System and method for determining characteristics of target

Abstract

To provide an approach that can identify one or more characteristics of a tissue or other target being removed, e.g., before or during a medical procedure.SOLUTION: A method for determining a characteristic of material at a target is provided. A target is illuminated with a pulsed light source. A fluorescence signal from the target when the pulsed light source is in an "off" state is then sensed. Based on analysis of the fluorescence signal, a characteristic of material at the target is identified. A device can then be controlled based on the identified characteristic of the material at the target.SELECTED DRAWING: Figure 4

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 270,805, filed October 22, 2021, the contents of which are incorporated herein in their entirety.

[0002] This document relates generally to surgical devices and more particularly, but not exclusively, to surgical devices that can use fluorescent radiation to identify tissue or other targets to be removed. [Background technology]

[0003] A variety of surgical procedures may be used to remove material, such as hard or soft tissue, from a patient. For example, surgical procedures may be used to remove kidney stones during lithotripsy procedures, to remove cancerous tissue, to make incisions in tissue, to vaporize tissue, such as during the treatment of Benign Prostatic Hyperplasia (BPH), etc. However, a number of problems may arise with the devices used to perform the surgical procedures.

[0004] For example, various parameters associated with the device may be modified during a surgical procedure, but the practitioner may not have the technical knowledge to ensure that each of these parameters is at its optimal setting, which may affect the efficiency of tissue removal, such as by increasing the time associated with the surgical procedure.

[0005] In cases where radiation from a surgical device is used to remove cancerous tissue, remove kidney stones, or treat BPH, if the device parameters are not set properly, the device may not function as intended by the practitioner. The radiation from the device may not correspond to what the practitioner desires. For example, when treating a cancerous site, tissue removal may occur more quickly than the practitioner anticipates. In such a scenario, excessive tissue may be removed. For example, in cases where a device is used to treat BPH, capsular perforation may occur if tissue removal occurs more quickly than the practitioner anticipates.

[0006] In some cases, the tissue being removed may change from one type, such as cancerous tissue or a kidney stone, to another type, such as healthy tissue, without the practitioner noticing the change. Misidentifying the tissue may lead to improper device settings, which can result in the potential problems described above, such as removing too much tissue or causing capsular perforation. Summary of the Invention [Problem to be solved by the invention]

[0007] There is a need for techniques that can identify one or more characteristics of tissue or other targets to be removed, such as before or during a medical procedure. [Means for solving the problem]

[0008] This document describes examples of using a fluorescent response from a target site to determine characteristics of the target site. The characteristics of the target site may include the type, material, composition, composition profile, structure, or hardness of the target. The target site may include, for example, tissue, kidney stones, pancreaticobiliary, or gallbladder stones. The device can determine the characteristics of the target using the spectrum emitted from the target in response to illumination of the target site using a light source. To activate the surface of the target site, the target site can be illuminated with a light source. In response, a fluorescent response signal can be obtained from the activated surface of the target site, such as when the light source is deactivated and placed in an "off" state (i.e., deactivated). The spectrum of the fluorescent response signal can be used to determine the characteristics of the target.

[0009] For example, the light source of the device can be operated in an "on" state (i.e., activated) or an "off" state (i.e., deactivated). A photodetector can be used to detect the fluorescent response light signal to illumination when the light source is in the "off" state. This prevents the illumination light from the light source from becoming saturated and obscuring the fluorescent response signal from the target.

[0010] For example, the light source can have multiple LEDs. Different LEDs among the multiple LEDs can emit light of different wavelengths. The light source can have a first LED emitting light of a first wavelength, a second LED emitting light of a second wavelength, and a third LED emitting light of a third wavelength. The first LED can be in an "on" state while the second and third LEDs are in an "off" state. When the first LED is in the "on" state, the target site can be illuminated with light of the first wavelength. The first LED can then be switched to an "off" state and the second LED can be switched to an "on" state, so that the target site can be illuminated with light of the second wavelength. While the target site is illuminated with the second LED, a first fluorescence response signal emitted from the target site in response to excitation by the first LED can be detected. The second LED can then be switched to an "off" state and the third LED can be switched to an "on" state to illuminate the target site with light of the third wavelength. While the target site is illuminated with the third LED, a second fluorescent response signal emitted from the target site in response to excitation by the second LED can be detected. The third LED can then be switched to an "off" state, and a third fluorescent response signal emitted from the target site in response to excitation by the third LED can be detected. Using the first, second, and third fluorescent response signals from the target site, a fluorescent response spectrum can be determined, and from the fluorescent response spectrum, a characteristic of the target site can be determined based on the spectrum.

[0011] During operation, the characteristics of the target may optionally be determined in real time, such that the device used to remove the target may be controlled in real time, e.g., based at least in part on the determined characteristics. For example, if a laser is used to remove material from the target, one or more parameters of the laser (e.g., the pulse width of the laser pulse, the pulse shape of the laser pulse, the peak power of the laser pulse, or the pulse frequency, which represents the number of laser pulses per unit time) may be established or adjusted in real time, e.g., based at least in part on the determined characteristics. Furthermore, after removing material from the target site during a first time period, a fluorescent response may be used to determine whether the characteristics of the target site have changed. For example, the characteristics may be determined based on a second spectrum emitted from the material at the target site in response to the material being again illuminated using the light source. Based on the second determination, the device may be controlled in real time, e.g., by establishing or adjusting one or more device parameters based on the change in the characteristics determined from the change in the fluorescent response from the target.

[0012] Using the techniques of the present invention, several potential advantages may be possible: For example, a fluorescent response signal corresponding to energy absorbed at a target site may be detected without illuminating the target site with light from a light source, such as by switching the light source between "on" and "off" states, and thereby saturating or obscuring the fluorescent effect.

[0013] Furthermore, when using multiple LEDs or other illumination sources, the fluorescence response to a first illumination source can be determined after the first illumination source is turned off. Even if a second LED or other illumination source is turned on during this detection of the first fluorescence response to the first illumination source, such as when the second illumination source emits light at a second wavelength longer than the first fluorescence response wavelength, there can still be an advantage in detecting the first fluorescence response, which makes filtering easier during fluorescence response signal detection or signal processing, reducing the likelihood of saturating or obscuring the first fluorescence response signal or interfering with detecting the first fluorescence response signal. By using a light source with multiple LEDs, such as when one LED of the multiple LEDs illuminates the target site, a fluorescence response signal corresponding to energy absorbed at the target site from illumination from another LED of the multiple LEDs can be detected.

[0014] Another potential advantage may include identifying the properties of a target material in real time, which may further enable real-time adjustment of one or more parameters of a device being used to remove or otherwise treat the material at the target site based on the identified properties.

[0015] Another potential advantage may relate to more precise material removal from the target site, thereby reducing or minimizing the likelihood of over-removing or under-removing material from the target site by establishing or altering device settings to be more suited to the desired material removal at the target site. [Brief explanation of the drawings]

[0016] [Figure 1] 1 illustrates an example of a portion of a system that may include an endoscope for use in a procedure to remove material from a target site. [Figure 2] 2A-2C illustrate various exemplary features of the endoscope of FIG. 1. [Figure 3] FIG. 2 illustrates an example embodiment of a portion of the feedback analyzer of the system of FIG. 1. [Figure 4] FIG. 1 illustrates an example of a portion of a method for determining a characteristic of a target site. [Figure 5] 10A-10C illustrate an example of illuminating a target area using pulsed light or the like. [Figure 6] FIG. 1 shows an example of the fluorescence response emission of a fluorophore excited by illumination light. [Figure 7] FIG. 1 shows an example of emission and sensing of a fluorescent response signal from a target site. [Figure 8] 5A-5C illustrate examples of removing tissue from a target site using a laser beam from a laser having one or more parameters established or adjusted based on the method shown in FIG. 4 or the like. [Figure 9] FIG. 1 shows an example of the difference in fluorescence response intensity as a function of wavelength for tumorous or healthy tissue. [Figure 10] FIG. 1 illustrates an example of determining the characteristics of a target site. [Figure 11] 10A-10C illustrate an example of illuminating a target site with pulsed light. [Figure 12] FIG. 10 shows an example of illumination and sensing of a fluorescent response signal from a target site. [Figure 13] FIG. 1 is a schematic diagram illustrating an example of a portion of a computer-based clinical strategy support system configured to determine characteristics of a target site. [Figure 14] FIG. 2 is a block diagram illustrating an example of a portion of a software architecture that may be installed on a machine. [Figure 15] FIG. 1 is a schematic diagram illustrating an example of a machine in the form of a computer system with which a set of instructions may be executed to perform any one or more of the techniques described in this specification. [Figure 16] FIG. 1 illustrates an example of a method for determining a characteristic of a target site. DETAILED DESCRIPTION OF THE INVENTION

[0017] A medical device can use the fluorescence response signal to determine characteristics of a target site. Characteristics may include the type, material, composition, composition profile, structure, or hardness of the target. For example, a target site may include tissue, kidney stones, pancreaticobiliary, or gallbladder stones. The device can determine the characteristics of the target based on the spectrum of response light emitted from the target in response to illumination of the target with a light source to activate the surface of the target site. The target site can be illuminated by the light source periodically, repeatedly, or randomly. The light source can have an "on" state (i.e., activated and emitting illumination light) and an "off" state (i.e., deactivated and not emitting illumination light). A fluorescence response signal corresponding to a pulse from the light source can be detected after the pulsed light source is turned "off." The device can then determine the spectrum of the fluorescence response signal. Using the determined spectrum, the device can determine the characteristics of the target (i.e., type, material, composition, composition profile, structure, hardness, etc.). The techniques of the present invention may be used in conjunction with laser, ultrasound, or other systems to remove material from a target site or to perform another desired medical procedure.

[0018] A fluorescence response signal from the target site can be used to determine characteristics of the target site. For example, a first LED light source can be used to illuminate the target site using a first illumination wavelength, such as within a range between about 180 nm and about 800 nm. Materials at the surgical target site can absorb energy from the light. For example, such materials at the surgical target site can include tissue, kidney stones, pancreaticobiliary tract, or gallbladder stones. In response to absorbing the illumination energy, the materials at the target site can emit one or more fluorescence response photons. The fluorescence response radiation can be at a second wavelength different from the first wavelength of the illumination light emitted from the light source and absorbed at the target site. In cases where the light source is pulsed between an "on" state and an "off" state, fluorescence response photon radiation can be detected when the illumination source is in the "off" state. This can help avoid (or at least reduce) saturation of the detected fluorescence response signal due to the simultaneous presence of illumination light from the illumination source. The fluorescent response emission can be analyzed, spectroscopically or otherwise, and used to characterize the tissue, which can then be used to adjust one or more parameter settings.

[0019] FIG. 1 illustrates an example of a portion of a system 100 that may be used to treat or remove material from a target site, such as a surgical site. The system 100 may include an endoscope 102 in communication with an imaging platform 104 that may be used to provide an image of the target site to a practitioner, such as a medical professional. For example, the endoscope 102 may include a nephroscope, cystoscope, ureteroscope, or any other type of endoscope. The endoscope 102 may have a body 106 that is at least partially insertable into a patient. The body 106 may have a handle, hub, or other graspable proximal portion 108, an elongated rigid portion 110 extending from the graspable proximal portion 108, and a flexible distal portion 112 extending distally from the elongated rigid portion 110 to a distal end 114. An articulation control 116 may be located on the graspable proximal portion 108. An articulation controller 116 can be actuable by the practitioner when the practitioner grasps the graspable proximal portion 108. The articulation controller 116 can adjust the position of the flexible distal portion 112. The graspable proximal portion 108 can further have an electrical port 118 that can be coupled (e.g., via one or more wires extending along the body 106) to a substrate 200 ( FIG. 2 ) that can be located at the distal end 114 of the body 106. While the examples described herein include endoscopes, the present subject matter is not limited to only endoscopes or devices that perform spectroscopic techniques, but can also include the use of other types of therapeutic devices.

[0020] The endoscope 102 can have a visualization system at the distal end 114 of the body 106 to enable the practitioner to visualize the target site. The visualization system can illuminate a working area of material, such as tissue or a stone (e.g., a kidney stone or a pancreaticobiliary or gallbladder stone), and can generate a video image or one or more still images of the illuminated area of material. The visualization system can transmit the video image to a display device 120.

[0021] The visualization system may include at least one light source 202 located on a substrate 200 at the distal end 114 of the endoscope 102, as shown in FIG. 2 . Alternatively, the light source may be located at the proximal end of the endoscope 102 (or may be located remotely from the endoscope 102) and transmit light to the distal end of the endoscope via, for example, an optical fiber or illumination channel. The substrate 200 may include one or more of a circuit board, a hybrid chip, a ceramic component, or other suitable components or elements. An electrical port 118 may receive electrical power for powering the circuit board on the substrate 200. The circuit board or other substrate 200 may wirelessly communicate digital video signals to the display device 120. The circuit board or other substrate 200 may mechanically support and electrically power the light source 202. In addition to the circuit board or other substrate 200 and the light source 202 located at the distal end 114 of the endoscope 102, an imaging sensor 302 may also be located at the distal end 114 of the endoscope 102. For example, the imaging sensor 302 may include an imaging camera, such as a CCD camera or CMOS camera sensitive to ultraviolet (UV), visible (VIS), or infrared (IR) wavelengths.

[0022] A circuit board or other substrate 200 may alternatively be located in the proximal portion 126 of the endoscope 102, in the graspable proximal portion 108 of the endoscope 102, or the like, along with a light source 202. The substrate 202 can have the components and functionality described herein when located in either the distal portion 114 or the proximal portion 126 of the endoscope 102.

[0023] The light source 202 may include, among other things, a light-emitting diode (LED) or a xenon light. The light source 202 may include an LED. The LED may output white light, which may include one or more of a blue wavelength, a green wavelength, a yellow wavelength, or a red wavelength. The light source 202 may include an LED that can emit light of various wavelengths, such as to assist in obtaining one or more target characteristics at a target site, as described further below. In some embodiments, the light source 202 may function as a user-visible aiming light for the endoscope 102, which the practitioner can visually observe and use to determine where to point the laser of the endoscope 102, while simultaneously using the standard light to illuminate the target site to detect one or more fluorescent response signals from the target site, as described later herein.

[0024] The light source 202 can emit light directed distally away from the distal end 114 of the body 106, such as to illuminate material at the target site. As described above, the light source can be an external light source (e.g., external to the endoscope 102) that provides light transmitted through the body 106 of the endoscope 102, such as through an optical fiber or fiber optic bundle, to illuminate material at the target site. The light source 202 can emit white light to illuminate stones. The white light can allow the practitioner to observe discoloration or other color-based effects on material at the target site at or near the distal end 114 of the body 106. The light source 202 can additionally or alternatively emit blue light to illuminate material at the target site. Blue light can be well suited to indicating thermal diffusion and can thereby be used to detect actual or potential thermal damage within material. Other color wavelengths or color bands, such as red, amber, yellow, or green, may also be used. The light source 202 may be coupled to an optical lens 206, which can refractively or otherwise angularly adjust the light output from the light source 202. The optical lens 206 can narrow the beam of light output from the light source 202. Additionally, the optical lens 206 can widen the beam of light output from the light source 202. Such angular adjustment can help ensure that material at the target site is adequately illuminated within a specified angular field of view.

[0025] The optical fiber 204 or fiber optic bundle may be integrated into the endoscope 102. The optical fiber 204 may extend along a fiber channel (which may be the working channel or a channel different from the working channel) within the body 106 of the endoscope 102. The optical fiber 204 may be separate from the endoscope 102. The optical fiber 204 may be fed along a fiber channel of the endoscope 102 before or during use and retrieved from the fiber channel of the endoscope 102 after use. The optical fiber 204 may be coupled, via an appropriate connector or the like, to a material removal device 501 ( FIG. 5 ), such as a laser emitter, external to the endoscope 102, which can deliver a laser beam to material at a target site for material removal. The target site may include a kidney stone that can be ablated into stone fragments by the laser beam. The target site may include tissue that can be ablated from the target site by the laser beam. The material removal device 501 is not limited to only a laser beam. For example, an ultrasound transducer may be used to ablate soft and / or hard tissue from a target site.

[0026] The laser beam generated by the laser emitter of the material removal device 501 can have a wavelength corresponding to the spectral peak of absorption of human blood or saline, such as 2100 nm, 1942 nm, and other wavelengths. For example, a wavelength in the range between 1900 nm and 3000 nm can correspond to the spectral region of optical absorption of water, while a wavelength between 400 nm and 520 nm can correspond to the spectral region of optical absorption of oxyhemoglobin and / or deoxyhemoglobin. For example, the material removal device 501 can include a thulium fiber laser capable of generating a laser beam with a wavelength of 1908 nm or 1940 nm. The material removal device 501 can include a thulium:yttrium-aluminum-garnet (YAG) laser capable of generating a laser beam with a wavelength of 2010 nm. The material removal device 501 can also be a holmium:YAG laser capable of generating a laser beam with a wavelength of 2120 nm. Material removal device 501 may include an Erbium:YAG laser capable of producing a laser beam with a wavelength of 2940 nm. Other wavelengths within this range may also be used.

[0027] Additionally, the material removal device 501 may include a neodymium:YAG (Nd:YAG) laser capable of generating a laser beam at a wavelength of 1064 nm. Generally, it may be advantageous to deliver a laser beam with sufficient light absorption in blood and saline because such a laser beam may have reduced impact on surrounding tissue. This may help reduce or eliminate damage to different materials near the target site. The laser may provide light with an output power within an appropriate range of output power, such as between 20 watts and 120 watts. The optical fiber 204 may include a multimode fiber or a single-mode fiber.

[0028] The visualization system may include an image acquisition device 208 that may be located on a circuit board or other substrate 200 that may mechanically support and electrically power the image acquisition device 208. The image acquisition device 208 may have an imaging sensor, such as a camera, and may capture a video image or one or more still images of the illuminated material at the target. The video image may be real-time or near real-time with a relatively low latency for processing, allowing the practitioner to observe material at the target site or surrounding tissue as the practitioner manipulates the body 106 to control the endoscope 102. The image acquisition device 208 may have a lens and a multi-pixel photodetector sensor, such as a focal plane array (FPA), that may be located at the focal plane of the lens. The sensor may include a color sensor, such as an RGB sensor, that provides intensity values for red, green, and blue light at each pixel in the video image. The circuit board may generate a digital video signal representing the captured video image of the illuminated material at the target site. The digital video signal may have a video refresh rate of 10 Hz, 20 Hz, 24 Hz, 25 Hz, 30 Hz, 40 Hz, 50 Hz, 60 Hz, or another suitable video refresh rate. In another embodiment, the image capture device 208 may be a Spectroscopic Charge Coupled Device (CCD) camera or a complementary metal-oxide-semiconductor (CMOS) camera.

[0029] In another example, the image acquisition device 208 can acquire a spectrum emitted from the target region and provide this spectrum to a feedback analyzer 121 of the imaging platform 104, such as via an optical path 209. The optical path 208 can comprise a multimode optical fiber or a single-mode optical fiber, or an optical fiber bundle. As described further below, the feedback analyzer 121 can be configured to determine the spectrum of the fluorescent signal. Furthermore, as described further below, the feedback analyzer 121 can be configured to identify a characteristic of the target region using the identified spectrum.

[0030] The endoscope 102 may further include an irrigation lumen 210 and an aspiration lumen 212 (each of which may be the same as or different from the working channel). The irrigation lumen 210 may provide an irrigant to the target site during the procedure. Additionally, the aspiration lumen 212 may remove irrigant and waste materials from the target site. The endoscope 102 may optionally include a tube, chamber, additional working channel, or other passageway 214 within the body 106 of the endoscope 102. The passageway 214 may be used by the practitioner to deploy any type of separate tool or instrument, such as a lithotriptor, stone retrieval basket, or another appropriate tool or instrument.

[0031] 1 , the endoscope 102 can have a laser control device 122, such as a laser control device that can be located on the graspable proximal portion 108. Alternatively, the laser control device 122 can be located remotely from the endoscope 102. The laser control device 122 can switch the state of the laser beam between an operating state ("on" state) and a non-operating state ("off" state). For example, the laser control device 122 can send a wired and / or wireless laser control signal to a laser located external to the endoscope 102. The laser control signal can turn the laser on or off. In some implementations, the practitioner can use the laser control device 122 to adjust one or more settings of the laser, such as output power, pulse width, pulse shape, and / or pulse frequency.

[0032] During a procedure, the laser control device 122 can be operated by the practitioner to activate the laser for a period of time, such as 1 minute, 2 minutes, 3 minutes, 4 minutes, or any suitable length of time. During the period of laser operation, the practitioner can manipulate the body 106 of the endoscope 102 to move the delivered laser beam over the surface of the material at the target site. The laser power level and exposure time can be such that the practitioner can manually and safely turn the laser power on and off without the need for a mechanized or automatic exposure mechanism. The laser power can also be sufficiently low to prevent accidental exposure of surrounding tissue from affecting the surrounding tissue. Additionally, the endoscope 102 can have or be coupled to a flash controller 124, which can be used to control the flow rate of irrigant through the irrigation lumen 210 and the suction power through the suction lumen 212.

[0033] FIG. 3 illustrates the structure of the feedback analyzer 121. The feedback analyzer 121 can include a photodetector 300 configured to detect an optical signal (e.g., a fluorescent signal) from the target structure and analyze the received signal to determine characteristics of the target. Signal processing and analysis can include, for example, analyzing the fluorescence intensity, fluorescence excitation spectrum, fluorescence emission spectrum, fluorescence decay time, or other characteristics associated with the detected fluorescent signal. For example, the feedback analyzer 121 can generate one or more spectroscopic properties from the detected signal. The spectroscopic properties can include one or more fluorescent characteristics and, in addition to or alternatively, one or more other characteristics, such as reflectance, reflectance spectrum, or absorption index. The photodetector 300 can include, among other things, a spectroscopic sensor, such as a Fourier Transform Infrared (FTIR) spectrometer, a Raman spectrometer, a UV-VIS spectrometer, a UV-VIS-IR spectrometer, or a fluorescence spectrometer. Additionally, optical sensors such as sensors based on CMOS technology, CCD technology, etc., using photodiodes to convert photons into electrical signals are suitable. The photodetector may be an individual photodiode or an array of photodiodes, such as those used in CMOS or CCD imagers for digital cameras. Both types of devices provide an electrical signal corresponding to the intensity of an optical signal at a particular wavelength and are suitable for performing spectroscopy. In addition, any type of spectrometer or spectrophotometer capable of collecting light intensity versus wavelength may be used. The photodetector 300 may correspond to a spectroscopic method or technique. For example, UV-VIS spectroscopy may be used to gather information from fluorescent light or reflected light from a target or target site, which may be similar to information obtained from the eye or from color images produced by a high-resolution camera, but is more quantitative and objective. For example, spectroscopy may provide information about a substance based on reflected light from a target.This is because the reflection and absorption of light can be determined by its chemical composition and surface properties. Information about both the surface and bulk properties of a sample can be obtained using this technique. Reflectance spectroscopy can be used to identify the composition of soft or hard tissues. FTIR spectroscopy can be used for rapid material analysis, has relatively good spatial resolution, and can provide information about the chemical composition of a material. Raman spectroscopy can be used to identify the composition of hard and soft tissues. As a high spatial resolution technique, Raman spectroscopy is also useful for determining the spatial distribution of material composition within a target object.

[0034] Additionally, the photodetector 300 can be used in conjunction with fluorescence spectroscopy. Fluorescence spectroscopy is a type of electromagnetic spectroscopy that analyzes fluorescence from a sample. Fluorescence spectroscopy can involve using a beam of illumination light, such as ultraviolet light, to excite material components at a target site, causing them to emit fluorescent response light, typically in the visible or IR range. Fluorescence spectroscopy can be applied to the analysis of some organic components, such as to help distinguish between hard and soft tissues. The photodetector 300 can have two or more types of spectrometers or imaging cameras, such as those that enable a wider range of capabilities for sensing and detecting various structures (e.g., charred tissue, non-charred tissue, or vasculature). Additionally, an imaging sensor can utilize one or more imaging capabilities of an endoscope 102 available for use during a therapeutic or diagnostic procedure. For example, the endoscope 102 can be used to visualize anatomical structures during a therapeutic procedure (e.g., laser ablation of tumors or kidney stones). In such cases, the endoscopic imaging capabilities of endoscope 102 may be used or augmented by photodetector 300. For example, endoscope 102 may provide narrowband imaging suitable for improving visualization of one or more anatomical structures (e.g., lesions, tumors, vasculature, stones, etc.). Combining photodetector 300 with endoscopic imaging (white light and / or narrowband imaging) may assist in detecting one or more tissue properties, such as the level of carbonization, and this information may be used to precisely control the delivery of therapeutic therapy. For example, photodetector 300 may be operably coupled to optical path 209. Thus, an optical signal, such as a fluorescent signal, received at optical path 209 may be provided to photodetector 300.

[0035] The feedback analyzer 121 can include the imaging sensor 121 along with one or more of the target detector 304 or the target classifier 306. The target detector 304 can be configured to identify the target structure as one of a plurality of structural segments, such as may include using one or more fluorescent properties of the detected fluorescent response signal and / or one or more spectroscopic properties, such as those generated by the photodetector 300, as described above. Additionally, the target detector 304 can be configured to identify the target structure as one of a plurality of structural segments in combination with the imaging properties detected by the imaging sensor 302. For example, the target detector 304 can use one or more fluorescent and / or spectroscopic properties to identify a target characteristic, such as to assist in characterizing the target structure as a stone structure segment or as an anatomical structure segment. Examples of stone structures can include stones or fragmented stones in various stone-forming regions, such as the urinary system, gallbladder, nasal cavity, gastrointestinal tract, stomach, or tonsils. Examples of anatomical structures may include soft tissue (eg, muscles, tendons, ligaments, blood vessels, fascia, skin, fat, and fibrous tissue), hard tissue such as bone, connective tissue such as cartilage, among others.

[0036] The feedback analyzer 121 can generate a response signal spectrum, such as a reflectance spectrum, using the received reflected signal and can extract one or more spectral features from the reflectance spectrum. The response signal spectrum can include reflection intensity across multiple wavelengths. Reflectance can be determined as a function of incident electromagnetic power reflected at a material interface. Reflectance can represent the effectiveness of a material surface at reflecting electromagnetic radiation. In addition to reflectance, the response signal spectrum can also represent illumination energy absorbed at the surgical site and re-emitted at the fluorescence response signal wavelength, including a short time after the light source no longer illuminates the surgical site. The reflectance spectrum can be formatted as a data array or as a graphical representation, such as a spectral reflectance curve. For example, the reflectance spectrum can represent reflectance across wavelengths in a range from about 400 nm to about 1000 nm.

[0037] The joint controller 116, laser controller 112, flash controller 124, feedback analyzer 121, and / or target detector 304 described herein may be implemented as a single controller or separate controllers. Additionally, two or more of these may be implemented as a single controller, while the rest may be implemented as separate controllers. The controllers used herein may be implemented as hardware, software, or a combination of the two. Software may be written in any of a number of high-level languages, such as FORTRAN, PASCAL, JAVA, C, C++, C#, BASIC, various scripting languages, and / or HTML. Additionally, software may be implemented as assembly language for a microprocessor resident on a target computer. Software may be embodied in an article of manufacture, including, but not limited to, a floppy disk, jump drive, hard disk, optical disk, magnetic tape, PROM, EPROM, EEPROM, field programmable gate array, or CD-ROM. Hardware circuitry may be implemented using, for example, one or more FPGA, CPLD, or ASIC processors.

[0038] FIG. 4 illustrates an example method 400 for determining material characteristics of a target site. At 402, the target site may be illuminated with a light source. The light source may be activated and deactivated periodically or randomly, such as to generate pulsed illumination. For example, at 402, the light source may be activated to illuminate the target (i.e., the light source is in an "on" state). To further illustrate an example related to method 400, referred to herein as a "first example," reference is now made to FIG. 5, at 402, the endoscope 102 may be controlled to illuminate a surgical target site 500 with pulsed light 502. The light source 202 may provide white light from an LED or other broadband light to the surgical target site 500 at 402. In the first example, broadband light or white light may be used. The white light may include all wavelengths of light in the visible spectrum at equal intensity. Thus, the white light may include wavelengths that can excite fluorophores at the surgical target site 500. In a first example, a surface 504 of a surgical target site 500 is illuminated with pulsed light 502. More specifically, the surgical target site surface 504 absorbs energy, such as photons, which causes excitation, such as excitation of fluorophores, at or below the surgical target site surface 504.

[0039] In Figure 4, at 403, the light source 202 may be switched from an "on" state, in which the LED emits light, to an "off" state, in which the LED does not emit light. During this time (i.e., when the pulsed light source is in the "off" state), a fluorescent signal emitted from the target site is detected by the photodetector 300 of the feedback analyzer 121 in response to the illumination at 404. Here, because the pulsed light source is in the "off" state, the fluorescent signal from the target does not need to be obscured or saturated by the wavelength of the illumination energy that activates the target site. This can help enable more accurate determination of the target's characteristics at the target site based on the detected fluorescent signal.

[0040] The material at the target site may contain a fluorophore that can be excited by a particular wavelength of light emitted by the light source. When the fluorophore is excited, it can emit light over a short period of time, as shown with reference to FIG. 6 . Specifically, an excitation pulse EP, such as pulsed broadband light or white light, is directed toward the material containing the fluorophore, and the energy absorbed by the material containing the fluorophore decays over time T, where the decay time is proportional to the intensity I associated with the light used to illuminate the material with the fluorophore, as shown by fluorescence F. The fluorescence F can be used to determine the fluorescence intensity and the fluorescence excitation spectrum. Furthermore, the fluorescence F can be used to determine the fluorescence emission spectrum and the fluorescence decay time. A CCD, CMOS, or other photosensor can be used to detect the fluorescence F before the intensity associated with the fluorescence F decays below the point where it becomes impossible to detect the fluorescence F by the CCD, CMOS, or other photosensor. At 404, the absorbed energy can be detected as a fluorescence response signal.

[0041] At 403, the light source 202 may be switched from an “on” state to an “off” state in operation 402. When the light source 202 is switched to the “off” state, the method 400 may perform a first example operation 404. Specifically, at 404, energy absorbed by the surgical target site surface 504, shown generally as energy 700 in FIG. 7 , is emitted as a fluorescent light signal 702, which may correspond to a wavelength emitted from the surgical target site surface 504. Thus, when the surgical target site surface 504 is activated, the fluorescent light signal 702 may correspond to a wavelength emitted from the activated surgical target site surface 504. In the first example, the fluorescent light signal 702 may be transmitted via the optical path 209, the optical fiber 204, and / or the passageway 214 to the feedback analyzer 121, such that the feedback analyzer 121 may analyze the detected fluorescent light signal 702.

[0042] Once the fluorescence signal is detected at 404, method 400 optionally performs operation 406, in which the fluorescence properties (e.g., fluorescence intensity, fluorescence excitation spectrum, fluorescence emission spectrum, and / or fluorescence decay time) and / or a spectrum associated with the fluorescence signal are determined. The feedback analyzer 121 may be used to determine the spectrum associated with the fluorescence signal, as discussed above. Additionally or alternatively, a spectrum may be extracted from the reflectance spectrum or normalized reflectance spectrum of a particular stone structure at the target site. The reflectance features may include a reflectance spectrum (or normalized reflectance spectrum) at a particular wavelength or over a particular wavelength range, statistics calculated from the reflectance spectrum (e.g., change in reflectance over two or more different wavelengths, or rate of change of reflectance over a certain wavelength range, etc.), or graphical features representing the shape of at least a portion of the spectral reflectance curve (e.g., slope, curvature, arc of the curve, etc.). The stone reflectance features and tissue reflectance features may be stored in memory circuitry of the imaging platform 104.

[0043] After determining the spectrum associated with the fluorescence signal at 406, characteristics of the target site can be determined at 408 using the fluorescence properties and / or spectrum. For example, to determine characteristics of the target site at 408, the target detector 304 can additionally or alternatively extract one or more reflectance features from the reflectance spectrum determined at 406. The target detector 304 can compare the fluorescence properties and / or reflectance features to a predetermined threshold or value range based on the properties, thereby identifying the target as a stone structure if the target fluorescence properties and / or reflectance features exceed the feature threshold or are within a certain value range. Additionally, the target detector 304 can identify the target as kidney tissue if the target fluorescence properties and / or reflectance features are below the predetermined threshold or are outside the value range based on the properties. The predetermined threshold or value range can be determined using stone fluorescence properties and / or reflectance features and tissue fluorescence properties and / or reflectance features obtained in vitro and / or in vivo before the procedure. Additionally, thresholds or value ranges associated with individual characteristics of the targets may be stored in a look-up table in the imaging platform 104. In an embodiment, the threshold may be determined as a threshold that separates the stone fluorescence and / or reflectance properties and tissue fluorescence and / or reflectance properties by a specified margin.

[0044] At 408, the target detector 304 can trend the fluorescent properties and / or reflectance intensities of materials at the target site over a range of wavelengths, and the material can be determined based on the trend in the fluorescent properties and / or reflectance intensities (or "fluorescence trend" or "reflectance trend"). For example, a fluorescent trend or reflectance trend can be generated within a first range of 400 nm to 550 nm. If the fluorescent trend or reflectance trend monotonically increases within the first wavelength range, the material can be determined to be a calculus structure. If the fluorescent trend or reflectance trend does not monotonically increase within the first wavelength range, the material can be identified as kidney tissue. In another example, a fluorescent trend or reflectance trend can be generated within a second range of 650 nm to 700 nm. If the fluorescent trend or reflectance trend monotonically increases within the second wavelength range, the material can be determined to be a calculus structure. If the fluorescent trend or reflectance trend monotonically decreases within the second wavelength range, the material can be determined to be kidney tissue.

[0045] A template matching method may be used by the target detector 304 to determine that material at the surgical site is a stone structure or an anatomical structure. The target fluorescence properties and / or reflectance features may be compared to at least one of the stone fluorescence properties and / or reflectance features or at least one of the material fluorescence properties and / or reflectance features stored in the memory 308 of the feedback analyzer 121 to determine whether a matching criterion is met. For example, material at the surgical site may be determined to be a stone structure if a dissimilarity metric between the target fluorescence properties and / or reflectance features and the stone fluorescence properties and / or reflectance features is less than a first similarity threshold, or may be identified as kidney tissue if a dissimilarity metric between the target fluorescence properties and / or reflectance features and the tissue fluorescence properties and / or reflectance features is less than a second similarity threshold.

[0046] As described above, the target classifier 306 can use differences within a reflectance spectrum between various structure types of the same section to classify material at the target site as one of multiple structure types of the same section, such as a specific tissue type within a specified section of an anatomical structure or a specific stone type within a specified section of a stone structure. This classification can be based on one or more of the reflectances at a specific wavelength, a statistical feature (e.g., a difference or other measure of difference) of the reflectance across two or more different wavelengths, or a graphical feature generated from a graphical representation of the reflectance spectra. For example, in an example where the target site contains stones, the target classifier 306 can compare the normalized reflectance at a specific wavelength (e.g., 550 nm) or wavelength range to one or more thresholds to classify the stones at the surgical site as a specific stone type based on the distinct normalized reflectance spectra among the various stone types.

[0047] One or more spectral properties may be used by the target classifier 306 to classify the determined anatomical structure as one of a plurality of tissue types. For example, the target classifier 306 may be configured to classify the determined kidney tissue as one of tissue types at distinct anatomical locations, such as renal calyx tissue, cortical tissue, bone marrow tissue, or ureteral tissue. For example, based on distinct normalized fluorescence and / or reflectance spectra among various tissue types, the target classifier 306 may classify tissue at the surgical site as a particular tissue type based on a comparison between the normalized fluorescence and / or reflectance of a particular wavelength (e.g., 480 nm) or wavelength range and one or more fluorescence and / or reflectance thresholds.

[0048] The target classifier 306 may be configured to classify the determined anatomical structure as normal tissue or abnormal tissue (e.g., cancerous tissue). Normal and cancerous tissues may exhibit distinct fluorescence and / or reflectance spectra with different shapes and peak locations (i.e., wavelengths at which the fluorescence and / or reflectance spectra reach peak values in a certain wavelength range). The classifier 306 may be configured to classify or determine the anatomical structure as a treatment area (e.g., a tumor or polyp intended to be removed) or a non-treatment area (e.g., a blood vessel, muscle, etc.). This classification may be based on one or more of the fluorescence and / or reflectance at a particular wavelength, statistical characteristics (e.g., variance or other difference quantities) of the fluorescence and / or reflectance across two or more different wavelengths, or a graphical representation (e.g., slope) generated from a graphical representation of the fluorescence and / or reflectance spectra. Cancerous tissue may have a different spectrum compared to non-cancerous tissue. Thus, the target classifier 306 may classify tissues based on the spectrum.

[0049] The feedback analyzer 121 can further include a controller 310. The controller 310 can automatically control the laser 510 or other material removal device 501. This can eliminate the need for a practitioner to manually control the material removal device 501.

[0050] Returning to the first example, at 406, the detected fluorescence signal 702 at 404 is transmitted to the feedback analyzer 121, which determines that the spectrum of the target when illuminated with a light source (e.g., having a wavelength in the range of 450 nm to 500 nm) has a particular spectrum (e.g., 460 nm to 700 nm). Further, at 408, the feedback analyzer 121 identifies characteristics of the target at the surgical site (e.g., type, material, composition, composition profile, structure, hardness, etc.) based on the detected fluorescence signal (e.g., spectral shape and peak locations).

[0051] At 410, a treatment device may optionally be controlled based on the identification of the material properties at 408. For example, the control signal may be used to adjust various parameter settings of the device, such as energy emission from the device. For example, if the device has a laser system, the parameter settings may include laser pulse energy, pulse frequency, laser power, and pulse mode, laser pulse width, laser pulse shape, peak power of the laser pulse, or pulse frequency, which represents the number of laser pulses per unit time. Here, emission can be associated with the laser related to these parameters. Additionally, 410 may be performed in real time, such that one or more control signals may be sent by the controller 310 to the device to adjust the device during a surgical procedure to remove tissue or any other type of organic deposits from a target site.

[0052] For example, if the material at the target site is determined to include cancerous tissue (or, in some embodiments, a kidney stone) and the device is a laser device, the controller 310 can control the laser to emit a laser beam capable of removing the cancerous tissue (or, in some embodiments, breaking down the kidney stone). Accordingly, the controller 310 can control the treatment device based at least in part on the determined first characteristic. Returning to the first example, here the material removal device 501 can include a Nd:YAG laser. Additionally, as discussed above, the feedback analyzer 121 identifies tissue at the surgical site as cancerous based on the spectral shape and peak location. Thus, in the first example 410, the controller 310 can automatically control the material removal device 501 to emit a laser beam at, for example, a wavelength of 1064 nm to remove the cancerous tissue at the surgical target site 500, such that the material removal device 501 is controlled based at least in part on the first identified target characteristic. 8, automatic controller 310 can send a signal 802 to material removal device 501 to target laser beam 800 at surgical site 500 via optical fiber 204. Upon completion of 410, method 400 is complete, or alternatively, operations 402-410 may be performed repeatedly until a particular therapeutic effect is achieved (e.g., when kidney stone fragmentation or pulverization is complete).

[0053] When light source 202 is switched between an "on" state and an "off" state, different excitation wavelengths may be emitted during the time when the light source is in the "off" state. For example, light source 202 or material removal device 501 may be capable of emitting different excitation wavelengths. To further illustrate, the different excitation may have a wavelength of 370 nm, which may produce fluorescence between approximately 425 nm and 550 nm, as shown in FIG. 9. In FIG. 9, if tumorous tissue is present, the spectrum will reflect this, as shown at 900. Additionally, the spectrum may also reflect the presence of healthy tissue, as shown at 902.

[0054] Method 400 may be performed during a first time period, in which a first spectrum associated with the fluorescent signal is determined, a property of the material at the surgical target site 500 is determined during the first time period, and a first control signal, such as control signal 802, is sent from controller 310 to material removal device 501, in which material removal device 501 may be controlled in real time based on the determinations made during the first time period. Method 400 may be repeated during a second time period, in which a second spectrum associated with the fluorescent signal is determined, a second property of the material at the surgical target site 500 is determined during the second time period, and material removal device 501 is controlled in real time based on the determinations made during the second time period. Specifically, controller 310 may send signal 804 ( FIG. 8 ) based on the determinations made during the second time period, in which a second property of the target may be determined during the second time period using the principles discussed herein. Furthermore, the second property may be different from or the same as the first property. For example, a characteristic may be determined to be different from the characteristic determined during the first time period. Here, the laser may be controlled based on the determination of the characteristic during the second time period. Further, the second control signal 804 and a second adjustment after the second time period based on the second control signal 804 may be made in real time.

[0055] The apparatus can be controlled by making a second adjustment to the laser. The second adjustment can include adjusting one or more parameters of the laser, such as laser pulse energy, pulse frequency, laser power, and pulse mode. Furthermore, in some embodiments, the parameters adjusted after the first time period and the parameters adjusted after the second time period can be different. For example, after the first time period, the laser pulse energy can be adjusted, whereas after the second time period, the pulse frequency can be adjusted.

[0056] By detecting fluorescence when the broadband or white light source is in the "off" state after illuminating the surgical target site in the "on" state, the characteristics of the surgical target site can be determined. Multiple light sources (e.g., light-emitting diodes, or LEDs) can be pulsed to illuminate the surgical target site, and a fluorescence response signal can be measured after each pulsing of the light source. For example, each light source (e.g., LEDs) of the multiple light sources can sequentially emit different colors at a sufficiently high rate so that different color combinations can be perceived by the human eye as white light. For three light sources, such as one that emits red light, a second that emits green light, and a third that emits blue light, the combination of the red, green, and blue light sources creates white light. Furthermore, although red, green, and blue colors are discussed herein as creating white light, any color of light can be used to determine the characteristics of the surgical target site. The spectrum and characteristics of the target at the surgical target site can be determined based on the fluorescence emitted in response to all light sources illuminating the surgical target site, such as in a manner further described in FIG.

[0057] FIG. 10 shows an example of a method 1000 for characterizing a surgical target site using multiple LEDs, each emitting light of a different wavelength. The LEDs can be sequentially switched on and off at a sufficiently high rate so that different color combinations are perceived by the human eye as white light. While a current LED (emitting light of a different wavelength) illuminates the target site, a fluorescent signal in response to an already activated LED can be detected. For example, a light source can have a red LED, a green LED, and a blue LED. The light source can sequentially emit red light, green light, blue light, red light, green light, blue light, etc. at a sufficiently high frequency during a laser procedure. While the green or blue LED is currently emitting light, a fluorescent signal in response to the already emitted red light can be detected and analyzed. At 1002, a target site can be illuminated using a first pulsed light source in an "on" state of the first pulsed light source. For example, the first light source can correspond to a first color, such as red. 11 , at 1002, the endoscope 102 can be controlled to illuminate the surgical target site 1100 with a first pulsed first color light 1102. In a second example, at 1002, the light source 202 can provide red light from an LED to the surgical target site 1100, where the red light can correspond to the first pulsed light 1102. In a second example, the endoscope 102 can illuminate the surgical target site 1100 by causing the light source to emit red light in an “on” state, such that the surface 1104 of the surgical target site 1100 is illuminated with the first pulsed first color light 1102. For example, the surgical target site surface 1104 can absorb photons, which can cause excitation of fluorophores at the surgical target site surface 1104.

[0058] At 1004, the target site may be illuminated with a second pulsed, second color light source in an "on" state of the second pulsed light source. For example, the second light source may correspond to a second color, such as green. At 1004, the first pulsed light source that illuminated the surgical target site in 1002 is in an "off" state.

[0059] During 1004, before 1004, or after 1004, at 1006, when the first pulsed light source site is in an "off" state, a first fluorescent signal may be emitted from the surgical target site and detected. The target site may contain fluorophores that can be excited by a particular wavelength of light emitted from the light source. Here, the fluorescent signal emitted in response to excitation by the first pulsed light signal may be detected while the target site is illuminated with a second pulsed light source. When the fluorophores are excited, they may emit light for a short period of time. At 1006, a first fluorescent light corresponding to the first pulsed light source may be detected while the surgical target site 1100 is illuminated with the second pulsed light source.

[0060] At 1004, the endoscope 102 may be controlled to illuminate the surgical target site 1100 with a second pulsed light 1106 having a different color than the first pulsed light 1102. For example, at 1004, the light source 202 may be in an "on" state and provide green light from an LED to the surgical target site 1100. Additionally, at 1004, the first pulsed light source is in an "off" state.

[0061] In a second example, when the surgical target site 1100 is illuminated 1006 with a second pulsed light source while the first pulsed light source is in an “off” state, energy absorbed by the surgical target site surface 1104, shown generally as energy 1200 in FIG. 12 , can be emitted as a first fluorescent light signal 1202. In the second example, the first fluorescent light signal 1202 can correspond to a wavelength emitted from the surgical target site surface 1104. When the surgical target site surface 1104 is illuminated with the first pulsed light 1102, the surgical target site surface 1104 can be in an activated state, and a resulting first fluorescent response signal 1202 can be detected, which can correspond to a wavelength emitted from the activated surgical target site surface 1104. In the second example, the first fluorescent light signal 1202 can be transmitted to the feedback analyzer 121 via the optical path 209.

[0062] At 1008, the target site may be illuminated with a third pulsed light source, for example, in an "on" state of the third pulsed light source, illuminating using blue light. At 1008, the second pulsed light source that illuminated the target site at 1004 may be in an "off" state. Similarly, at 1008, the first pulsed light source that illuminated the target site at 1002 may be in an "off" state.

[0063] During 1008, before 1008, or after 1008, at 1010, when the second pulsed light source site is in an "off" state, a second fluorescent signal may be detected emitting from the target site in response to illumination from the second pulsed light source. While the target site is illuminated with a third pulsed light source, a fluorescent signal may be emitted from the target site. At 1010, while the surgical target site 1100 is illuminated with the third pulsed light source, a second fluorescent light corresponding to the second pulsed light source may be detected.

[0064] After the third pulsed light source is switched to the "off" state (and while the first pulsed light source is switched to the "on" state), a third fluorescent signal emitted from the target site can be detected when the third pulsed light source site is in the "off" state at 1012. In an embodiment, the fluorescent signal is generated by excitation from the second pulsed light source.

[0065] At 1008, the endoscope 102 can be controlled to illuminate the surgical target site 1100 (FIG. 11) with a third pulsed light 1108, such as blue light. At 1008, the light source 202 can be in an "on" state and provide blue light from an LED to the surgical target site 1100, while the first pulsed light source and the second pulsed light source are in an "off" state.

[0066] When the surgical target site 1100 is illuminated with a third pulsed light 1108 while the first and second pulsed light sources are in the “off” state, the energy 1200 absorbed by the surgical target site surface 1104 when the surgical target site 1100 was illuminated with the pulsed light 1106 at 1010 can be emitted as a second fluorescent light signal 1204 that can correspond to a wavelength emitted from the surgical target site surface 1104 in response to being excited by the second pulsed light 1106. Thus, when the surgical target site surface 1104 is activated, a fluorescent light signal can correspond to a wavelength emitted from the activated surgical target site surface 1104 in response to being illuminated by the second pulsed light 1106. In a second example, the second fluorescent light signal 1204 can be transmitted to a feedback analyzer 121 via an optical path 209.

[0067] After the second fluorescent signal is detected at 1010, a third fluorescent signal 1206 may be detected at 1012. Specifically, the third fluorescent signal 1206 may correspond to a wavelength emitted from the surgical target site surface 1104 in response to being excited by the second pulse of light 1106. Thus, when the surgical target site surface 1104 is activated, a fluorescent signal may correspond to a wavelength emitted from the activated surgical target site surface 1104 in response to being illuminated by the third pulse of light 1108. In a second example, the third fluorescent signal 1206 may be transmitted to the feedback analyzer 121 via the optical path 209.

[0068] While method 1000 of FIG. 10 depicts the detection of a first fluorescent signal, a second fluorescent signal, and a third fluorescent signal, detecting one or two of these signals may be sufficient to determine the characteristics of one or more targets. For example, it may be sufficient to use only the first fluorescent signal or a combination of the first and third fluorescent signals to determine the characteristics of the targets. After the first (and, in some embodiments, the second and third) fluorescent signals are detected at 1012, fluorescent properties appropriately associated with the detected signals may be determined at 1014. For example, spectra associated with the first, second, and / or third fluorescent signals may be determined using feedback analyzer 121, etc.

[0069] After determining the fluorescence properties or spectra associated with the first, second, and / or third fluorescence signals at 1014, the characteristics of the target site may be identified at 1016 using the fluorescence properties or spectra. To identify the characteristics of the target site at 1016, the target detector 304 may extract one or more target fluorescence properties and / or reflectance features from the detected fluorescence signals and / or reflectance spectra determined at 1014. By comparing the target fluorescence properties and / or reflectance features to a property threshold and / or feature threshold or value range, if the target fluorescence properties and / or reflectance features exceed the feature threshold or are within the value range, the target detector 304 may identify the characteristics of the target site as a stone structure. If the target fluorescence properties and / or fluorescence features are below the property threshold and / or feature threshold or are outside the value range, the target detector 304 may identify the characteristics of the target site as kidney tissue. Property and / or feature thresholds or value ranges may be determined using the stone fluorescence properties and / or stone reflectance features and the tissue fluorescence properties and / or tissue reflectance features. Further, the fluorescence property and / or feature thresholds or value ranges may be stored in a look-up table in the imaging platform 104. The fluorescence property and / or feature thresholds may be determined as thresholds that separate the stone fluorescence properties and / or reflectance features and the tissue fluorescence properties and / or reflectance features by a specified margin.

[0070] At 1016, the target detector 304 can trend one or more of the characteristic fluorescent properties and / or reflectance intensities at the target site over a range of wavelengths, as previously described above, and identify the characteristics based on one or more trends in the fluorescent properties (or "fluorescence trends") and / or reflectance intensities (or "reflectance trends").

[0071] Returning to the second example, at 1014, the first fluorescent signal 1202, the second fluorescent signal 1204, and / or the third fluorescent signal 1206 detected at 1006, 1010, and 1012 may be transmitted to a feedback analyzer 121, which determines that the fluorescent properties or spectrum of the tissue at the surgical site, for example, has a spectrum of 460 nm to 700 nm when illuminated with a light source within the range of 450 nm to 500 nm. In the second example, each of the first fluorescent signal 1202, the second fluorescent signal 1204, and the third fluorescent signal 1206 may be stored and simultaneously transmitted to the feedback analyzer 121. Further, at 1016, similar to the first example, in the second example, the feedback analyzer 121 identifies the tissue at the surgical site as cancerous, for example, based on the shape and peak locations of the spectra.

[0072] After the characteristics at the target site are identified at 1016, an apparatus, such as a treatment device, may be controlled at 1018 based on the identification of the characteristics. In an example, controlling the apparatus may include adjusting various parameters of the apparatus, such as laser pulse energy, pulse frequency, laser power, and pulse mode, if the apparatus includes a laser. Additionally, 1018 may be performed in real time, where one or more parameters of the apparatus may be adjusted during the surgical procedure to remove tissue, stones, or any other type of organic deposits from the surgical site.

[0073] In an embodiment, if a determination is made that the tissue at the surgical site is cancerous, the control device 310 can control the laser to emit a laser beam capable of ablating the cancerous tissue. Returning to the second example, here the material removal device 501 is an Nd:YGA laser. Additionally, as described above, the feedback analyzer 121 identifies the tissue at the surgical site as cancerous based on spectral shape, peak location, or other properties. Accordingly, at 1016 in the second example, the automatic control device 310 automatically controls the material removal device 501 to emit a laser beam of a particular wavelength (e.g., 1064 nm) for the purpose of ablating the cancerous tissue at the surgical target site 500. Upon completion of 1018, the method 1000 is complete. Alternatively, operations 1002-1018 may be performed repeatedly until a therapeutic effect is achieved (e.g., when kidney stone fragmentation or pulverization is complete).

[0074] As described, the light source can be controlled to emit light of various wavelengths. One or more optical filters can be used to filter the sensed fluorescent signal, such as to enable the use of a single or common light pulse. For example, optical filtering techniques can be used to filter wavelengths associated with the second and third wavelengths, thereby enabling the transmission of a fluorescent signal associated with only the first wavelength. Similarly, optical filtering techniques can be used to filter wavelengths associated with the first and third wavelengths, thereby enabling the transmission of a fluorescent signal associated with only the first wavelength. In addition, optical filtering techniques can be used to filter wavelengths associated with the first and second wavelengths, thereby enabling the transmission of a fluorescent signal associated with only the third wavelength. Thus, the light source can emit light of the first, second, and third wavelengths, and optical filtering techniques can be used to filter the fluorescent signals associated with each of the first, second, and third wavelengths. Furthermore, in conjunction with spectrally based characteristics, the spectrum can be determined based on the filtered wavelengths for purposes of controlling a therapeutic device, as discussed above. For example, hardware such as wavelength filters can be used to filter the fluorescent signals associated with each of the first, second, and third wavelengths. Additionally, the hardware device can be programmed with software that provides the hardware with functionality for filtering the fluorescent signals associated with each of the first, second, and third wavelengths.

[0075] Method 1000 may be performed during a first time period, during which a characteristic at surgical target site 500 is determined and material removal device 501 is controlled in real time based on the determination. Method 1000 may be repeated during a second time period, during which a characteristic at surgical target site 500 is determined and material removal device 501 is controlled in real time based on the determination. The determined characteristic may change between the first and second time periods. The laser may be controlled in real time based on the change or based on the identification of the characteristic during the second time period.

[0076] For example, a laser may be controlled by making a second adjustment aimed at adjusting one of the laser or laser parameters, such as laser pulse energy, pulse frequency, laser power, and pulse mode, etc. The parameter adjusted after the first time may be different from the parameter adjusted after the second parameter, as described above.

[0077] 13 shows a schematic diagram of an example computer-based clinical decision support system (CDSS) that can be configured to control a laser system based on determining a property of a material at a target site, such as tissue at a surgical site. The CDSS 1300 can have an input interface 1302 through which patient-specific spectra associated with the tissue at the surgical site are provided as input features to an artificial intelligence (AI) model 1304, which, in conjunction with a processor 1306, outputs a property of the tissue at the surgical site. In an inference operation, the spectrum associated with the tissue at the surgical site is applied to the AI model to generate an output 1308 representing a property of the material at the target site, and the property of the material at the target site is communicated to a user, such as a clinician, through a user interface (UI).

[0078] The input interface 1302 can have a direct data link between the CDSS 1300 and one or more medical devices, such as the endoscope 102, that generate at least a portion of the input features. For example, the input interface 1302 can directly transmit spectra associated with tissue at a surgical site to the CDSS 1300 during a therapeutic and / or diagnostic medical procedure. Additionally or alternatively, the input interface 1302 can have a user interface that facilitates interaction between a user and the CDSS 1300. To further illustrate, the input interface 1302 can support a user interface through which a user can manually input spectra associated with tissue at a surgical site. Additionally or alternatively, the input interface 1302 can provide the CDSS 1300 with access to an electronic medical record, from which one or more input features can be extracted. In any of these cases, the input interface 1302 is configured to collect one or more of the various input features associated with a particular patient at or before the CDSS 1300 is used to determine the properties of material at a target site. For example, the first through nth input features can relate to spectra associated with tissue at the surgical site at various time intervals. By way of further example, the first input feature can correspond to a spectrum associated with tissue at the surgical site at a first time interval, while the nth input feature can correspond to a spectrum associated with tissue at the surgical site at an nth time interval.

[0079] Based on one or more of the input features, the processor 1306 can perform inference operations using an AI model to generate a characteristic of the substance at the target site. For example, the input interface 1302 can send spectra associated with the substance at the target site to an input layer of the AI model, which passes these input features through the AI model to an output layer. An AI model can provide a computer system with the ability to perform tasks by making inferences based on patterns seen in analyzing data without being explicitly programmed. An AI model trains and builds algorithms (e.g., machine learning algorithms) that can learn from existing data and make predictions about new data. Such algorithms operate by assembling an AI model from example training data to make a data-driven prediction or a decision expressed as an output or evaluation.

[0080] Forms of machine learning (ML) may include supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples correlating inputs to outputs or outcomes) to learn relationships between inputs and outputs. The goal of supervised ML is to learn a function that best approximates the relationship between the training inputs and outputs, given some training data, so that an ML model, given an input, can implement the same relationship to generate a corresponding output. Unsupervised ML is the training of an ML algorithm using uncategorized and unlabeled information, allowing the algorithm to act on that information without guidance. Unsupervised ML is useful for exploratory analysis because it can automatically identify structure in the data.

[0081] Some tasks for supervised ML are classification and regression problems. Classification problems, also called categorization problems, aim to classify an item into one of multiple category values (e.g., is this object an apple or an orange?). Regression algorithms aim to quantify some items (e.g., by providing a score for the values of some inputs). Some commonly used examples of supervised ML algorithms are logistic regression (LR), naive Bayes, random forest (RF), neural network (NN), deep neural network (DNN), matrix factorization, and support vector machine (SVM).

[0082] Some tasks for unsupervised ML include clustering, representation learning, and density prediction. Some examples of unsupervised ML algorithms are k-means, principal component analysis, and autoencoders.

[0083] Another type of ML is federated learning (also known as collaborative learning), which trains algorithms across multiple distributed devices with local data without exchanging data. This approach contrasts sharply with centralized machine learning techniques that upload multiple local datasets all to a single server, and even more decentralized approaches that can assume equal distribution of local data samples. Federated learning allows multiple actors to assemble a common, robust machine learning model without sharing data, thereby addressing important issues such as data privacy, data security, data access rights, and access rights to heterogeneous data.

[0084] In some examples, the AI model may be continuously or periodically trained before performing an inference operation by the processor 1306. Then, during the inference operation, patient-specific input features provided to the AI model may be passed from an input layer, through one or more hidden layers, and finally to an output layer, which provides an output corresponding to the material properties at the target site. For example, when the output layer generates an output corresponding to the material properties at the target site, a system used to ablate the surgical site, such as the endoscope 102, the imaging platform 104, the laser controller 122, the controller 310, or the material removal device 501, may be adjusted based on the material properties to perform the surgical procedure.

[0085] During and / or following the inference operation, the properties of the material at the target site may be communicated to a user via a user interface (UI) and / or automatically cause the endoscope 102, imaging platform 104, laser control device 122, control device 310, or material removal device 501 to perform a desired action, such as resecting the surgical site.

[0086] FIG. 14 is a block diagram 1400 illustrating a software architecture 1102 that may be installed on one or more of the devices described above (e.g., the joint controller 116, the laser controller 122, the flash controller 124, the feedback analyzer 121, and / or the target detector 304). It will be appreciated that FIG. 14 is merely a non-limiting example of a software architecture, and that many other architectures may be implemented to facilitate the functionality described herein. The software architecture 1402 may be implemented by hardware, such as a machine 1600 having a processor 1610, memory 1630, and / or I / O components 1650. In this example, the software architecture 1402 may be conceptualized as a stack of layers, where each layer may provide specific functionality. For example, the software architecture 1402 may have layers such as an operating system 1404, libraries 1406, frameworks 1408, and applications 1410. In operation, an application 1410 invokes application programming interface (API) calls 1412 through a software stack and receives messages 1414 in response to the API calls 1412, according to some implementations.

[0087] In various implementations, operating system 1404 manages hardware resources and provides general services. Operating system 1404 has, for example, kernel 1420, services 1422, and drivers 1424. In some implementations, kernel 1420 serves as an abstraction layer between the hardware and other software layers. For example, kernel 1420 provides memory management, processor management (e.g., scheduling), component management, networking, and security configuration, among other functionalities. Services 1422 may provide other general services for other software layers. Drivers 1424 may be responsible for controlling or interacting with the underlying hardware. For example, drivers 1424 may include a display driver, a camera driver, a Bluetooth driver, a flash memory driver, a serial communication driver (e.g., a Universal Serial Bus (USB) driver), a Wi-Fi driver, an audio driver, a power management driver, etc.

[0088] In some implementations, libraries 1406 provide a low-level, general infrastructure that can be utilized by applications 1410. Libraries 1406 may include system libraries 1430 (e.g., C standard libraries) that can provide functions such as memory allocation functions, string manipulation functions, and mathematical functions. Additionally, libraries 1406 may include API libraries 1432, such as a media library (e.g., a library for supporting the rendering and manipulation of various media formats, such as Moving Picture Experts Group-4 (MPEG4), Advanced Video Coding (H.264 or AVC), Moving Picture Experts Group Layer-3 (MP3), Advanced Audio Coding (AAC), Adaptive Multi-Rate (AMR) audio codec, Joint Photographic Experts Group (JPEG or JPG), or Portable Network Graphics (PNG)), a graphics library (e.g., an OpenGL framework used for rendering in two-dimensional (2D) or three-dimensional (3D) contexts on a display), a database library (e.g., SQLite for providing various relational database functions), and a web library (e.g., WebKit for providing web browsing functionality). Libraries 1406 may further include a wide variety of other libraries 1434 for providing many other APIs to application 1410.

[0089] According to some implementations, framework 1408 provides a high-level, general infrastructure that can be utilized by applications 1410. For example, framework 1408 provides various graphic user interface (GUI) functions, high-level resource management functions, high-level location functions, etc. Framework 1408 can provide a wide spectrum of other APIs that can be utilized by applications 1410, some of which may be specific to a particular operating system or platform.

[0090] The applications 1410 may include a wide variety of other applications, such as a home application 1450, a contacts application 1452, a browser application 1454, a book reader application 1456, a location application 1458, a media application 1460, a messaging application 1462, a game application 1464, and third-party applications 1466. The applications 1410 may include programs that perform functions defined within the programs. Various programming languages may be employed to create one or more of the applications 1410, which may be structured in various ways, such as object-oriented programming languages (e.g., Objective-C, Java, or C++) or procedural programming languages (e.g., C or assembly language). In particular examples, third-party application 1466 (e.g., an application developed using an Android™ or iOS™ software development kit (SDK) by an entity other than a particular platform vendor) may be mobile software running on a mobile operating system such as iOS™, Android™, Windows Phone, or other mobile operating system. In this example, third-party application 1466 may invoke API calls 1412 provided by the mobile operating system (e.g., operating system 1404) to facilitate the functionality described herein.

[0091] Particular embodiments are described herein as including logic or as including multiple components, modules, or mechanisms. A module may constitute a software module (e.g., code embodied (1) on a non-transitory machine-readable medium or (2) in a transmission signal) or a hardware-implemented module. A hardware-implemented module is a tangible unit capable of performing specific operations and may be configured or arranged in a particular way. In embodiments, one or more computer systems (e.g., stand-alone computer systems, client computer systems, or server computer systems) or one or more processors may be configured by software (e.g., an application or portion of an application) as a hardware-implemented module that operates to perform specific operations described herein.

[0092] In various embodiments, a hardware-implemented module may be implemented mechanically or electronically. For example, a hardware-implemented module may include dedicated circuitry or logic that is permanently configured (e.g., as a special-purpose processor such as a field programmable gate array (FPGA) or application-specific integrated circuit (ASIC)) for performing specific operations. A hardware-implemented module may also include programmable logic or circuitry (e.g., contained in a general-purpose processor or other programmable processor) that is temporarily configured by software to perform specific operations. It will be appreciated that the decision to mechanically implement a hardware-implemented module in dedicated, permanently configured circuitry or in temporarily configured circuitry (e.g., configured by software) may be driven by cost and time considerations.

[0093] Thus, the term "hardware-implemented module" should be understood to encompass a tangible entity that is a physically constructed entity that is permanently configured (hardwired) or temporarily configured (e.g., programmed) to behave in a particular way and / or to perform particular operations described herein. Although examples are discussed in which the hardware-implemented modules are temporarily configured (e.g., programmed), each of the hardware-implemented modules need not be configured or instantiated at any one instance of time. For example, if the hardware-implemented modules include a general-purpose processor configured using software, the general-purpose processor may be configured as different hardware-implemented modules at various times. Thus, the software may configure the processor, for example, to construct a particular hardware-implemented module at one instance of time and to construct another hardware-implemented module at another instance of time.

[0094] Hardware-implemented modules can provide information to and receive information from other hardware-implemented modules. Accordingly, the described hardware-implemented modules can be considered to be communicatively coupled. When multiple such hardware-implemented modules are present simultaneously, communication can be achieved through signal transmission (e.g., via appropriate circuits and buses) connecting the hardware-implemented modules. In embodiments in which multiple hardware-implemented modules are configured or instantiated at various times, communication between such hardware-implemented modules can be achieved, for example, through the storage and retrieval of information in memory structures accessed by the multiple hardware-implemented modules. For example, one hardware-implemented module can perform an operation and store the output of the operation in a memory device communicatively connected to the one hardware-implemented module. Furthermore, another hardware-implemented module can later access the memory device to retrieve and process the stored output. Hardware-implemented modules can also initiate communication with input or output devices and operate on resources (e.g., collecting information).

[0095] Various operations of the example methods described herein may be performed, at least in part, by one or more processors that are temporarily or permanently configured (e.g., by software) to perform the associated operations. Whether temporarily or permanently configured, the processor may constitute a processor-implemented module that operates to perform one or more operations or functions. Modules referenced herein may, in some embodiments, include processor-implemented modules.

[0096] Similarly, the methods described herein may be at least partially processor-implemented. For example, at least some of the operations of the methods may be performed by one or more processors or processor-implemented modules. Performance of particular operations may be distributed among one or more processors that reside not only within a single machine but also deployed across multiple machines. In some embodiments, the processor may be located at a single location (e.g., in a home environment, office environment, or server farm), while in other embodiments, the processor may be distributed across multiple locations.

[0097] The one or more processors may further operate to facilitate performance of associated operations within a "cloud computing" environment or as "Software as a Service (SaaS)." For example, at least some of the operations may be performed by a group of computers (examples of machines that include processors), which are accessible via a network 115 (e.g., the Internet) and via one or more suitable interfaces (e.g., application program interfaces (APIs)).

[0098] Embodiments can be implemented in digital electronic circuitry, or in computer hardware, firmware, software, or in combinations of them. Embodiments can also be implemented using a computer program product, such as a computer program tangibly embodied in an information carrier, such as a machine-readable medium, for execution by or to control the operation of a data processing apparatus, such as a programmable processor, a computer, or multiple computers.

[0099] A computer program may be written in any form of programmable language, including compiled or interpreted languages, and may be deployed in any form, including as a stand-alone program or as a module, subroutine, or other unit suitable for use in a computing environment. A computer program may be deployed to be executed on one computer or on multiple computers at one site or distributed across multiple sites and interconnected by a communications network.

[0100] A computing system may include clients and servers. Clients and servers are generally remote from each other and may interact through a communications network. The relationship of client and server arises by virtue of computer programs running on the respective computers, which have a client-server relationship to each other. It will be appreciated that in embodiments deploying a programmable computing system, it is necessary to consider both hardware and software architectures. In particular, it will be appreciated that whether to implement particular functionality in permanently configured hardware (e.g., ASICs), temporarily configured hardware (e.g., a combination of software and a programmable processor), or a combination of permanent and temporary configured hardware may be a design choice. Various embodiments of deployable hardware (e.g., machines) and software architectures are described below.

[0101] FIG. 15 is a block diagram of a machine with which instructions may be executed to implement any one or more of the methodologies described herein. In one embodiment, the machine may be any of the devices described above. In alternative embodiments, the machine may operate as a stand-alone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine may operate in the capacity of a server machine or a client machine in a server-client network environment, or as a peer machine in a peer-to-peer (or distributed) network environment. The machine may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile phone, a web appliance, a network router, switch, or bridge, or any machine capable of executing instructions (serialized or otherwise) that specify actions to be performed by the machine. Furthermore, although only a single machine is shown, the term "machine" should also be construed to include any collection of machines that individually or collectively execute a set (or sets) of instructions to implement any one or more of the methodologies discussed herein.

[0102] An embodiment of computer system 1500 includes a processor 1502 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), or both), a main memory 1504, and a static memory 1506, which communicate with each other via a bus 1508. Computer system 1500 may further include a video display unit 1510 (e.g., a liquid crystal display (LCD) or a cathode ray tube (CRT)). Computer system 1500 may further include an alphanumeric input device 1512 (e.g., a keyboard), a user interface (UI) navigation device (cursor control device) 1514 (e.g., a mouse), a disk drive unit 1516, a signal generation device 1518 (e.g., a speaker), and a network interface device 1520.

[0103] Drive unit 1516 includes machine-readable medium 1522 on which one or more sets of instructions and data structures (e.g., software) 1524 embodying or utilized by any one or more of the methodologies or functions described herein are stored. The instructions 1524 may also reside, completely or at least partially, within main memory 1504 and / or processor 1502 during their execution by computer system 1500, with main memory 1504 and processor 1502 further constituting machine-readable media. The instructions 1524 may also reside within static memory 1506.

[0104] While machine-readable medium 1522 is shown in one embodiment as being a single medium, the term "machine-readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database and / or associated caches and servers) that store one or more instructions or data instructions 1524. The term "machine-readable medium" should also be interpreted to include any tangible medium that can store, encode, or retain instructions 1524 for execution by a machine, cause a machine to perform any one or more of the methodologies of the present invention, or store, encode, or retain data structures utilized by or related to the instructions 1524. Accordingly, the term "machine-readable medium" should be interpreted to include, but not be limited to, solid-state memory and optical / magnetic media. Specific examples of machine-readable media include, by way of example, semiconductor memory devices such as erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), and flash memory devices, magnetic disks such as internal hard disks and removable disks, magneto-optical disks, and non-volatile memory including CD-ROM disks and DVD-ROM disks.

[0105] Further, the instructions 1524 may be transmitted or received over a communications network 1526 using a transmission medium. The instructions 1524 may be transmitted using a network interface device 1520 and any one of a number of well-known transmission protocols (e.g., HTTP). Examples of communications networks include a local area network ("LAN"), a wide area network ("WAN"), the Internet, a cellular phone network, a plain old telephone service (POTS) network, and a wireless data network (e.g., Wi-Fi and Wi-Max networks). The term "transmission medium" shall be interpreted to include any intangible medium capable of storing, encoding, or carrying instructions 1524 for execution by a machine, including digital or analog communications signals, or other intangible medium for facilitating communication of this software.

[0106] 16 shows an example of a method 1600 using a single tunable light source that can be tuned to emit light at multiple excitation wavelengths that can be used to determine characteristics of a target site. To further illustrate, a single quantum cascade laser (QCL) can be used to emit light at multiple wavelengths for the purpose of determining characteristics at the target site. At 1602, the tunable light source can be used to illuminate the target with light at a first wavelength. The first wavelength can correspond to a first color, such as one of red, green, or blue. The QCL can be tuned to emit light at the first wavelength for the purpose of illuminating the target site. At 1604, a first fluorescent signal can be sensed using the techniques described above.

[0107] After the first fluorescent signal is detected at 1604, the adjustable light source can be controlled at 1606 to emit light at a second wavelength for illuminating the target with light at the second wavelength. Here, the second wavelength can correspond to a second color, such as one of red, green, or blue. The second color can be different from the first color. For example, if the first color is red, the second color can be one of green or blue. The QCL can be adjusted to emit light at the second wavelength for illuminating the target site. When illuminating the target site at 1606, a second fluorescent signal can be sensed as described above.

[0108] After the second fluorescent signal is detected in 1608, the adjustable light source can be controlled to emit light at a third wavelength for illuminating the target with light at the third wavelength at 1610. Here, the third wavelength can correspond to a third color, such as one of red, green, or blue. The third color can be different from the first color and the second color. For example, if the first color is red and the second color is green, the third color can be blue. The QCL can be adjusted to emit light at the third wavelength for illuminating the target site. Upon illuminating the target site at 1610, a third fluorescent signal can be sensed at 1612 using the techniques described above.

[0109] After sensing the first, second, and third fluorescent signals at 1604, 1608, and 1612, a spectrum associated with each of the first, second, and third signals may be determined at 1614. The feedback analyzer 121 may be used to determine the spectrum associated with the fluorescent signals, as discussed above. The reflectance spectrum may be extracted from the reflectance spectrum or normalized reflectance spectrum of a known stone structure at the target site.

[0110] After determining the spectra associated with the first, second, and third fluorescent signals at 1614, a characteristic at the target site can be identified at 1616 using one or both of the fluorescent spectrum or the reflectance spectrum or other response spectrum, as described above. Additionally, the target detector 304 can trend the reflectance intensity of the material at the target site over a range of wavelengths, as discussed above, and can identify a characteristic based on the trend in the reflectance intensity.

[0111] After the characteristics of the target site are determined, the method 1600 can control the treatment device in real time based on the determined characteristics at the target site at 1618. Upon completion of 1618, the method 1600 is complete.

[0112] Method 1600 discussed an embodiment in which an adjustable light source can be controlled to emit light of various wavelengths. According to an embodiment, an optical filter can be used to filter the sensed fluorescent signal. The types of filtering that can be used may include bandpass, lowpass, or highpass optical filters, or a combination thereof, which can be deployed to separate the fluorescent signal from adjacent signals and from the excitation wavelength. For example, if the fluorescent response signal to the excitation illumination has a longer wavelength than any other signal of interest, a highpass filter can be deployed to attenuate the signal to below this wavelength of interest. Here, highpass refers to wavelength instead of frequency. Higher frequencies have shorter wavelengths, and vice versa. Alternatively, if the fluorescent response signal of interest occurs at a wavelength surrounded by other signals, a bandpass filter centered on the wavelength of the fluorescent response can be deployed. For example, optical filtering techniques can be used to filter wavelengths related to the second and third wavelengths, thereby allowing the fluorescent signal related only to the first wavelength to be transmitted. Similarly, optical filtering techniques can be used to filter wavelengths associated with the first wavelength and the third wavelength, thereby allowing for the transmission of a fluorescent signal associated with only the first wavelength. Additionally, optical filtering techniques can be used to filter wavelengths associated with the first wavelength and the second wavelength, thereby allowing for the transmission of a fluorescent signal associated with only the third wavelength. Thus, a light source can emit light at the first wavelength, the second wavelength, and the third wavelength, and optical filtering techniques can be used to filter the fluorescent signals associated with each of the first wavelength, the second wavelength, and the third wavelength. Furthermore, in conjunction with spectral-based characteristics, the spectrum can be determined based on the filtered wavelengths for purposes of controlling a therapeutic device, as discussed above.

[0113] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." These embodiments may include elements in addition to those shown or described. However, the inventors also contemplate embodiments that provide only the elements shown or described. Furthermore, the inventors also contemplate embodiments that use any combination or permutation of the elements shown or described (or one or more aspects thereof) in connection with the particular embodiment (or one or more aspects thereof) or in connection with other embodiments (or one or more aspects thereof) shown or described herein.

[0114] In this document, the terms "a" or "an" are used to include one or more, as commonly used in patent documents, regardless of any other examples or the use of "at least one" or "one or more." In this document, the term "or" is used to mean non-exclusive, i.e., "A or B" includes "A but not B," "B but not A," and "A and B," unless expressly stated otherwise. In this document, the terms "including" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "wherein." Furthermore, in the following claims, the terms "including" and "comprising" are intended to be open-ended, i.e., a system, device, item, composition, systemic statement, or process that includes elements other than the listed elements when such terms appear in a claim is deemed to be within the scope of that claim. Moreover, in the following claims, the terms "first," "second," and "third," etc., are used merely as labels and are not intended to impose numerical requirements on their objects.

[0115] The above description is intended to be illustrative, not limiting. For example, the above-described embodiments (or one or more aspects thereof) may be used in combination with each other. Other embodiments may also be used, such as may occur to those skilled in the art upon reading the above description. The Abstract is provided to comply with 37 C.F.R. 1.72(b) to enable the reader to quickly ascertain the nature of the technical disclosure. Accordingly, the Abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, the inventive subject matter may exist without satisfying all features of a particular disclosed embodiment. Accordingly, the following claims are incorporated into the Detailed Description as examples, where each claim stands on its own as a separate embodiment, and it is contemplated that these embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. [Explanation of symbols]

[0116] 100 systems 102 Endoscope 104 Imaging Platform 106 Main Unit 108 Proximal part 110 Long, rigid part 112 Flexible distal section 114 Distal end 116 Joint Control Device 118 Electrical Port 120 Display Devices 121 Feedback Analyzer 122 Laser control device 124 Flash Controller 126 Proximal part 200 boards 202 Light source 204 Optical Fiber 206 Optical Lenses 208 Image Acquisition Device 209 Light path 210 cleaning lumens 212 suction lumen 214 Other passages 300 photodetectors 302 Imaging Sensor 304 Target Detector 306 Target classifier 308 memory 310 Control device 400 ways 500 surgical site 501 Material removal device 502 Pulsed Light 504 Surgical target site surface 510 Laser 700 Energy 702 Fluorescence signal 800 laser beams 802 signal 804 signal 1000 ways 1100 Surgical target area 1102 First pulsed light 1104 Surgical target site surface 1106 Second pulsed light 1108 Third Pulse of Light 1200 Energy 1202 First Fluorescence Signal 1204 Second Fluorescence Signal 1206 Third Fluorescence Signal 1300 CDSS 1302 Input Interface 1304 Artificial Intelligence Model 1306 processor 1308 Output 1400 Block Diagram 1402 Software Architecture 1404 Operating System 1406 Library 1408 Framework 1410 Applications 1412 Application Programming Interface Calls 1420 kernel 1422 Service 1424 driver 1432 API Library 1434 other libraries 1450 Home Application 1452 Contact Application 1454 Browser Applications 1456 Book Reader Applications 1458 Location Application 1460 Media Applications 1462 messaging applications 1464 Game Applications 1466 Third-Party Applications 1500 Computer Systems 1502 processor 1504 main memory 1506 Static Memory 1508 Bus 1510 Video Display Unit 1512 Alphanumeric Input Device 1514 User Interface Navigation Device 1516 Disk Drive Unit 1518 Signal Generating Device 1520 Network Interface Device 1522 machine-readable medium 1524 Instructions and Data Structures 1600 Machines, methods 1630 memory 1650 I / O Components

Claims

1. 1. A system comprising: a laser system configured to treat the target; a white light source at a proximal end of the system, the white light source configured to illuminate the target with white light; a controller configured to periodically activate and deactivate said white light source, thereby switching said white light source between an on state and an off state, respectively; an illumination channel for transmitting white light from the white light source to the target; an optical path, distinct from the illumination channel, for transmitting a fluorescent signal from the target at a distal end of the system, the fluorescent signal being transmitted in response to the white light being applied to the target; and an optical detector for detecting the emitted fluorescent signal when the white light source is in the off state; Equipped with The control device analyzing the detected fluorescent signal; operating the laser system based at least in part on the analysis of the fluorescent signal. The system is further configured as follows:

2. the white light source is activated and deactivated to generate a first illumination and a second illumination, with an off state between the first illumination and the second illumination, and the control device: analyzing a first fluorescent signal and a second fluorescent signal from the target in response to the first illumination and the second illumination, respectively; operating the laser system at a first setting based at least in part on the analysis of the first fluorescent signal; operating the laser system at settings adjusted based at least in part on the analysis of the second fluorescent signal; The system of claim 1 further configured to:

3. 3. The system of claim 2, wherein the controller is further configured to automatically operate the laser system based at least in part on the analysis of the first fluorescent signal and to automatically operate the laser system at the adjusted settings based at least in part on the analysis of the second fluorescent signal.

4. 4. The system of claim 3, wherein the controller is configured to send control signals to adjust parameter settings of the laser system, the parameter settings corresponding to one of energy of laser pulses, pulse frequency, laser power, pulse mode, pulse width of laser pulses, pulse shape of laser pulses, peak power of laser pulses, or pulse frequency representing the number of laser pulses per unit time.

5. The control device repeatedly The following fluorescent signals are automatically analyzed: automatically operating the laser system at the next adjusted setting until a specific therapeutic effect is achieved; The system of claim 2 , configured to:

6. 10. The system of claim 1, wherein the controller is further configured to analyze at least one of a fluorescence intensity, a fluorescence excitation spectrum, a fluorescence emission spectrum, or a fluorescence decay time associated with the detected fluorescence signal to determine a characteristic of the target.

7. 7. The system of claim 6, wherein the controller is further configured to generate a spectroscopic property from the detected fluorescent signal, the spectroscopic property may include one of a reflectance, a reflectance spectrum, or an absorption index, and wherein a characteristic of the target may be determined from the spectroscopic property.

8. The system of claim 1 , wherein the controller is further configured to determine a characteristic of the target based on the analyzed detected fluorescent signal.

9. 9. The system of claim 8, wherein the detected fluorescent signal includes a spectral peak location within the detected fluorescent signal, and wherein a characteristic of the target is determined based on the spectral peak location.

10. The system of claim 9 , wherein the target characteristic relates to one of a stone structure or an anatomical structure.

11. The system of claim 1 , wherein the white light comprises wavelengths that excite fluorophores in the target.

12. The system of claim 1 , wherein the optical path is one of a multimode optical fiber, a single mode optical fiber, or a fiber bundle.

13. 1. A method of operating a system, said system comprising: a laser system configured to treat the target; a white light source at a proximal end of the system, the white light source configured to illuminate the target with white light; a controller configured to control operation of the white light source; a lighting channel; an optical path different from the illumination channel; a detector configured to detect a fluorescent signal; wherein the operating method comprises: transmitting the white light from the white light source to the target via the illumination channel when the controller periodically activates and deactivates the white light source, thereby switching the white light source between an on state and an off state, respectively; transmitting a fluorescent light signal from the target through the optical path at a distal end of the system, the fluorescent light signal being transmitted in response to the white light being applied to the target; detecting the transmitted fluorescent signal with the optical detector when the white light source is in the off state; the controller analyzing the detected fluorescent signal; the controller operating the laser system based at least in part on the analysis of the fluorescent signal; , including a method of operation.

14. the white light source is activated and deactivated to generate a first illumination and a second illumination, with an off state between the first illumination and the second illumination, and the method of operation includes: the controller analyzing a first fluorescent signal and a second fluorescent signal from the target in response to the first illumination and the second illumination, respectively; the controller operating the laser system at a first setting based at least in part on the analysis of the first fluorescent signal; the controller operating the laser system at settings adjusted based at least in part on the analysis of the second fluorescent signal; The method of claim 13 further comprising:

15. The operating method comprises: the controller automatically analyzing the fluorescent signal; causing the controller to automatically operate the laser system at the next adjusted setting until a specified therapeutic effect is achieved; The method of claim 14 further comprising:

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