38) for generating an excitation enhancement light being integrated into the operating room lighting device (12) and separate from the white light sources (18), - the imaging assembly (10) comprises a second means (40) for generating exogenous fluorescence excitation enhancement light, generating excitation radiation having a maximum intensity defined by an excitation wavelength between 680 and 850 nm, the fluorescence imaging device (14) comprising a filter blocking the wavelength of the second generation means, and the second means (40) for generating excitation enhancement light being integrated into the operating room lighting system (12) and separate from the white light sources (18), and in that the fluorescence imaging device (14) comprises: - a first removable bandpass filtering means (32) allowing the visualization of wavelengths between a first lower limit and a first upper limit, the first lower limit being between 700 and 750 nm and the first upper limit being between approximately 750 and 900 nm, - a second removable bandpass filtering means (34) allowing the visualization of wavelengths between a second lower limit and a second upper limit, the second lower limit being between 750 and 810 nm and the second upper limit being between 775 and 900 nm, - a third removable means (36), for the use of the imaging device (14) in color imaging mode, the first filtering means (32),The second filtration means (34) and the third means (36) are carried by a wheel, configured to bring one of these means into contact with the sensor (15) according to the desired configuration.

2. Assembly (10) of fluorescence imaging according to claim 1, wherein the first upper bound is between about 750 and 810 nm, and the second upper bound is between 810 and 900 nm.

3. Imaging assembly (10) according to any one of the preceding claims, wherein the first means (38) for generating endogenous fluorescence excitation enhancement light comprises a Laser or a Light Emitting Diode.

4. Imaging assembly (10) according to any one of the preceding claims, wherein the white light generated by the white light source (18) includes in its spectrum a second exogenous fluorescence excitation wavelength.

5. Imaging assembly (10) according to any one of the preceding claims, wherein the second means (40) for generating exogenous fluorescence excitation enhancement light is formed by a Laser or a Light Emitting Diode.

6. Imaging system (10) according to any one of the preceding claims, wherein the operating room lighting device (12) comprises, for each white light source (18), at least one second removable filtering element (22) capable of substantially filtering wavelengths above a second predefined value, the second predefined value being selected between 680 and 850 nm, for example equal to 750 nm, 775 nm, 785 nm or 808 nm.

7. Imaging assembly (10) according to claim 6, wherein, for each white light source (18), the first (20) and second (22) filtering element are carried by a wheel (24), rotatable to bring the first filtering element (20), the second filtering element (22), or at least a third element (26), into view of the white light source (18).

8. Imaging assembly (10) according to claim 7, wherein the wheel (24) is common to several white light sources (18), and comprises as many first filtering elements (20) and second filtering elements (22) as there are white light sources (18) corresponding to this wheel (24), the wheel (24) being sized to bring the same type of filtering element opposite each white light source (18).

9. Imaging assembly (10) according to any one of the preceding claims, having at least three operating configurations, namely: - a first operating configuration for the detection of endogenous fluorescence, using the white light source (18) of the operating room lighting device (12) as the first means for generating excitation light, each white light source (18) being filtered by the corresponding first filtering element (20), and the first filtering means (32) being disposed in front of the sensor (15); - a second operating configuration for the detection of exogenous fluorescence, in particular for the detection of ICG fluorescence, and the second filtering means (34) being disposed in front of the sensor (15); and - a third operating configuration for color imaging, wherein the third removable means (36) is disposed in front of the sensor (15).

10. Imaging assembly (10) according to claim 9 wherein, in the first configuration, the first means (38) for generating a Endogenous fluorescence excitation enhancement light is activated.

11. Imaging assembly according to claim 9 or 10, wherein, in the first configuration, the fluorescence imaging device (14) is filtered to substantially block wavelengths out of the range between about a first lower bound and a first upper bound, the first lower bound being between about 700 and 750 nm, and the first upper bound being between about 775 nm and 900 nm, in particular between 775 nm and 825 nm.

12. Imaging assembly (10) according to any one of claims 9 to 11, taken in combination with any one of claims 6 to 8, wherein, in the second operating configuration, each white light source (18) is filtered by the corresponding second filtering element (22).

13. Imaging assembly (10) according to any one of claims 9 to 12, taken in combination with claim 5, wherein, in the second configuration, the second means (40) for generating exogenous fluorescence excitation light is activated.

14. Imaging assembly (10) according to claim 12 or 13, wherein, in the second configuration, the fluorescence imaging device (14) is filtered to block wavelengths above a second upper bound between 775 and 900 nm, preferably between 810 and 900 nm.

15. Imaging assembly (10) according to any one of claims 9 to 14, wherein, in the third configuration, the white light sources are substantially not filtered, or are only filtered using a cold filter to reduce radiant energy.

16. Imaging assembly (10) according to any one of claims 9 to 15, wherein the settings for the first, second and third operating configurations are automatically implemented in response to the selection of a first, second or third operating mode.

17. Imaging assembly (10) according to claim 16 taken in combination with claim 6 or 7, wherein the settings are implemented by rotating at least one of the wheels (24) carrying the filters.

18. Imaging assembly (10) according to claim 16 or 17, taken in combination with claims 4 and 5, wherein the settings are implemented by turning on or off the first means (38) for generating a reinforcement light and / or the second means (40) for generating a reinforcement light.

19. A method for detecting endogenous fluorescence by means of an imaging set according to any one of claims 1 to 18, comprising the excitation of an endogenously fluorescent substance by light at a first endogenous fluorescence excitation wavelength, and the detection of the endogenous fluorescence by means of the fluorescence imaging device (14), characterized in that the excitation of the substance is carried out by means of the operating room lighting device (12), comprising at least one white light source (18) generating white light comprising in its spectrum the first endogenous fluorescence excitation wavelength and, for each white light source (18), at least one first removable filtering element (20) suitable for filtering wavelengths above a first predefined value between 675 and 725 nm, preferably equal to 700 nm.

20. Use of the operating room lighting device (12) of an imaging set (10) according to any one of claims 1 to 19, to excite a fluorescent substance, for the purpose of detecting the endogenous or exogenous fluorescence of this substance by means of the fluorescence imaging device (14).

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