Devices, systems and methods for tumor visualization and removal

Abstract

To provide devices, systems and methods for tumor visualization and removal.SOLUTION: An imaging device 120 includes a body 110 having a first end portion 112 configured to be held in a user's hand and a second end portion 114 configured to direct light onto a surgical margin. The device includes at least one excitation light source 118 configured to excite autofluorescence emissions of tissue cells and fluorescence emissions of induced porphyrins in tissue cells of the surgical margin. A white light source is configured to illuminate the surgical margin during white light imaging of the surgical margin. The device includes an imaging sensor, a first optical filter configured to permit passage of autofluorescence emissions of tissue cells and fluorescence emissions of the induced porphyrins in tissue cells to the imaging sensor, and a second optical filter configured to permit passage of white light emissions of tissues in the surgical margin to the imaging sensor.SELECTED DRAWING: Figure 2

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Provisional Application No. 62 / 793,764, entitled "DEVICES, SYSTEMS, AND METHODS FOR TUMOR VISUALIZATION AND REMOVAL," filed January 17, 2019, and U.S. Provisional Application No. 62 / 857,155, entitled "DEVICES, SYSTEMS, AND METHODS FOR TUMOR VISUALIZATION AND REMOVAL," filed June 4, 2019, the entire contents of each of which are incorporated herein by reference. [Background technology]

[0002] Technical Field The present disclosure relates to devices, systems and methods for tumor visualization and removal. The disclosed devices, systems and methods may be used to stage tumors and to assess surgical margins, such as tissue margins of resected tissue and margins of tissue / surgical beds from which tumors and / or tissues have been removed. The disclosed devices, systems and methods may also be used to identify one or more of residual cancer cells, pre-cancerous cells and satellite lesions and provide guidance for the removal and / or treatment of the same.

[0003] preface Surgery is one of the oldest types of cancer treatment and is an effective treatment for many types of cancer. Oncological surgery may take different forms depending on the purpose of the surgery. For example, oncological surgery may include biopsy procedures to diagnose or determine the type or stage of cancer, tumor removal to remove some or all of the tumor or cancerous tissue, exploratory surgery to locate or identify the tumor or cancerous tissue, debulking surgery to reduce the size or remove as much of the tumor as possible without adversely affecting other body structures, and palliative surgery to address conditions caused by tumors, such as pain or pressure on body organs.

[0004] In surgeries where the goal is to remove tumors or cancerous tissue, surgeons are often faced with uncertainty in determining whether all of the cancer has been removed. A surgical or tissue bed from which a tumor has been removed may contain residual cancer cells, i.e., cancer cells that remain in the surgical margins of the area from which the tumor was removed. If these residual cancer cells remain in the body, they increase the likelihood of recurrence and metastasis. In many cases, the suspected presence of residual cancer cells based on examination of the surgical margins of the resected tissue during pathological analysis of the tumor leads to a subsequent surgery to remove additional tissue from the surgical margins.

[0005] For example, breast cancer, the most common cancer in women, is routinely treated by breast-conserving surgery (BCS), e.g., lumpectomy, which removes the tumor while sparing as much healthy breast tissue as possible. The treatment efficacy of BCS relies on the complete removal of malignant tissue, while sparing enough healthy breast tissue to ensure a reasonable breast reconstruction, which may be insufficient if excess breast tissue is removed. Visualizing tumor margins under standard white light (WL) operating room conditions is challenging due to low contrast of tumor versus normal tissue, leading to reoperations (i.e., secondary surgery) in approximately 23% of patients with early-stage invasive breast cancer and 36% of patients with ductal carcinoma in situ. Re-excisions are associated with a higher risk of recurrence, and poor patient outcomes are associated with poor breast cosmesis and increased health care costs. Positive surgical margins (i.e., margins containing cancer cells) following BCS are also associated with decreased disease-specific survival.

[0006] Current best practice in BCS involves palpation and / or specimen radiography, and rarely intraoperative histopathology to guide resection. Specimen radiography assesses resection tissue margins using x-ray images, and intraoperative histopathology (touch prep or freeze) assesses a small sample of specimen tissue for cancer cells, both of which are limited by the time delay (~20 minutes) they cause and the inaccurate colocalization of the positive margins of the resection tissue to the surgical bed. Thus, there is an urgent clinical need for real-time intraoperative imaging techniques to assess resection specimen margins and surgical bed margins, and to provide guidance for removing one or more of the residual cancer cells, precancerous cells, and satellite lesions. Summary of the Invention [Problem to be solved by the invention]

[0007] overview The present disclosure may solve one or more of the problems set forth above and / or demonstrate one or more of the desirable features set forth above. Other features and / or advantages will become apparent from the description that follows. [Means for solving the problem]

[0008] According to one aspect of the disclosure, an imaging device includes a body having a first end portion configured to be held in a user's hand and a second end portion configured to direct light to a surgical margin. The device includes at least one excitation light source configured to excite autofluorescence emission of tissue cells and fluorescence emission of induced porphyrins in tissue cells of the surgical margin. The white light source is configured to illuminate the surgical margin during white light imaging of the surgical margin. The device includes an imaging sensor, a first optical filter configured to filter light signals emitted by the surgical margin in response to illumination with the excitation light and allow passage of autofluorescence emission of tissue cells and fluorescence emission of induced porphyrins in the tissue cells to the imaging sensor, and a second optical filter configured to filter light signals emitted by the surgical margin in response to illumination with the white light and allow passage of white light emission of tissue within the surgical margin to the imaging sensor.

[0009] According to another aspect of the disclosure, an imaging device includes a body having a first end portion configured to be held in a user's hand and a second end portion configured to direct light toward a surgical margin, a first excitation light source configured to emit excitation light having a first wavelength, and a second excitation light source configured to emit excitation light having a second wavelength. An imaging sensor is configured to detect the emission of the surgical margin. A first optical filter is configured to filter an optical signal emitted by the surgical margin in response to illumination of the surgical margin with the first excitation light. The first filter is configured to allow an optical signal having a wavelength corresponding to a first characteristic of the surgical margin to pass through the filter to the imaging sensor. A second optical filter is configured to filter an optical signal emitted by the surgical margin in response to illumination of the surgical margin with the first excitation light, and the second filter is configured to allow an optical signal having a wavelength corresponding to a second characteristic of the surgical margin different from the first characteristic to pass through the filter to the imaging sensor.

[0010] In accordance with another aspect of the present disclosure, a method of imaging tissue at a surgical margin includes illuminating tissue at the surgical margin with a first excitation light source configured to emit excitation light having a first wavelength, and imaging the tissue at the surgical margin through a first optical filter of an imaging device. receiving an optical signal emitted by the tissue, illuminating the tissue at the surgical margin with a second excitation light source configured to emit excitation light having a second wavelength, and receiving the optical signal emitted by the tissue at the surgical margin via a second optical filter of the imaging device.

[0011] The present disclosure can be understood from the following detailed description, either alone or in conjunction with the accompanying drawings, which are included to provide a further understanding, and are incorporated into and constitute a part of this specification. The drawings illustrate one or more exemplary embodiments of the present disclosure and, together with the description, serve to explain various principles and operations. [Brief description of the drawings]

[0012] [Figure 1] FIG. 1 is a diagram of a system for tumor visualization according to the present disclosure. [Diagram 2] FIG. 1 is a perspective view of a handheld imaging device for visualization of tumor / cancer cells according to an embodiment of the present disclosure. [Diagram 3] FIG. 3 is an end view of the handheld imaging device of FIG. 2. [Figure 4] FIG. 3 is a side view of the handheld imaging device of FIG. 2. [Diagram 5] 1 is a perspective view of a distal end portion of a handheld imaging device including a drape according to the present disclosure. [Figure 6] 2 is an end view of a distal end portion of a handheld imaging device according to the present disclosure. FIG. [Figure 7] FIG. 7 is an exploded view of the distal end portion of FIG. 6. [Figure 8] FIG. 2 is a plan view of a distal end PCB of a handheld imaging device according to an embodiment of the present disclosure. [Figure 9]1 is a schematic diagram of a rotatable optical filter portion of a handheld imaging device according to an embodiment of the present disclosure. [Figure 10] FIG. 2 is a chart illustrating exemplary bandpasses of various filters configured to detect emissions excited by excitation light that are incorporated into an embodiment of a handheld imaging device according to the present disclosure. [Figure 11] FIG. 2 is a chart illustrating exemplary bandpasses of various filters configured to detect emissions excited by excitation light that are incorporated into an embodiment of a handheld imaging device according to the present disclosure. [Figure 12] FIG. 2 is a chart illustrating exemplary bandpasses of various filters configured to detect emissions excited by excitation light that are incorporated into an embodiment of a handheld imaging device according to the present disclosure. [Figure 13] FIG. 2 is a chart illustrating exemplary bandpasses of various filters configured to detect emissions excited by excitation light that are incorporated into an embodiment of a handheld imaging device according to the present disclosure. [Figure 14] FIG. 2 is a chart illustrating exemplary bandpasses of various filters configured to detect emissions excited by excitation light that are incorporated into an embodiment of a handheld imaging device according to the present disclosure. [Figure 15] FIG. 2 is a chart illustrating exemplary bandpasses of various filters configured to detect emissions excited by excitation light that are incorporated into an embodiment of a handheld imaging device according to the present disclosure. [Figure 16] 1A-1D are exemplary display layout diagrams associated with various imaging modes of a handheld imaging device of the present disclosure. [Figure 17] 1A-1D are exemplary display layout diagrams associated with various imaging modes of a handheld imaging device of the present disclosure. [Figure 18] 1A-1D are exemplary display layout diagrams associated with various imaging modes of a handheld imaging device of the present disclosure. [Figure 19] FIG. 1 is a perspective view of a sterile drape for a handheld imaging device according to the present disclosure. [Figure 20]FIG. 20 is a perspective view of the sterile drape of FIG. 19 with a handheld imaging device inserted into the sterile drape. [Figure 21A] FIG. 20 is a perspective view of a lens cap portion of the surgical drape of FIG. 19. [Figure 21B] FIG. 21B is a cross-sectional view of the lens cap portion of FIG. 21A. [Figure 22] 1 is a perspective view of another embodiment of a handheld imaging device according to the present disclosure. [Figure 23] FIG. 23 is a top view of the handheld imaging device of FIG. 22. [Figure 24] 23 is another perspective view of the handheld imaging device of FIG. 22 in a partially disassembled state. [Diagram 25] 23 is an end view of the cover portion of the handheld imaging device of FIG. 22. [Figure 26] 23 is a partial exploded view of the distal end portion of the handheld imaging device of FIG. 22. [Figure 27] 23 is another partially exploded view of the distal end portion of the handheld imaging device of FIG. 22. [Figure 28] 23 is an end view of the distal end portion of the handheld imaging device of FIG. 22. [Figure 29] FIG. 1 is a chart showing ICG emission wavelengths and ICG absorption wavelengths measured in a 60 μM aqueous solution. [Diagram 30] FIG. 2 is a block diagram illustrating hardware components of a handheld imaging device according to an exemplary embodiment of the present disclosure. [Diagram 31] FIG. 1 is a perspective view of a USB connector according to an exemplary embodiment of the present disclosure. [Diagram 32] FIG. 32 is a perspective view of a housing of a handheld device according to an exemplary embodiment of the present disclosure having a USB port configured to receive the USB connector of FIG. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0013] Description of Various Exemplary Embodiments Existing surgical margin assessment techniques focus on resected samples to determine whether the surgical margins contain residual cancer cells. These techniques are limited by their inability to precisely spatially co-localize positive margins detected on resected samples to the surgical bed, a limitation that the present disclosure overcomes by directly imaging the surgical cavity.

[0014] Other non-targeted techniques to reduce re-excisions include studies combining non-targeted margin shaving with the standard of care for BCS. Although this technique can reduce the overall number of re-excisions, this approach includes several potential drawbacks. For example, larger resections are associated with poorer cosmetic outcomes, and non-targeted removal of additional tissue is inconsistent with the intent of BCS. In addition, the end result of using such techniques appears to be in conflict with the recently updated ASTRO / SSO guidelines, which defined positive margins as "tumor in ink" and acknowledged that there is no added benefit of wider margins. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al., "Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with 2014;21(3):704-716. A recent retrospective study found no significant difference in re-excision following cavity shaving versus standard BCS. Pata G, Bartoli M, Bianchi A, Pasini M, Roncali S, Ragni F. Additional Cavity Shaving at the Time of Breast-Conserving Surgery Enhances Accuracy of Margin Status Examination. Ann Surg Oncol. 2016;23(9):2802-2808. If margin shaving is ultimately proven to be effective, FL-guided surgery may be a viable option following shaving. This can be used to refine the process by adding the ability to target specific areas within the surgical margins for BCS, thus redirecting an untargeted approach that indiscriminately removes additional tissue toward a targeted approach that is more in line with the intent of BCS.

[0015] The present application discloses devices, systems, and methods for fluorescence-based tumor visualization, including in vivo and in vitro visualization and / or evaluation of tumors, polymorphic disease, and surgical margins, as well as intraoperative guidance for removal of residual tumors, satellite lesions, precancerous cells, and / or cancerous cells within surgical margins. In certain embodiments, the devices disclosed herein are handheld and configured to be located at least partially within a surgical cavity. In other embodiments, the devices are portable and do not have a wired connection. However, it is within the scope of the present disclosure that the devices can be larger than a handheld device and can instead include handheld components. In such embodiments, it is contemplated that the handheld components can be connected to a larger device housing or system by a wired connection.

[0016] Also disclosed are methods for intraoperative in vivo imaging using the devices and / or systems. The imaging devices can be multispectral. Also contemplated is that the devices can be hyperspectral. In addition to providing information regarding the type of cells contained within the surgical margin, the disclosed devices and systems also provide information regarding the location (i.e., anatomical context) of the cells contained within the surgical margin. Additionally, methods are disclosed that provide guidance for intraoperative treatment of surgical margins using the devices, such as fluorescence-based image guidance of surgical margin resection. The devices, systems, and methods disclosed herein can be used on subjects, including humans and animals.

[0017] According to one aspect of the present disclosure, some disclosed methods combine the use of the disclosed devices and / or systems with the administration of a non-activated non-targeted compound configured to induce porphyrins in tumor / cancer cells, pre-cancerous cells, and / or satellite lesions. For example, a subject may be given a diagnostic dose (i.e., not a therapeutic dose) of a compound (imaging / contrast agent) such as the prodrug aminolevulinic acid (ALA). As will be understood by those skilled in the art, a dose of ALA less than 60 mg / kg is generally considered diagnostic, and a dose greater than 60 mg / kg is generally considered therapeutic. As disclosed herein, the diagnostic dose of ALA can be greater than 0 mg / kg and less than 60 mg / kg, between about 10 mg / kg and about 50 mg / kg, between about 20 mg / kg and 40 mg / kg, and can be administered to a subject at a dose of 5 mg / kg, 10 mg / kg, 15 mg / kg, 20 mg / kg, 25 mg / kg, 30 mg / kg, 35 mg / kg, 40 mg / kg, 45 mg / kg, 50 mg / kg, or 55 mg / kg. ALA can be administered orally, intravenously, by aerosol, by immersion, by lavage, and / or topically. Although the diagnostic dose is contemplated for visualization of residual cancer cells, precancerous cells, and satellite lesions, the use of the disclosed devices, systems, and methods within the scope of this disclosure is to provide guidance during the treatment and / or removal of these cells and / or lesions. In such cases, the surgeon's preferred method of treatment may vary based on the individual surgeon's preferences. Such treatments may include, for example, photodynamic therapy (PDT). In cases where PDT or other light-based treatments are potentially contemplated, administration of higher doses of ALA, i.e., therapeutic doses rather than diagnostic doses, may be desirable. In these cases, subjects may be prescribed doses of ALA greater than 60 mg / kg.

[0018] ALA induces porphyrin formation (protoporphyrin IX (PpIX)) in tumor / cancer cells, and when excited by appropriate excitation light, PpIX-containing cells produce ALA results in red fluorescence emission from the tumor / cancerous tissue cells and enhances the red vs. green fluorescence contrast between the tumor / cancerous tissue cells and the normal tissue cells (e.g., collagen) imaged with the device. While ALA is non-fluorescent by itself, PpIX is fluorescent at approximately 630 nm, 680 nm, and 710 nm, with the emission at 630 nm being the strongest. Alternatively, the intrinsic fluorescence difference between the tumor / cancerous or pre-cancerous cells and the normal / healthy cells can be used without the imaging / contrast agent.

[0019] In exemplary embodiments, the non-activated non-targeted compound configured to induce porphyrins in tumor / cancer cells, precancerous cells, and / or satellite lesions is administered to the subject between about 15 minutes and about 6 hours before surgery, between about 1 hour and about 5 hours before surgery, between about 2 hours and about 4 hours before surgery, or between about 2.5 hours and about 3.5 hours before surgery. These exemplary time frames allow sufficient time for ALA to be converted to porphyrins in tumor / cancer cells, precancerous cells, and / or satellite lesions. ALA or other suitable compounds can be administered orally, intravenously, by aerosol, by immersion, by lavage, and / or topically.

[0020] In cases where the administration of the compound is outside of the desired or preferred time frame, it is possible that PpIX can be further induced (or initially induced if the compound was not administered before surgery) by, for example, applying the compound via an aerosol composition, i.e., spraying it into the surgical cavity or onto the resected tissue (before or after incision for examination). Additionally or alternatively, the compound can be administered in liquid form, for example as a surgical cavity wash. Additionally or alternatively, for a removed specimen, PpIX can be induced into the resected specimen when it is immersed in a liquid compound such as liquid ALA almost immediately after resection. The sooner the resected tissue is immersed, the more chance there will be of PpIX or additional PpIX being induced into the resected tissue.

[0021] During surgery, tumors, e.g., primary, palpable, or index tumors, are removed by the surgeon if possible. A handheld, fluorescent-based imaging device is then used to identify, locate, and guide treatment of any remaining cancerous, pre-cancerous, and / or satellite lesions in the surgical bed from which the tumor was removed. The device can also be used to inspect the resected tumor / tissue specimen to determine whether tumor / cancerous and / or pre-cancerous cells are present in the outer margins of the resection specimen. The presence of such cells may indicate a positive margin, which should be considered by the surgeon in determining whether further resection of the surgical bed should be performed. The location of any tumor / cancerous cells identified in the outer margins of the resection specimen can be used to identify a corresponding location in the surgical bed, which can be targeted for further resection and / or treatment. This can be particularly beneficial in situations where visualization of the surgical bed itself does not identify any remaining tumor / cancerous, pre-cancerous, or satellite lesions. In addition, handheld fluorescence-based imaging devices can be used to guide the surgical removal of the primary tumor itself, and to subsequently locate residual cancerous cells, precancerous cells, and / or satellite lesions in the surgical bed from which the tumor was removed, as discussed above.

[0022] According to one aspect of the present disclosure, a handheld fluorescence-based imaging device for visualization of tumor / cancer cells is provided. The fluorescence-based imaging device may include a body sized and shaped to be held and operated by a user in one hand. Exemplary embodiments of the handheld fluorescence-based imaging device are shown in FIGS. 2-4. As shown, in some example embodiments, the body may have a generally elongated shape and may include a first end portion configured to be held in a user's hand and a second end portion configured to direct light onto an outer surface of a resected tumor, of one or more sections of a resected tumor, or onto a surgical margin within a surgical cavity from which the tumor / tissue was removed. The second end can be further configured to be positioned within a surgical cavity encompassing a surgical margin. The body of the device can include one or more materials suitable for sterilization, such that the body of the device can be subjected to sterilization, such as autoclaving. An example of a suitable material is polypropylene. Those skilled in the art will be familiar with other suitable materials. Components within the body of the device that may not be able to withstand autoclave conditions, such as electronics, can be secured or otherwise housed in a protective housing, e.g., a metal or ceramic housing.

[0023] The device can be configured to be used with a surgical drape or shield. For example, the inventors have found that image quality improves when ambient and artificial light is reduced in the area of ​​imaging. This can be accomplished by reducing or eliminating ambient and / or artificial light sources during use. Alternatively, a drape or shield can be used to block at least a portion of the ambient and / or artificial light from the surgical site where imaging is occurring. In one exemplary embodiment, the shield can be configured to fit over the second end of the device and can be moved over the device toward and away from the surgical cavity to vary the amount of ambient and / or artificial light that may enter the surgical cavity. The shield can be shaped into a cone or umbrella. Alternatively, the device itself can be enclosed within a drape, with a clear sheath portion covering the end of the device configured to illuminate the surgical site with excitation light. Other variations on the drape configured to reduce or eliminate ambient and / or artificial light can be utilized as would be understood by one skilled in the art. Additionally or alternatively, the handheld fluorescence-based imaging device can include a sensor configured to identify whether lighting conditions are satisfactory for imaging. The device can also be used in conjunction with a surgical drape to maintain sterility of the surgical field and / or to protect the tip of the device from bodily fluids. The surgical drape and the ambient light reducing drape can be combined into a single drape design. Alternatively, the surgical drape can enclose the device and the ambient light reducing drape or shield can be located on top of the surgical drape.

[0024] The device can further include at least one excitation light source contained within the body of the device and configured to excite autofluorescence emissions of tissue cells and fluorescent emissions of derived porphyrins in tissue cells of the surgical margin. The at least one excitation light source can be disposed at, around, and / or adjacent to one end of the device. Each light source can include, for example, one or more LEDs configured to emit light at a selected wavelength.

[0025] The excitation light source can provide excitation light of a selected single wavelength to excite tissue autofluorescence emission and fluorescence emission of derived porphyrins in tumor / cancer cells contained within the surgical margins of the resected tumor / tissue and / or the surgical bed of the resected tumor / tissue cells. In one example, the excitation light can have a wavelength in the range of about 350 nm to about 600 nm, or in the range of 350 nm to about 450 nm and 550 nm to about 600 nm, or, for example, 405 nm, or, for example, 572 nm.

[0026] Alternatively, the excitation light source can be configured to provide two or more wavelengths of excitation light. The wavelength of the excitation light can be chosen for different purposes, as will be understood by those skilled in the art. For example, by varying the wavelength of the excitation light, it is possible to vary the depth to which the excitation light penetrates the surgical bed. Because the penetration depth increases with a corresponding increase in wavelength, different wavelengths of light can be used to excite tissue below the surface of the surgical bed / surgical margin. In one example, excitation light having a wavelength in the range of 350 nm to 450 nm, e.g., 405 nm, and excitation light having a wavelength in the range of 550 nm to 600 nm, e.g., 572 nm, can be used to excite tissue below the surface of the surgical bed / surgical margin. The tissue forming the This would allow the user of the device, e.g., a surgeon or pathologist, to visualize tumor / cancer cells at or below the surface of the surgical bed / surgical margin. Additionally or alternatively, excitation light having a wavelength in the near infrared / infrared region could be used, e.g., between about 750 nm and about 800 nm, e.g., 760 nm, 780 nm, or other wavelengths. In addition, to penetrate tissue to a deeper level, the use of this type of light source could be utilized in conjunction with a second type of imaging / contrast agent, such as an infrared dye (e.g., IRDye800, ICG). This would allow visualization of, for example, vascularization, vascular perfusion, and blood pools within the surgical margin / surgical bed, and this information could be used by the surgeon in making a decision regarding the possibility of residual tumor / cancer cells remaining in the surgical bed. Additionally, the utility of visualizing vascular perfusion is to improve anastomosis during reconstruction.

[0027] The device may include an additional light source, such as a white light source for white light (WL) imaging of the surgical margins / surgical bed. In at least some instances, such as during BCS, e.g., lumpectomy, removal of the tumor will create a fossa that encompasses the surgical bed / surgical margins. WL imaging may be used to obtain images or videos of the interior of the fossa and / or the surgical margins to provide visualization of the fossa. The white light source may include one or more white light LEDs. Other sources of white light may be used as needed. As would be understood by one of skill in the art, the white light source should be stable and reliable and should not generate excessive heat during prolonged use.

[0028] The body of the device can include controls to allow switching / toggling between white light imaging and fluorescence imaging. The controls can also allow the use of various excitation light sources, together or separately, in various combinations, and / or sequentially. The controls can cycle through various different light source combinations, sequentially control the light sources, strobe the light sources, or otherwise control the timing and duration of light source use. The controls can be automatic, manual, or a combination thereof, as would be understood by one of skill in the art.

[0029] The body of the device may also include one or more optical imaging filters configured to prevent the passage of reflected excitation light and allow the passage of emission having wavelengths corresponding to the autofluorescence emission of tissue cells and the fluorescence emission of induced porphyrins in the tissue cells. In one example embodiment, the device includes one filter for white light (WL) imaging and infrared (IR) imaging, and another filter for fluorescence (FL) imaging. The device may be configured to switch between different imaging filters based on the desired imaging mode and the excitation light emitted by the handheld device.

[0030] The handheld fluorescence-based imaging device also includes an imaging lens and an image sensor. The imaging lens or lens assembly can be configured to focus the filtered autofluorescence and fluorescence emissions onto the image sensor. A wide-angle imaging lens or a fish-eye imaging lens are examples of suitable lenses. A wide-angle lens can provide a 180 degree field of view. The lens can also provide optical magnification. Very high resolution is desirable for the imaging device so that it is possible to differentiate between very small cell groups. This is desirable to achieve the goal of maximizing the amount of healthy tissue retained during surgery while maximizing the possibility to remove substantially all remaining cancerous, pre-cancerous, and satellite lesions. The image sensor is configured to detect the filtered autofluorescence emissions of tissue cells and the fluorescence emissions of derived porphyrins in tissue cells at the surgical margins. The image sensor can have 4K video capabilities as well as autofocus and optical and / or digital zoom capabilities. CCD or CMOS imaging sensors can be used. In one example, a CMOS sensor combined with a filter can be used, i.e., Ximea Company The handheld device may include a hyperspectral imaging sensor such as those sold by Ximea. Example filters include a visible light filter (https: / / www.ximea.com / en / products / hyperspectral-cameras-based-on-usb3-xispec / mq022hg-im-sm4x4-vis) and an IR filter (https: / / www.ximea.com / en / products / hyperspectral-cameras-based-on-usb3-xispec / mq022hg-im-sm5x5-nir). The handheld device may also include a processor configured to receive the detected emission and output data related to the detected filtered autofluorescence emission of tissue cells and the fluorescence emission of induced porphyrins in tissue cells of the surgical margin. The processor may have the ability to seamlessly execute concurrent programs (including but not limited to wireless signal monitoring, battery monitoring and control, temperature monitoring, image reception / compression, and button press monitoring). The processor interfaces with the internal memory, buttons, optics, and wireless module. The processor also has the ability to read analog signals.

[0031] The device may also include a wireless module and may be configured for fully wireless operation. It may utilize high throughput wireless signals and may have the capability to transmit high resolution video with minimal latency. The device is both Wi-Fi and Bluetooth enabled (Wi-Fi for data transmission, Bluetooth for high speed connection). The device may utilize 5 GHz wireless transmission band operation for isolation from other devices. Additionally, the device may be enabled as a soft access point, which eliminates the need for a connection to the Internet and also keeps connected devices and modules separate from other devices related to patient data security. The device may be configured for wireless charging and may include an inductive charging coil. Additionally or alternatively, the device may include a port configured to receive a charging connection.

[0032] Additional details regarding the structure, function, and operation of the exemplary devices described herein can be found in U.S. Provisional Application Nos. 62 / 625,983 (filed February 3, 2018 and entitled "Devices, Systems, and Methods for Tumor Visualization and Removal") and 62 / 625,967 (filed February 3, 2018 and entitled "Devices, Systems, and Methods for Tumor Visualization and Removal"), the entire contents of each of which are incorporated herein by reference.

[0033] 1, a system 102 is shown that includes a handheld imaging device 100. The handheld imaging device 100 communicates with a hub 104, such as by wireless transmission (e.g., Wi-Fi, Bluetooth, or other wireless RF protocol). The hub 104 transmits imaging data received from the handheld imaging device 100 to a display monitor 106 for display using a protocol such as High Definition Multimedia Interface (HDMI). The hub 104 can also transmit the imaging data to a computer system 108, such as a terminal or a network, for storage of the imaging data.

[0034] In accordance with one aspect of the disclosure, an example embodiment of a handheld imaging device 100 in accordance with the present teachings is shown in Figures 2-4. The handheld device 100 includes a body 110 having a first end portion 112 and a second end portion 114. The first end portion 112 is sized and shaped to be held in one hand by a user of the device. The first end portion 112 can include controls 113 configured to activate the device, toggle and / or otherwise control different light sources, and switch between one or more optical imaging filters. Such controls can include buttons, switches, capacitive discharge sensors, or other devices operated by a user.

[0035] 2-4, the second end portion 114 of the handheld device 100 can be tapered and / or elongated to facilitate insertion of the distal end or tip 116 of the second end portion through a 2-3 cm sized surgical incision into a surgical cavity from which tumor or cancerous tissue has been removed. The second end portion 114 can be rigid and angled relative to the first end portion 112 to facilitate better access under a skin flap, or can be configured to be flexible to facilitate imaging of surgical cavities having complex geometries.

[0036] The distal end 116 includes one or more light sources 118, such as light emitting diodes (LEDs) configured to emit light having a particular wavelength. For example, the one or more light sources 118 can be configured to emit wavelengths of 405 nm, 760 nm, 780 nm, or other wavelengths. The distal end 116 further includes an imaging device 120, such as a camera assembly configured to capture images of the surgical cavity illuminated by the one or more light sources 118. The distal end 116 further includes one or more spectral filters positioned to filter light entering the imaging device 120, as discussed in more detail below in connection with FIG. 5.

[0037] The device 100 includes provisions for facilitating attachment of a drape to support sterility of the handheld device 100. For example, referring now to FIG. 19, a drape 1960 configured for use with the device 100 is shown. The drape 1960 can provide a sterile barrier between a non-sterile device contained within the drape and the sterile surgical field, thereby allowing a non-sterile device fully contained within the sterile drape to be used in a sterile environment. The drape can cover the handheld device 100 and can also provide a blackening shield extending from the distal end (e.g., distal end 116) to cover the area adjacent the surgical cavity, protecting the surgical cavity area from light intrusion from sources of light other than the handheld device 100. The drape may also include or be coupled with a rigid optical window, such as a lens cap 1962 (or, in other embodiments, lens cap 524, discussed further below in connection with FIG. 5) that covers the distal end of the handheld device 100 to ensure accurate transmission of light emitted from the light source 118 and corresponding transmission of light back to the imaging device 120. The body of the drape 1960 may include a polymeric material, such as polyethylene, polyurethane, or other polymeric material. Optionally, the lens cap 1962 may include a different material, such as polymethylmethacrylate (PMMA), or other rigid, optically clear polymers, glass, silicone, quartz, or other materials.

[0038] 20, the device 100 can be inserted into a drape 1960 to protect the device 100 from exposure to the surgical environment and ensure that non-sterile devices do not contaminate the sterile surgical field. The drape 1960 can be coupled to the device 100 with a retention device. As shown in FIG. 4, the distal end 116 of the handheld device 100 includes a circumferential groove 122 configured to interact with one or more features of the drape 1960 to retain the drape 1960 to the handheld device. For example, referring now to FIGS. 21A and 21B, the lens cap 1962 can optionally include features that engage the groove 122 (FIG. 4). 21A and 21B embodiment, the lens cap 1962 includes a plurality of legs 1964, each of which features an engagement tang 1966 that is configured to engage with the groove 122 (FIG. 4) when the lens cap 1962 is placed over the distal end 116 of the device 100. Additionally or alternatively, the drape can include a device such as a retaining ring or band to retain the drape on the handheld device 100. The retaining ring can be or include an elastic band, a snap ring, or a similar component.

[0039] In some embodiments, the handheld device 100 may include a built-in display screen instead of or in addition to a link to the hub 104 (FIG. 1). For example, the built-in screen may eliminate the need for an external display device, such as the display 106 and / or computer system 108, or may provide additional information to the user, such as the mode in which the handheld device 100 is operating. Furthermore, the displayed information may additionally or alternatively be provided to a head mounted display or projected onto a holographic display for augmented reality (AR) or virtual reality (VR) surgery, including remote and / or robotic surgery.

[0040] 4, in some exemplary embodiments, the handheld device 100 may include a channel 423 formed in a sidewall of the distal end 116. The channel 423 may be used to facilitate the insertion of additional tools, such as optical fibers for auxiliary light sources or auxiliary imaging sensors, cauterization tools, biopsy forceps, tagging tools (for marking tissue with clips, optical tags, dyes or paints, etc.), or other tools, while the handheld device 100 is positioned within the surgical site. Alternatively or additionally, some embodiments may include a channel formed in the distal tip 116 of the device 100, i.e., an internal channel within the device for introducing any of the above-mentioned tools to the surgical site while the handheld device 100 is in use.

[0041] The handheld device 100 may also include provisions to facilitate stand mounting of the device 100 during use. For example, while the handheld device 100 may be designed and constructed primarily for handheld use, in some circumstances it may be desirable to place the handheld device 100 on a stand or fixed mount, for example to ensure that the image context and position are consistent across multiple images during use as different images of the same tissue are taken. The handheld device may be coupled to a stand, such as a gooseneck type flexible stand with a weighted or clamp type mount to hold the assembly in place on a desk or surgical table. In other embodiments, the stand mount may be cart-based and may be moved outside of the surgical sterile field while holding the device. The stand mount may allow the device to be used without the user having to hold it in the user's hand. The stand may be configured to hold additional auxiliary light sources, imaging devices, support tools, such as biopsy forceps, tagging tools, or other devices.

[0042] 5, a perspective view of a distal end 516 of a handheld device according to an embodiment of the present disclosure is shown. The distal end 516 can be mated with a sterile lens cap 524. The lens cap 524 can be coupled with a drape as discussed above, which can be configured to cover the body of the handheld device and provide a light shield extending from the distal end of the handheld device to prevent ambient light from entering the area to be imaged by the handheld device. Similar to the embodiment of the lens cap 1962 of FIGS. 21A and 21B discussed above, the lens cap 524 can include one or more features configured to engage features of the distal end of the handheld device, such as by engaging the groove 122 shown in FIG. 4.

[0043] As discussed in more detail below, the handheld device includes various electrical subsystems including one or more imaging devices, such as a camera sensor, one or more fluorescent LEDs, one or more infrared LEDs, one or more white light LEDs, etc., and various sensors, such as temperature sensors, ambient light sensors, and distance sensors. Other components include one or more LED drivers that generate drive voltages to drive the LEDs on demand to achieve a set point drive current, and one or more LED sensors to allow the video stream to be tagged with the position of the handheld device, e.g., to provide the spatial orientation of features within a surgical cavity. The handheld device may include one or more accelerometers and gyroscopes, flash memory for providing local storage of video and still images, a USB hub for providing an interface for factory loading of software testing and calibration of the handheld device, an inductive battery charging system, motor drive electronics for providing automatic switching of optical filters as discussed below, a Wi-Fi radio subsystem, a user interface for providing information to the user regarding the mode of the device, a rechargeable battery (such as a lithium ion battery), an audio device such as a speaker for providing audible feedback of the system status to the user, and other components. Such components may be operatively coupled to one or more controllers, such as a computer processor, contained within the handheld device.

[0044] For example, in one embodiment, the handheld device includes one or both of an application processor and a microcontroller unit. The application processor can perform functions including, but not limited to, a camera interface and sending a video stream (e.g., still images and motion video) to a wireless transmission function for display or transmission of the data to a computer terminal, interfacing with an accelerometer, gyroscope, and on-board flash memory, interfacing with the microcontroller unit, driving a speaker for audible feedback to the user, and managing the wireless communication subsystem.

[0045] The microcontroller unit can provide functions such as controlling the LED drive electronics including a temperature compensation loop, communicating with temperature sensors, ambient light sensors and distance meters, and interfacing with an application processor for communicating and receiving system usage and context state. The microcontroller unit can also monitor the system for exception conditions, control indicator LEDs, control push buttons or other user interface devices, control the motor drives to switch between optical filters, monitor wireless battery charging and charging status, control power management as well as other functions.

[0046] Referring now to Figure 6, the distal end portion 516 of the handheld device shown in Figure 5 is shown in an end view. The handheld device 500 includes an imaging device 520 that may be or include a camera, such as an imaging device including a charge-coupled device (CCD), a complementary metal-oxide semiconductor (CMOS) device, or other image capture technology, such as a hyperspectral image sensor module. As shown in Figure 5, the imaging device 520 is in an offset position at the end of the handheld device 500. While the embodiments of Figures 5 and 6 include a single imaging device 520, other exemplary embodiments of the present disclosure may include two or more separate imaging devices to support additional imaging modes.

[0047] The handheld device 500 further includes a diffuser 522 that diffuses the light generated by the light source, for example, an LED similar to the LED 118 discussed in connection with the embodiment of Figures 2-4. The diffuser 522 can be configured to ensure that the light exiting the handheld device 500 is sufficiently diffused to uniformly illuminate the target area (e.g., a surgical cavity) to provide uniform excitation of the tissue. The diffuser 522 can be made from a polymeric material that scatters the light emitted by the LED into a more homogenous output. The diffuser 522 can include materials such as, for example, acrylic, polycarbonate, mylar, plastic film, or other materials. The diffuser 522 can be shaped so as not to interfere with other components at the distal end of the device 100, such as a temperature sensor, a range finder, an ambient light sensor, or other components described below in connection with Figure 8.

[0048] The handheld device may include one or more printed circuit board (PCB) components to facilitate manufacturing and assembly of the handheld device. For example, referring now to FIG. 7, the distal end 516 of the handheld device 500 is shown in an exploded view, illustrating a number of PCB components for mounting and interconnecting various electronic components. The handheld device 500 includes an LED PCB 726, which may include one or more light emitting diodes (LEDs) 718 and associated electrical components. The LED PCB 726 may be operatively coupled to other electronic systems of the handheld device via wiring (e.g., a bus) and may also be connected to a control system of the handheld device 500, e.g., controller 113 (FIG. 2), a power source, e.g., a battery, and the like. The distal end 516 may include an electric motor drive system 727 for rotating a filter wheel 938, discussed below in connection with FIG. 9.

[0049] The distal PCB 728 can be located adjacent to the imaging device 520 and can include components that support the imaging device 520, such as components that interface the imaging device 520 to the controller 113 (FIG. 2) and a power source for the handheld device 500, e.g., a battery. In some embodiments, the light source 118 (FIG. 2) for the handheld device can be included on the distal PCB 728.

[0050] For example, referring now to Figure 8, an example layout for a distal end PCB 830 is shown. In the embodiment of Figure 8, the PCB 830 includes first and second LED devices 832 and 834. By way of non-limiting example, the first and second LED devices 832 may include LEDs configured to emit light having a wavelength of 405 nm, while the second LED device 834 may include LEDs configured to emit light at a wavelength of 760 nm, 780 nm, or other wavelengths. The PCB 830 may further include a white light LED 836 configured to provide visual illumination to the area to be imaged.

[0051] As will be appreciated by those skilled in the art, the arrangement of components at the distal end of the imaging device can take many configurations. Such configurations can be driven by the size of the device, the footprint of the device, and the number of components used. However, functional factors should also be considered when arranging the components. For example, issues such as light leakage from the device's light source and / or ambient light entering the housing can interfere with the proper or optimal operation of the device and can also result in less than desirable outputs such as image artifacts. The configurations illustrated in Figures 6-8 and elsewhere herein represent example configurations in which the camera sensor is isolated to prevent light leakage from the light source and ambient light.

[0052] The distal PCB may include other components that are operatively coupled to the control system of the handheld device and configured to provide other information to the control system to support effective operation of the handheld device. For example, the distal PCB 830 may include a temperature sensor 833 that is used to provide feedback to the LED set point temperature compensation loop to ensure that the system is operating within a safe temperature range and to minimize the effect of temperature changes on the LED radiant flux. The LED radiant flux efficiency for a target light output as a function of LED drive current is temperature dependent, and as such, the temperature compensation loop adjusts the nominal LED drive set point as a function of temperature to facilitate maintaining a constant radiant flux over temperature. The temperature control loop may be implemented in software running on the microcontroller unit, fully in hardware, or a combination thereof.

[0053] Range finder 835 can measure the distance between the camera sensor and the target to be imaged, and , can be used to provide feedback to the user to guide the user in imaging at the correct distance. Changes in the measured target distance can optionally be utilized to trigger refocusing activity of the camera sensor. The ambient light sensor 837 can provide feedback to the user regarding the level of ambient light when fluorescence imaging is only effective in suitable dark environments. The measured ambient light level may also be useful during white light imaging mode to enable or control the intensity of the white light LED. The distal PCB 830 can be operatively coupled to other portions of the handheld device, such as the controller 113 (FIG. 2), a power source such as a battery, one or more processors such as a microcontroller unit and an application processor, or other components.

[0054] The LED devices 832, 834 and 836 can be controlled by a closed loop system using information from the temperature sensor as an input to a control loop that adjusts the LED drive current set point. In some embodiments, low and high range LED intensity modes can be supported for different applications. Examples include closed range imaging in surgical cavities and far range lumpectomy imaging in pathology suites.

[0055] As discussed above, the handheld device may include one or more optical filters configured to allow the passage of specific wavelengths or wavelength bands of light while blocking other wavelengths. By placing such a filter between the imaging device 520 (FIG. 6) and the area to be imaged, a specific wavelength or band of wavelengths is isolated in the image, allowing visualization of the area emitting light of that wavelength or wavelength band. For example, the handheld device may include one or more of a notch filter configured to pass a specified wavelength, a filter configured to transmit green (approximately 500-550 nm light) and red (approximately 600-660 nm) wavelengths, or other types of optical spectrum filters. One example of an optical filter configured to transmit green and red wavelengths is available from CHROMA® Technology Corp. (10 Imtec Corporation, 1-4000 1-1000 1-1000 1-8000 (Part No. 59022m), is available from Imtec Corporation, 1-8000 1-1000 1-8000 (Part No. 59022m). The one or more filters may be configured to allow a user to switch between one or more filters when using different light sources, different compounds or dyes, etc. Such filter switching may be performed automatically based on other user-defined settings of the handheld device, such as the user's selected mode.

[0056] The device can be modified using optical or variably oriented polarizing filters (e.g., linear or circular combined with optical waveplates) attached to the excitation / illumination light sources and imaging sensors in a rational manner. In this way, the device can be used to image tissue surfaces, either by white light reflectance and / or fluorescence imaging, with polarized illumination and non-polarized detection or vice versa or polarized illumination and polarized detection. This can allow imaging of tissues with minimal specular reflection (e.g., glare from white light imaging), as well as imaging of fluorescence polarization and / or anisotropy dependent changes in connective tissues (e.g., collagen and elastin) within the tissue. The ability to use polarized optics in the device allows for polarization of either the reflected light or the fluorescent light from targets. This can potentially provide improved image contrast, reflecting the 405 nm excitation light differently or emitting separate polarization information from the 500-550 nm and 600-660 nm emitted fluorescent light.

[0057] The handheld device can include components configured to allow filters to be rapidly switched in a manual or automated fashion. For example, referring now to FIG. 9, a filter wheel 938 according to an embodiment of the present disclosure is shown. The filter wheel can be positioned in the handheld device between an imaging device (e.g., imaging device 520) and the area to be imaged. For example, in the embodiment of FIGS. 5 and 6, the filter wheel can be at the distal end 516 of the handheld device, distal to the imaging device 520.

[0058] The filter wheel 938 includes a first optical filter 940 configured to support white light and infrared (WL / IR) imaging and a second optical filter 942 configured to support fluorescent (FL) imaging. The first filter 940 and the second filter 942 are disposed opposite each other across a rotation axis AR of the filter wheel 938 about which the filter wheel 938 is rotatable. As discussed above, the imaging device 520 (FIG. 6) can be offset so that each of the first filter 940 and the second filter 942 can be alternately positioned in front of the imaging device 520 as desired by a user. The filter wheel 938 can be rotated by an internal electromechanical system controllable by a user, such as a motor and pinion gear that meshes with a gear of the filter wheel 938 or other mechanism configured to rotate the filter wheel 938. As will be discussed in more detail below, in connection with Figures 10-15, a user may select one of the first filter 940 and the second filter 942 based on the compound or dye being used and / or the wavelength of excitation light being applied to the surgical cavity. Additionally or alternatively, rotation of the filter wheel 938 may be performed manually, such as by providing the filter wheel 938 with a peripheral surface that can be grasped by a user. Although the filter wheel 938 shown in Figure 9 includes two filters, other embodiments of the filter wheel may include three filters, four filters, or any desired number of desired filters that can fit onto the filter wheel 938.

[0059] In an exemplary embodiment, the first filter 940 includes a notch filter configured to block light having wavelengths between 675 nm and 825 nm and allow the passage of wavelengths less than 675 nm and greater than 825 nm. In a different embodiment, the first filter 940 can include a notch filter configured to block light having wavelengths between 690 nm and 840 nm and allow the passage of wavelengths less than 690 nm and greater than 825 nm. The second filter 942 can include an optical filter that transmits green and red light, for example, the filter having the characteristics discussed below in connection with Figures 12-15.

[0060] Referring now to Figure 30, a block diagram illustrating various components of a handheld imaging device according to an exemplary embodiment of the present disclosure is shown. In the diagram of Figure 30, the components are grouped into an optical PCB 3000 and an electronics system 3002. In the embodiment of Figure 30, the optical PCB includes four fluorescent wavelength LEDs 3004, two infrared LEDs 3006, and two white light LEDs 3008. The optical PCB further includes an ambient light sensor 3010, a laser range finder 3012, and a temperature sensor 3014.

[0061] The optical PCB 3000 is operatively coupled to an electronics system 3002. The electronics system 3002 can include electronic control components such as, for example and without limitation, an application processor module 3016, a real-time microcontroller unit (MCU) 3018, and a power management subsystem 3020. The electronics system 3002 can further include components and systems that interface with other electronics components of the handheld imaging device. For example, the electronics system 3002 can include a CMOS camera interface 3022 and motor drive electronics 3024 for the optical filter system. The electronics system can also include connectors 3026 and 3027 for a fluorescent camera and a white light camera, respectively, to facilitate switching between the fluorescent and white light imaging modes discussed herein.

[0062] Other supporting electronic systems and components of the electronics system 3002 include a flash memory device. The electronic system 3002 may include a memory such as a wireless device 3028, a rechargeable battery such as a lithium ion battery 3030, and an inductive battery charging system 3032. Some components of the electronic system 3002 may include communications components, such as a Wi-Fi and / or Bluetooth wireless subsystem 3034, and one or more of spatial orientation components, such as a magnetometer, an accelerometer, and a gyroscope 3035.

[0063] The electronics system 3002 can include various user controls, such as a power switch 3036, a system status LED 3038, a charging status LED 3040, a picture capture switch 3042, a video capture switch 3044, and an imaging mode switch 3046. The various user controls can interface with other components of the electronics system via a user interface module 3048 that provides signals to and from the user controls.

[0064] Other components of the electronics system 3002 can include drivers 3050 for fluorescent, infrared, and white light LEDs, and a USB hub 3052 for uplink and downlink data signals and / or power from an external computer system, such as a workstation or other computer, to which the electronics system 3002 can be connected via the USB hub 3052. The electronics system 3002 can also include one or more devices for providing feedback to a user, such as, but not limited to, a speaker 3054. Other feedback devices can include various audible and visual indicators, tactile feedback devices, displays, and other devices.

[0065] The electronics system 3002 (FIG. 30) can be operatively coupled to a computer by a USB hub 3052 (FIG. 30) via a detachable USB connection cable 3156 as shown in FIG. 31. The cable 3156 can include various features configured to ensure that the cable does not interfere with the surgical field and to ensure that the cable is not inadvertently detached from the handheld device during use. Although the description herein may refer to a Universal Serial Bus (USB) type connection, it should be understood that the present disclosure is not limited to any particular connection protocol, and that connection protocols other than various types of USB interfaces are within the scope of the present disclosure.

[0066] The cable 3156 can include a shaped strain relief feature 3158 to facilitate keeping the cable out of interference with the surgical field. For example, in the embodiment of FIG. 31, the cable 3156 is configured to be inserted into a connection port on the back of a handheld device according to the present disclosure. The strain relief feature 3158 is shaped to create an approximately 90 degree curvature in the cable 3156 when in an unstressed state. The curvature of the cable 3156 facilitates routing of the cable 3156 to and away from the surgical field. The cable curvature can be less than or greater than 90 degrees. As an exemplary range, the cable curvature can be, but is not limited to, 70 degrees to 110 degrees. Curves less than 70 degrees or greater than 110 degrees are within the scope of the present disclosure. The particular shape of the cable imparted by the strain relief feature 3158 may depend on the location of the connection port on the handheld device. For example, for a handheld device with a connection port on the side, the strain relief feature can be straightened for routing the cable away from the surgical field.

[0067] The cable 3156 may also include a connection interface 3160 configured to electrically and mechanically couple the cable 3156 to a handheld device. The connection interface 3160 may include a locking ring 3162 that provides a positive mechanical engagement between the cable 3156 and the handheld device, preventing the cable 3156 from being inadvertently pulled from the handheld device during use.

[0068] For example, referring now to FIG. 32 , a portion of the housing 3263 is shown including a connection port 3264 configured to receive a connection interface 3160 of the cable 3156. The connection port 3160 includes a peripheral portion including a slot 3265 configured to receive a corresponding tab 3266 of the locking ring 3162. After the locking ring 3162 is inserted such that the tab 3266 of the locking ring 3162 is received in the slot 3265, the locking ring 3162 is rotated such that the tab 3266 rotates into the circumferentially extending portion 3267 of the slot 3265 and the locking ring 3162 retains the connection interface 3160 within the connection port 3264.

[0069] The locking ring 3162 and the surrounding portion may comprise a material having sufficient mechanical strength to withstand forces that may be applied to the connection interface 3160 during use. For example, one or both of the locking ring 3162 and the surrounding portion of the connection port 3264 may comprise a metal, such as an aluminum alloy, a high strength polymer, a composite material, or other material.

[0070] Because the strain relief feature 3158 routes the cable away from the handheld device, application of a force to the cable 3156 and / or the strain relief feature 3158 can generate a relatively large torque at the connection interface 3160 thanks to the strain relief feature 3158 acting as a moment arm. The connection interface 3160 of the cable 3156 and the corresponding connection port of the housing of the handheld device can include features configured to withstand such torque and other forces without applying these forces to the more sensitive electrical contact components of the connection interface 3160 and the corresponding connection port.

[0071] For example, the connection port 3264 can include a pin 3268 extending from a face of the port 3264. The connection interface 3160 of the cable 3156 includes recesses 3269 (only one of which is shown in FIG. 32 ) in which the pin 3268 is received. The pin 3268 and recess 3269 form a mechanical interface between the connection port 3264 and the connection interface 3160 that has sufficient mechanical strength to withstand typical forces to which the cable 3156 and the connection port 3264 are exposed during use and also prevents excessive stress from being placed on the electrical interface components of the connection port 3264 and the connection interface 3160.

[0072] Additionally, in some exemplary embodiments, one or both of the connection port 3264 and the connection interface 3160 can include a seal to prevent ingress of various contaminants, such as biological or therapeutic liquids or substances, into the electrical contacts of the connection port 3264 and the connection interface 3160. For example, in the embodiment of FIG. 32, the connection port 3264 includes a gasket 3270 that forms a seal against the connection interface 3160 when the connection interface 3264 is secured to the connection port 3264 with the locking ring 3162. Additionally, in some embodiments, the gasket or other seal can be configured to provide a preload force between the connection port 3264 and the connection interface 3160 to help secure the locking ring 3162 in the mated state of the connection interface 3160 at the connection port 3264. When in the mated state, the cable 3156 can provide a data and / or power transmission conduit for a handheld device to be attached to the computer, as discussed above. Additionally, the cable 3156 may include a sterile sheath configured to be attached to a sterile drape 1960 (FIG. 19) to maintain a sterile barrier between the handheld device 100 and the surgical field when the cable 3156 is coupled to the connection port 3264.

[0073] 10-15 show potential use scenarios for handheld devices according to various embodiments of the present disclosure. 10, in this usage scenario, tissue is illuminated with a light source (such as, for example, one or more LEDs 118 of the handheld device 100) that provides an excitation light wavelength of 760 nm. The tissue is treated with an IR dye, such as ICG. A filter positioned to filter light entering an imaging device, such as imaging device 520 (FIG. 6), includes a 760 nm notch filter to filter the excitation light from capture by the image sensor. The filter has a notch between 675 nm and 825 nm. As can be seen in the chart of FIG. 10, light emitted from the ICG-treated tissue has an emission wavelength of 835 nm and thus passes through the notch filter and is captured by the image sensor, thereby generating an image revealing the ICG-treated tissue.

[0074] Referring now to Figure 11, tissue is illuminated with a light source having a wavelength of 780 nm. A notch filter with a short pass wavelength of 690 nm and a long pass wavelength of 840 nm is used to filter the light returning to the imaging device. The tissue is treated with an IR dye such as ICG, which when excited by the 780 nm light source emits light having a peak intensity wavelength of 835 nm that passes through the notch filter and is captured by the imaging device, again revealing the ICG-treated tissue in the resulting image.

[0075] 12-15 are example usage scenarios in which the handheld device is used for fluorescence imaging to improve tumor-to-normal contrast. Referring now to FIG. 12, a subject may be given a diagnostic dose of aminolevulinic acid (ALA) to induce PpIX formation in tumor tissue. The tissue is illuminated with a light source having a wavelength of 405 nm. A CHROMA® filter transmitting green and red wavelengths is used to filter the light captured by the imaging device. As shown in FIG. 12, PpIX emits light having a wavelength of 635 nm within the red transmission band of the filter, and thus can be captured by the imaging device, revealing the tissue in which PpIX formation was induced in the resulting image.

[0076] 13-15 present examples similar to that of FIG. 12, where various modifications have been made to the filter used in FIG. 12 to improve tumor-to-normal contrast. In FIG. 13, the filter is modified to reduce the green band transmission by about 50%. In other embodiments, the reduction in green band transmission can be less than or greater than 50%, for example, any amount in the range of about 10% to about 90%, less than 10%, or greater than 90%. In FIG. 14, the filter is modified to broaden the red transmission band to 600-725 nm (from about 600-675 nm shown in FIGS. 12 and 13). In FIG. 15, the filter is modified to both reduce the green band transmission by 50% and broaden the red band transmission to 725 nm.

[0077] According to embodiments of the present disclosure, changing from the white light and infrared imaging modes discussed in connection with FIGS. 10 and 11 to the fluorescence imaging modes discussed in connection with FIGS. 12-15 can be accomplished by rotating a filter wheel 938 (FIG. 9) so that a desired filter (e.g., a notch filter or a filter that transmits green and red wavelengths) is placed in front of the imaging device to filter the light wavelengths returning to the handheld device. A controller of the handheld device, such as controller 113 (FIG. 2), can include a switch, button, etc., to switch the light source from a 760 nm or 780 nm LED to a 405 nm LED or a white light LED. In some embodiments of the present disclosure, the filter wheel can be configured to automatically rotate from one filter to another based on the selected mode of the handheld device, e.g., user input at controller 113.

[0078] The handheld device may be further configured to provide imaging modes in addition to those described above. For example, the handheld device may include a handheld device in which the image sensor, light source, and filters are aligned to the screen. It may include a mode configured to provide three-dimensional imaging for topographical mapping of an imaged surface. Additional details regarding the use of three-dimensional imaging may be found in Provisional Application No. 62 / 793,837 (filed Jan. 17, 2019 and entitled "Systems, Methods, and Devices for Three-Dimensional Imaging, Measurement, and Display of Wounds and Tissue Specimens"), the entire contents of which are incorporated herein by reference.

[0079] As an example of another imaging mode, the handheld device can be configured to provide fluorescence lifetime imaging of tissue. Fluorophores such as PpIX have a fluorescence emission decay profile that dictates how quickly the visible fluorescent light fades once the excitation source is removed. Thus, by capturing an image immediately after the excitation source is removed or stopped, different fluorophores can be imaged in isolation by tailoring the image capture time of each unique fluorophore after the excitation source that excited the particular fluorophore is removed. For example, if PpIX and another fluorophore have decay times of 9 ns and 5 ns, respectively, PpIX can be imaged in isolation by capturing an image between 5 and 9 ns after the excitation source is removed. In this manner, fluorescence lifetime imaging can enable the detection of multiple unique fluorophores by their respective fluorescence lifetime signatures based on differences in the exponential decay rates of the fluorescence from the fluorophores. Such a time-resolved fluorescence imaging method can be achieved by pulsing the various excitation wavelength LEDs and gating the imaging sensor to detect the fluorophore lifetime of interest. Fluorescence lifetime imaging of tissue can be used to identify and distinguish between healthy and diseased tissues, as well as between different tissue components, including other biological components such as microorganisms and intrinsically fluorescent agents or drugs.

[0080] Other possible imaging modes can include various combinations of white light imaging, infrared imaging, and fluorescence imaging. For example, in one possible imaging mode, both white light and IR light sources are used to illuminate the tissue. An infrared dye, such as ICG, can be excited by the IR light source, and the resulting IR image can be superimposed onto the white light image to place the IR image in an anatomical context.

[0081] In another imaging mode, white light illumination is followed by 405 nm light illumination. Imaging filters for WL / IR are used during white light illumination and FL filters are used during 405 nm illumination. Sequential white light and fluorescent images can be captured and superimposed to provide anatomical context (white light image) for tumor location (FL image). For example, as shown in FIG. 16, display 1600 can be partitioned into several panels. Panel 1602 displays a static white light image while panel 1604 displays a static fluorescent image. Panel 1606 displays an image where the fluorescent image is superimposed on the white light image. Panel 1608 displays a dynamic display that can switch between white light and fluorescent images as desired. In the case of dynamic panel 1608 in fluorescent mode, the user would then scan the cavity / sample to find fluorescent tumor tissue and possibly tag the tissue with a vascular clip or similar. Fluorescence superimposition on the white light (static) panel 1606 will provide anatomical context during this procedure. If the dynamic panel 1608 is in white light mode, the user will scan the fossa or sample to find the location that corresponds to the static white light panel 1602, and then use the fluorescence image superimposed on the white light image in panel 1606 to determine where the tumor tissue is located.

[0082] 17, a similar configuration can include white light and infrared images. For example, a display 1700 can be divided into panels 1702, 1704, 1706, and 1708. Panel 1702 displays a static white light image. Panel 1708 displays a static white light image. Panel 704 displays a static infrared image. Panel 1706 provides a static image of the infrared image superimposed on a white light image. Finally, panel 1708 provides a dynamic view that can be switched between the white light image and the infrared image as desired.

[0083] If the dynamic panel 1708 is in infrared mode, then the user will scan the fossa / sample to align with the infrared (static) panel 1704. The infrared superimposition on the white light (static) panel 1706 will provide anatomical context during this procedure.

[0084] If the dynamic panel 1708 is in white light mode, then the user would scan the fossa / sample to find the location that corresponds to the white light (static) panel 1702, and then use the infrared overlay on the white light (static) panel 1706 to determine where the relevant tissue is located.

[0085] Referring now to FIG. 18, another imaging mode is disclosed. A white light image, an infrared image, and a fluorescent image after switching the white light / infrared filter to a fluorescent filter are captured sequentially. The display 1800 is partitioned into display panels 1802-1816 as shown in FIG. 1800, and includes white light, infrared, and fluorescent static panels and various overlays. The dynamic panel 1816 can display any one of the white light, infrared, and fluorescent images. If the dynamic panel 1816 is in a fluorescent mode, then the user will scan the fossa / sample to find red fluorescence and possibly tag the tissue with a vascular clip or similar. The fluorescent overlay on the white light (static) panel will provide anatomical context during the procedure. The fluorescent + infrared (static) panel will show vasculature or other infrared fluorescent tissue components in the field of view coexisting with green and red fluorescence. If the dynamic panel 1816 is in white light mode, then the user would scan the fossa / sample to find the location that corresponds to the white light (static) panel, and then use the fluorescent superposition on the white light (static) panel and the infrared superposition on the white light (static) panel to determine where the relevant tissue is located.

[0086] 22-28, another embodiment of a handheld device 2200 is shown. While the embodiments discussed above describe various configurations of switchable filters, such as the filter wheel 938 (FIG. 9), other embodiments, such as the embodiment illustrated in FIGS. 22-28, include multiple filters and multiple cameras with fixed positions. In such embodiments, the handheld device 2200 can simply switch modes by activating different light sources and cameras, and no changes in the mechanical configuration are required to move between modes.

[0087] 22 shows a front perspective view of a handheld device 2200. The handheld device 2200 includes a first end portion 2212 that is sized and shaped for a user to grasp and hold the handheld device 2200. Opposite the first end portion 2212 is a second end portion 2214, which may include one or more optical filters, one or more light sources, and one or more sensors, such as imaging sensors, temperature sensors, and proximity sensors, as in the embodiments discussed above.

[0088] 23, a top view of a handheld device 2200 is shown. The handheld device 2200 includes a control array 2250. In the illustrated embodiment, the control array 2250 includes three buttons 2252. The buttons 2252 provide a user with an interface for switching between various imaging modes of the handheld device 2200, such as the various infrared and fluorescent imaging modes discussed above in connection with other embodiments of the handheld device. The buttons 2252 are located on the housing of the handheld device 2200. A hermetic seal can be provided around it to simplify cleaning of the device and prevent contamination of the internal components of the handheld device 2200 .

[0089] 24, a perspective view of a first portion 2212 of a handheld device 2200 is shown. In the embodiment of FIGS. 22-28, the handheld device 2200 has a removable cover portion 2254 that covers various components of the handheld device 2200, such as an electrical connection port 2256. In this illustrated embodiment, the electrical connection port 2256 is a Universal Serial Bus (USB) port, facilitating connection of the handheld device 2200 to external devices, such as computers (such as PC workstations), tablets, phones, and other devices, for various tasks such as updating the software and firmware of the handheld device 2200, downloading images stored in the memory of the handheld device 2200, and the like. Additionally or alternatively, the device can be directly connected to a storage device, such as a USB stick, USB flash drive, or thumb drive, for directly transferring data. For example, the handheld device can download data, images, and / or other material to the storage device. In another example, the storage device can be used to load new software or instructions into the handheld device. As discussed above with respect to the previous embodiment, such activities can optionally be accomplished using a wireless communication link between the handheld device 2200 and an external device, such as a computer, tablet, phone, or other device. In some embodiments, the handheld device 200 can include both USB connectivity and wireless communication (such as Wi-Fi, Bluetooth, etc.) functionality.

[0090] FIG. 25 shows a rear view of the cover portion 2254 of the handheld device 2200. The cover portion 2254 includes a fastener device 2258 that facilitates removal and installation of the cover portion 2254 by a user. For example, in the embodiment of FIG. 25, the fastener device 2258 is a quarter turn fastener that locks the cover portion 2254 in place on the handheld device 2200. To remove the cover portion 2254, the user simply rotates the fastener device 2258 a quarter turn to remove the cover portion 2254 from the handheld device 2258. The fastener device 2258 can take many other forms, as will be understood by those skilled in the art. The cover portion 2254 can also include a gasket 2260 (FIG. 24) that forms a seal between the cover portion 2254 and the handheld device 2200 to prevent contamination of the internal components of the handheld device 2200.

[0091] In some embodiments, the handheld device 2200 can include a removable lens assembly configured to protect components located within the second end 2214. Referring now to FIG. 26, the second end portion 2214 is shown with the lens assembly 2262 removed from the handheld device 2200. The lens assembly 2262 can include a lens frame 2264 connected to an optically transmissive lens 2266. In this embodiment, the lens frame 2264 can include a metal or metal alloy material, and the optically transmissive lens 2266 can include glass or another optically transmissive material, such as an acrylic or other polymer. The optically transmissive lens 2266 can be connected to the lens frame 2264 using a bonding agent, such as a biocompatible epoxy or other suitable bonding agent. The lens assembly 2262 can be coupled to the handheld device 2200 in any suitable manner, such as by screws or other fasteners. 26, the lens assembly 2262 includes an opaque barrier 2265 positioned and configured to isolate different portions of the lens assembly 2262. For example, the opaque barrier 2265 is configured to isolate an optical sensor (such as the optical sensor discussed in connection with FIG. 28) from various light sources (such as light sources 2270, 2274, and 2276 discussed in connection with FIG. 28) located at the second end 2214 of the handheld device 2200.

[0092] FIG. 27 shows another exploded view of the handheld device 2200. As shown in FIG. The handheld device 2200 includes a heat sink 2268 in which the second end components, such as a camera, light source, and various other sensors, are contained as discussed below. The heat sink 2268 can be hollow to reduce weight, while still providing effective heat transfer from the components at the second end 2214 towards the body of the handheld device 2200. The heat sink 2268 can include a material having desired heat transfer properties, such as, for example, copper, aluminum, other metals or metal alloys, or other thermally conductive materials. When assembled into the handheld device 2200, the heat sink 2268 can extend from the second end 2214 towards the first end 2212 of the handheld device through a neck portion 2270 of the handheld device.

[0093] 28 is a close-up view of the second end 2214 of the handheld device 2200, illustrating various components of the second end 2214. The second end 2214 of the handheld device 2200 includes a plurality of excitation light sources 2270 (e.g., LEDs emitting excitation light having wavelengths of about 350 nm to about 400 nm, about 400 nm to about 450 nm, about 450 nm to about 500 nm, about 500 nm to about 550 nm, about 550 nm to about 600 nm, about 600 nm to about 650 nm, about 650 nm to about 700 nm, about 700 nm to about 750 nm, about 750 nm to about 800 nm, about 800 nm to about 850 nm, about 850 nm to about 900 nm, and / or combinations thereof) and a first optical filter 2272 configured to support fluorescence imaging. In one example embodiment, the excitation light source 2270 is configured to emit excitation light in the blue / violet range, for example, emitting excitation light having a wavelength of about 405 nm. The excitation light source 2270 can be generally positioned around the first optical filter 2272, and a first optical sensor, such as a camera (not visible), can be positioned behind the first optical filter 2272. FL imaging is used, for example, to visualize cancerous seeds in breast tissue. Cancerous seeds in breast tissue are visualized by illuminating the breast tissue with violet light (405 nm) to excite protoporphyrin (PpIX) accumulated in the cancer cells following ingestion of 5-aminolevulinic acid (ALA) by the patient. Localized PpIX within the cancerous tumor absorbs the excitation light (405 nm) and then emits light at longer wavelengths (peak at 635 nm), allowing visualization of the cancerous seeds in the breast tissue. See, for example, Figures 12-15.

[0094] The second end 2214 also includes one or more white light sources 2274 (such as LEDs) that emit visible white light. The white light source 2274 is located adjacent to a second optical filter 2278. WL imaging illuminates the entire field of view (FOV) to observe and capture images of breast tissue under standard lighting conditions similar to those present in an operating room setting.

[0095] One or more infrared light sources 2276 (infrared excitation light sources) are also located adjacent to the second optical filter 2278. The infrared excitation light sources can emit excitation light having a wavelength between about 700 nm and about 1 mm. In one example embodiment, the infrared excitation light sources can emit excitation wavelengths between about 750 nm and about 800 nm. In another example embodiment, the infrared excitation light sources can be configured to emit excitation wavelengths between about 760 nm and 780 nm. In another example embodiment, the infrared excitation light sources can be configured to emit excitation wavelengths of about 760 nm ± 15 nm. The second optical filter 2278 can be positioned in front of a second optical sensor, such as a camera (not shown), and the second optical filter 2278 can be configured to support imaging using white light or infrared light, as discussed in detail above. IR imaging can be used with indocyanine green (ICG) dye to visualize biological structures such as lymph nodes and blood vessels during breast-conserving surgery. ICG is a cyanine dye that is administered intravenously to patients and binds tightly to β-lipoproteins and in particular to albumin. Albumins are a family of globular proteins that are commonly found in plasma and the circulatory system. Additionally, due to the high protein content of lymph nodes, ICG accumulates in lymphatic pathways and lymph nodes. The accumulation of ICG makes it possible to visualize lymph nodes and vascular structures using IR imaging. CG is a dye and fluoresces after excitation under near-infrared light with a peak absorption at 800 nm and a peak emission at 835 nm. (See, for example, Figures 10 and 11.) As a further example, Figure 29 shows the ICG emission and ICG absorption wavelengths measured in a 60 μM aqueous solution.

[0096] The second end 2214 may also include other components such as an ambient light sensor 2280, a range finder 2282, a temperature sensor 2284, and other sensors or components. In an exemplary embodiment, the handheld device 2200 includes separate optical sensors (e.g., cameras) disposed behind each of the first optical filter 2272 and the second optical filter 2278.

[0097] A control array 2250 (FIG. 23) can be operatively coupled to various components within the handheld device 2200 via a controller (such as one or more microprocessors and associated components) to enable a user to switch between fluorescent, white light, or infrared imaging modes. The configuration of the handheld device 2200 of FIGS. 22-28 enables switching between fluorescent and IR / white light imaging modes without any mechanical configuration changes within the handheld device 2200, thereby contributing to a quick change of modes and potentially reducing the possibility of mechanical failure of components.

[0098] Furthermore, the devices and methods may include additional components or steps omitted from the drawings for clarity of illustration and / or operation. Thus, this description should be construed as merely illustrative and for the purpose of teaching those skilled in the art the general manner of carrying out the present disclosure. It should be understood that the various embodiments shown and described herein should be construed as illustrative. Elements and materials, and the arrangements of these elements and materials, can be substituted for those illustrated and described herein, parts and processes can be reversed, and certain features of the present disclosure can be utilized independently, all as would be apparent to one skilled in the art after having the benefit of the description herein. Changes can be made in the elements described herein without departing from the spirit and scope of the present disclosure and the following claims, including equivalents thereof.

[0099] It should be understood that the particular examples and embodiments described herein are not limiting, and modifications in construction, dimensions, materials, and methodologies may be made without departing from the scope of the present disclosure.

[0100] Furthermore, the terms of this description are not intended to be limiting of the disclosure. For example, spatially relative terms such as "lower," "below," "lower side," "upper," "top," "bottom," "right," "left," "proximal," "distal," "front," and the like may be used to describe the relationship of one element or feature to another element or feature as illustrated in the figures. It is intended that these spatially relative terms encompass different positions (i.e., locations) and orientations (i.e., rotational configurations) of the device in use or operation in addition to the positions and orientations shown in the figures.

[0101] For purposes of this specification and the appended claims, unless otherwise indicated, all numbers expressing quantities, percentages or proportions, and other numerical values ​​used in the specification and claims are to be understood as being modified in all instances, if not already so, by the term "about." Accordingly, unless indicated to the contrary, the numerical parameters set forth in the following specification and appended claims are approximations that may vary depending upon the desired properties sought to be obtained by the present disclosure. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should be expressed as In light of the number of significant digits conveyed, interpretation should at the very least be exercised by applying ordinary rounding techniques.

[0102] Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the present disclosure are approximations, the numerical values ​​set forth in the specific examples are reported as precisely as possible. However, any numerical value inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements. Moreover, all ranges disclosed herein should be understood to encompass any and all subranges subsumed therein.

[0103] It should be noted that, as used in this specification and the appended claims, the singular forms "a," "an," and "the," as well as any singular use of any word, include plural referents unless clearly and explicitly limited to one referent. As used herein, the term "comprises" and grammatical variations thereof are intended to be non-limiting, and thus, the recitation of items in a specification does not exclude other similar items that may be substituted for or added to the specified items.

[0104] It is to be understood that although the disclosure has been described in detail with respect to various exemplary embodiments thereof, it should not be considered limited thereto, and that numerous modifications are possible thereto without departing from the broad scope of the appended claims, including equivalents thereto which they encompass.

Claims

1. a body having a first end portion configured to be held in a user's hand and a second end portion configured to direct light toward a surgical margin; at least one excitation light source configured to excite autofluorescence emission of tissue cells and fluorescence emission of derived porphyrins in tissue cells of said surgical margin; a white light source configured to illuminate the surgical margin during white light imaging of the surgical margin; An imaging sensor; a first optical filter configured to filter light signals emitted by the surgical margin in response to illumination by excitation light to allow autofluorescence emissions of tissue cells and fluorescence emissions of the derived porphyrins in the tissue cells to pass to the imaging sensor; a second optical filter configured to filter light signals emitted by the surgical margin in response to illumination with white light to allow passage of white light emissions of tissue within the surgical margin to the imaging sensor; 1. An imaging device comprising:

2. The imaging device of claim 1 , wherein the first optical filter and the second optical filter are configured to be interleaved to filter optical signals passing through the filters to the imaging sensor.

3. The imaging device of claim 2 , wherein the first optical filter and the second optical filter are disposed on a filter wheel that is rotatable relative to the imaging sensor.

4. The filter wheel includes: a first position, in which the first optical filter filters an optical signal passing through the first filter to the imaging sensor; a second position, in which the second optical filter filters the optical signal passing through the second filter to the imaging sensor; and 4. The imaging device of claim 3 , operably coupled to an electric motor drive configured to rotate the filter wheel between

5. The imaging device of claim 4 , wherein the device further comprises a processor, the electric motor drive being in signal communication with the processor.

6. The imaging device according to any one of claims 3 to 5, wherein the rotatable filter wheel is arranged distal to the imaging sensor.

7. The imaging device according to any one of claims 1 to 6, wherein the excitation light source comprises a first excitation light source and a second excitation light source.

8. 8. The imaging device of claim 7, wherein the first excitation light source is configured to emit excitation light having a wavelength of about 350 nm to about 400 nm, about 400 nm to about 450 nm, about 450 nm to about 500 nm, about 500 nm to about 550 nm, about 550 nm to about 600 nm, about 600 nm to about 650 nm, about 650 nm to about 700 nm, about 700 nm to about 750 nm, about 750 nm to about 800 nm, about 800 nm to about 850 nm, about 850 nm to about 900 nm, and / or combinations thereof.

9. The imaging device of claim 8 , wherein the first excitation light source is configured to emit excitation light having a wavelength of about 400 nm to about 450 nm.

10. 10. The imaging device of claim 9, wherein the first excitation light source is configured to emit excitation light having a wavelength of about 405 nm ± 10 nm.

11. 8. The imaging device of claim 7, wherein the second excitation light source is configured to emit excitation light having a wavelength of about 350 nm to about 400 nm, about 400 nm to about 450 nm, about 450 nm to about 500 nm, about 500 nm to about 550 nm, about 550 nm to about 600 nm, about 600 nm to about 650 nm, about 650 nm to about 700 nm, about 700 nm to about 750 nm, about 750 nm to about 800 nm, about 800 nm to about 850 nm, about 850 nm to about 900 nm, and / or combinations thereof.

12. The imaging device of claim 11 , wherein the second excitation light source is configured to emit excitation light having a wavelength between about 750 nm and 800 nm.

13. The imaging device of claim 12 , wherein the second excitation light source is configured to emit excitation light having a wavelength between about 760 nm and about 780 nm.

14. The imaging device of claim 13 , wherein the second excitation light source is configured to emit excitation light having a wavelength of about 760 nm±10 nm.

15. The imaging device of claim 13 , wherein the second excitation light source is configured to emit excitation light having a wavelength of about 770 nm±10 nm.

16. The imaging device of claim 13 , wherein the second excitation light source is configured to emit excitation light having a wavelength of about 780 nm±10 nm.

17. The imaging device of claim 1 , wherein the first optical filter is configured to allow passage of optical signals having wavelengths from about 500 nm to about 550 nm and / or from about 600 nm to about 675 nm.

18. The imaging device of claim 1 , wherein the first optical filter is configured to allow passage of optical signals having wavelengths from about 500 nm to about 550 nm and / or from about 600 nm to about 725 nm.

19. The imaging device of claim 1 , wherein the first optical filter is configured to allow passage of an optical signal having a wavelength of about 635 nm.

20. 19. The imaging device of claim 17 or claim 18, wherein the first optical filter is configured to attenuate the passage of optical signals having wavelengths from about 500 nm to about 550 nm by an amount in the range of from about 10% to about 90%.

21. The imaging device of claim 1 , wherein the second optical filter is configured to allow passage of optical signals having wavelengths below about 675 nm and above about 825 nm.

22. The imaging device of claim 1 , wherein the second optical filter is configured to allow passage of optical signals having wavelengths below about 690 nm and above about 840 nm.

23. 23. The imaging device of claim 21 or claim 22, wherein the second optical filter is configured to allow passage of an optical signal having a wavelength of about 835 nm.

24. The imaging device of any one of claims 1 to 23, wherein the imaging sensor comprises a complementary metal oxide semiconductor (CMOS) sensor.

25. The imaging device of claim 1 , wherein the first filter and the second filter each have a fixed position relative to the body of the imaging device.

26. 26. The imaging device of claim 25, wherein the excitation light source is adjacent to the first optical filter and the white light source is adjacent to the second optical filter.

27. the imaging sensor is a first imaging sensor; the imaging device includes a second imaging sensor; the first optical filter is positioned to filter an optical signal entering the first imaging sensor; 26. The imaging device of claim 25, wherein the second optical filter is positioned to filter an optical signal entering the second imaging sensor.

28. The imaging device of claim 1 , further comprising a connection port configured to receive a connection cable for connecting the imaging device to an external computer system.

29. 30. The imaging device of claim 28, wherein the connection port includes a feature configured to interact with the connection cable to prevent rotation of the connection cable relative to the connection port.

30. The imaging device of any one of claims 1 to 29, a sterile drape configured to form a sterile barrier between the imaging device and the environment in which the imaging device is used; 1. An imaging system comprising:

31. The sterile drape comprises: a first portion configured to form a sterile barrier between the imaging device and an environment in which the imaging device is used; a second portion configured to shield the surgical cavity from ambient light; 31. The imaging system of claim 30, comprising:

32. 32. The imaging system of claim 30 or claim 31, wherein the sterile drape includes an optically clear lens cap positioned over the imaging sensor when the sterile drape is placed over the imaging device.

33. 33. The imaging system of claim 32, wherein the lens cap is configured to engage a feature of the second end portion of the device.

34. 34. The imaging system of claim 33, wherein the feature of the second end portion of the device includes a circumferential groove.

35. The imaging system of any one of claims 30 and 32-34, further comprising a darkening drape configured to reduce ambient light at the surgical margin to be imaged.

36. The imaging system of any one of claims 30 to 35, further comprising a connection cable having a portion configured to connect to the connection port of the imaging device in a non-rotatable manner.

37. 37. The imaging system of claim 36, further comprising a sterile sheath for the connecting cable.

38. a body having a first end portion configured to be held in a user's hand and a second end portion configured to direct light toward a surgical margin; a first excitation light source configured to emit excitation light having a first wavelength; a second excitation light source configured to emit excitation light having a second wavelength; an imaging sensor configured to detect the release of the surgical margin; a first optical filter configured to filter an optical signal emitted by the surgical margin in response to illumination of the surgical margin with the first excitation light, the first optical filter configured to allow an optical signal having a wavelength corresponding to a first characteristic of the surgical margin to pass through the filter to the imaging sensor; a second optical filter configured to filter an optical signal emitted by the surgical margin in response to illumination of the surgical margin with the first excitation light, the second optical filter configured to allow an optical signal having a wavelength corresponding to a second characteristic of the surgical margin different from the first characteristic to pass through the filter to the imaging sensor; 1. An imaging device comprising:

39. the first optical filter is configured to be positioned to filter optical light passing to the image sensor when the first light source is activated; 40. The imaging device of claim 38, wherein the second optical filter is configured to be positioned to filter optical light passing to the imaging sensor when the second light source is activated.

40. 40. The imaging device of claim 39, wherein the first and second optical filters are on a filter wheel that is rotatable relative to the imaging sensor.

41. In a first mode of operation, the first light source is activated to illuminate a target tissue, and the first optical filter is positioned to filter an optical signal emitted by the target tissue in response to the illumination and entering the image sensor; An imaging device according to any one of claims 38 to 40, wherein in a second operating mode, the second light source is activated to illuminate the target tissue and the second optical filter is positioned to filter light entering the image sensor.

42. 40. The imaging device of claim 38, wherein the first optical filter and the second optical filter each have a fixed position relative to the body of the imaging device.

43. 43. The imaging device of claim 42, wherein the first excitation light source is adjacent to the first optical filter and the second excitation light source is adjacent to the second optical filter.

44. the imaging sensor is a first imaging sensor; the imaging device includes a second imaging sensor; the first optical filter is positioned to filter an optical signal entering the first imaging sensor; 40. The imaging device of claim 38, wherein the second optical filter is positioned to filter an optical signal entering the second imaging sensor.

45. The imaging device of any one of claims 38 to 44, a sterile drape configured to form a sterile barrier between the imaging device and the environment in which the imaging device is used; 1. An imaging system comprising:

46. 46. ​​The imaging system of claim 45, wherein the sterile drape includes an optically clear lens cap positioned over the imaging sensor when the sterile drape is placed over the imaging device.

47. 47. The imaging system of claim 44 or claim 46, further comprising a darkening drape configured to reduce ambient light in a surgical cavity to be imaged.

48. The imaging system of any one of claims 44 to 47, further comprising a connection cable having a portion configured to connect in a non-rotatable manner to a connection port of the imaging device.

49. 49. The imaging system of claim 48, further comprising a sterile sheath for the connecting cable.

50. 1. A method of imaging tissue at a surgical margin, comprising: illuminating the tissue at the surgical margin with a first excitation light source configured to emit excitation light having a first wavelength; receiving an optical signal emitted by the tissue at the surgical margin through a first optical filter of an imaging device; illuminating the tissue at the surgical margin with a second excitation light source configured to emit excitation light having a second wavelength; receiving an optical signal emitted by the tissue at the surgical margin through a second optical filter of the imaging device; The method includes:

51. Based on the signal from the processor, moving the first optical filter away from a location where the optical signal emitted from the tissue at the surgical margin is filtered through the first optical filter; moving the second optical filter to a position where the optical signal emitted from the tissue at the surgical margin is filtered through the second optical filter; 51. The method of claim 50, further comprising:

52. 51. The method of claim 50, wherein moving the first optical filter away from a position and moving the second optical filter to a position comprises operating an electric motor to move the first optical filter and the second optical filter.

53. 53. The method of claim 52, wherein operating an electric motor to move the first optical filter and the second optical filter comprises operating the electric motor to rotate a filter wheel that includes the first optical filter and the second optical filter.

54. 54. The method of any one of claims 50 to 53, wherein illuminating the tissue at the surgical margin with a first excitation light source configured to emit excitation light having a first wavelength comprises illuminating the tissue with a first excitation light source having a wavelength of about 405 nm ± 10 nm.

55. 55. The method of claim 52, wherein illuminating the tissue at the surgical margin with a second excitation light source configured to emit excitation light having a second wavelength comprises illuminating the tissue with a second excitation light source having a wavelength of about 750 nm to 800 nm.

2. The method according to claim 1.

56. 56. The method of any one of claims 52 to 55, wherein receiving optical signals emitted by the tissue at the surgical margin through a first optical filter comprises filtering optical signals emitted by the tissue through a filter that allows the passage of optical signals having wavelengths of about 500 nm to about 550 nm and / or about 600 nm to about 675 nm.

57. 56. The method of any one of claims 52 to 55, wherein receiving optical signals emitted by the tissue at the surgical margin through a first optical filter comprises filtering optical signals emitted by the tissue through a filter that allows the passage of optical signals having wavelengths of about 500 nm to about 550 nm and / or about 600 nm to about 725 nm.

58. 58. The method of any one of claims 52 to 57, wherein receiving optical signals emitted by the tissue at the surgical margin through a second optical filter comprises filtering optical signals emitted by the tissue through a filter that allows the passage of optical signals having wavelengths below about 675 nm and above about 825 nm.

59. 59. The method of any one of claims 52 to 58, wherein receiving optical signals emitted by the tissue at the surgical margin through a second optical filter comprises filtering optical signals emitted by the tissue through a filter that allows the passage of optical signals having wavelengths below about 690 nm and above about 840 nm.

60. 60. The method of any one of claims 52 to 59, further comprising administering ALA to the patient prior to illuminating tissue at the surgical margin.

61. 61. The method of any one of claims 52 to 60, further comprising administering ICG to the patient prior to illuminating tissue at the surgical margin.

62. 62. The method of any one of claims 52 to 61, further comprising placing a sterile drape over the imaging device prior to illuminating tissue at the surgical margin.

63. 63. The method of any one of claims 52 to 62, further comprising reducing ambient light at a surgical site where the surgical margins are located.

64. 64. The method of claim 63, wherein reducing ambient light comprises placing a darkening drape around the surgical site such that the surgical margin is located within a field of view of the imaging device within the darkening drape prior to illuminating tissue at the surgical margin.

65. 65. The method of any one of claims 52 to 64, further comprising determining whether the level of ambient light is sufficient to allow fluorescence imaging.

66. 1. A method for visualizing breast cancer cells, comprising: administering to the patient one or more imaging agents, at least one of the imaging agents configured to induce the formation of protoporphyrin in breast cancer cells; Following administration of the one or more imaging agents, illuminating breast tissue of the patient with a first excitation light source configured to cause protoporphyrin to fluoresce. And, receiving, in response to illumination with the first excitation light, an optical signal emitted by cells in the breast tissue that contain protoporphyrin through a first optical filter of an imaging device; illuminating the breast tissue with a white light source; receiving an optical signal emitted by the breast tissue through a second optical filter of the imaging device in response to illumination with the white light; The method includes:

67. 67. The method of claim 66, wherein administering one or more agents to the patient comprises administering ALA to the patient.

68. 67. The method of claim 66, wherein administering one or more agents to the patient comprises administering ICG to the patient.

69. 69. The method of any one of claims 66 to 68, wherein receiving an optical signal emitted by cells in the breast tissue containing protoporphyrin through a first optical filter in response to illumination with the first excitation light comprises receiving an optical signal through the first optical filter with a first imaging sensor.

70. 70. The method of claim 69, wherein receiving an optical signal emitted by the breast tissue through a second optical filter in response to illumination with the white light comprises receiving the optical signal through the second optical filter with a second imaging sensor.

71. 69. The method of any one of claims 66 to 68, further comprising: moving the first optical filter from a first position where the optical signal is filtered by the first optical filter before being received by an imaging device; and moving the second optical filter to the first position.

72. 72. The method of any one of claims 66 to 71, further comprising operably coupling the handheld device to an external computer system by a cable connected to a port on the handheld device.

73. 73. The method of any one of claims 66 to 72, further comprising placing a sterile drape over the imaging device prior to illuminating the patient's breast tissue.

74. 74. The method of any one of claims 66 to 73, further comprising reducing ambient light at a surgical site where the breast tissue is located.

75. 75. The method of claim 74, wherein reducing ambient light comprises placing a darkening drape around the surgical site such that breast tissue is located within a field of view of the imaging device within the darkening drape prior to illuminating the breast tissue.

76. 76. The method of any one of claims 66 to 75, further comprising determining whether the level of ambient light is sufficient to allow fluorescence imaging.

Images