Optical detector integration time during medical procedures

Abstract

A system for adjusting integration time of an optical detector during a lithotripsy procedure involving illumination of the target by an illumination source may comprise an optical detector and controller circuitry, control circuitry, processing circuitry, or the like. The controller circuity may be configurable or configured to establish an integration time for the optical detector. The controller circuitry may further cause the optical detector to receive a signal from the target in response to the illumination of the target by the illumination source and analyze the response signal received at the optical detector. Based at least in part on the analyzed response signal, such as upon determination of an occurrence of an event, the controller circuitry may adjust the integration time of the optical detector and adjust at least one setting of a medical device based at least in part on the occurrence of the event.

Description

OPTICAL DETECTOR INTEGRATION TIME DURING MEDICAL PROCEDURESPRIORITY CLAIM

[0001] This application claims priority to U.S. Provisional Patent Application Serial No. 63 / 661,247, filed lune 18, 2024, the contents of which are incorporated herein by reference.TECHNICAL FIELD

[0002] The present disclosure relates to analysis of signals from a target during lithotripsy procedures and determining integration time of an optical detector.BACKGROUND

[0003] During a medical procedure, such as a lithotripsy procedure, a user such as a physician or a robot may interact with one or more targets of various types and / or sizes. Characteristics of the target (e.g., size, shape, material composition, etc.) may vary depending on the type of procedure and may change during the procedure. One or more characteristics of the target may impact how to proceed during the procedure, what instrument to use during the procedure, instrument settings (e.g., ablation settings) to use during the procedure, or the like.

[0004] The quality or intensity of a signal from the target can vary based on a number of factors. A lower-quality signal can result in a poor quality analysis of the signal. A poor quality analysis of the signal from the target can, in turn, affect the quality of information that can be determined about the target.SUMMARY

[0005] A signal (e.g., a response signal) from a lithotripsy target may be analyzed to identify one or more characteristics of the target. The lithotripsy target may include a calculus such as a kidney stone, or may be a tumor, a piece of tissue, or the like. Spectroscopy can be used to identify the composition of the target (e.g., what material the target is made or composed of) or another characteristic of the target. For example, when the target is a kidney stone, spectroscopy of a signal spectrum of the signal reflected or scattered by,transmitted from, emitted by, or absorbed by the stone may be used to determine whether the stone is formed from uric acid, calcium oxalate, or a combination of these or other materials. The signal may include a response signal received at an optical sensor, optical detector, light detector, or charge collection device such as a spectrometer. The response signal may include light scattered by or reflected from the target in response to a signal emitted from a light source toward the target. The integration time of the optical sensor or optical detector (e.g., the amount of time a spectrometer is collecting an optical signal such as photons or light from the target) may need to be adjusted based on, for example, the quality of the signal received from the target or conditions at or near the target, such as at the surgical scene or at the tip of an endoscope.

[0006] A system for adjusting integration time of an optical detector during a lithotripsy procedure involving illumination of the target by an illumination source may comprise an optical detector and controller circuitry, control circuitry, processing circuitry, or the like. The controller circuitry may be configurable or configured to establish an integration time for the optical detector. The controller circuitry may further cause the optical detector to receive a signal from the target in response to the illumination of the target by the illumination source and analyze the response signal received at the optical detector (or cause the optical detector to analyze the response signal). Based at least in part on the analyzed response signal, the controller circuitry may adjust the integration time of the optical detector.

[0007] In an example, the integration time may be established based on one or more of a variety of factors. The factors may include a type of illumination source, an intensity of the illumination source, a type of lithotripsy procedure, or the like. The integration time may be adjusted (e.g., during the lithotripsy procedure) based on one or more additional factors. For example, the integration time may be adjusted based on a color of the target, a surface feature of the target, a clarity level of the surgical scene at or near the target, a flashing of a laser signal emitted from the laser source, or whether a laser signal emitted from the laser source contacts the target. Additionally, or alternatively, the integration time may be adjusted based at least in part on an intensity level or quality of the received response signal. For example, when the signal quality or intensity level is high or above an upper threshold value, a shorter integration time (e.g., lessthan 100 milliseconds (ms)) may be used. Conversely, when the signal quality is low or below a lower threshold value, the integration time may be longer (e.g., 100 ms or greater).

[0008] The received response signal may be analyzed to determine a signal-to- noise characteristic, such as a signal -to-noise ratio (SNR). In such an example, the integration time may be adjusted based at least in part on the signal -to-noise characteristic.

[0009] The system may include a single optical detector using or configured for an adjustable integration time. In another example, the system may include two optical detectors (a first and second optical detector), each using or configured for different integration times. In such an example, the controller circuitry may select the appropriate optical detector based on the determined integration time (e.g., the initial or first integration time) and may selectively switch to the other optical detector based at least in part on the analyzed response signal or other factors which may call for a different or adjusted integration time. Stated differently, the first optical detector may be selected based on the established or determined integration time such as at the beginning of the medical procedure. When the response signal from the target is analyzed, for example, based on one or more of the factors listed above, or conditions of the surgical site warrant a change to the integration time, the controller circuitry may switch to the second optical sensor.

[0010] The identification and classification of one or more lithotripsy targets may be made by one or more algorithms. For example, an algorithm can include an artificial intelligence (Al) or machine learning (ML) or other algorithm (e.g., a non-AI or non-ML deterministic algorithm) or process. Additionally, or alternatively, a portion of the identification and / or classification may be made using a hardware-based feedback loop or feedback control. Thus, as lithotripsy procedures include automation, such as via the use or integration of trained Al or ML algorithms, it is desirable to maintain a sufficient signal -to-noise characteristic in data used to train the algorithms. Using data with a better signal- to-noise characteristic to train the algorithms may result in better decisions or recommendations being delivered from these models as such data may provide better, and more accurate information about the target or targets.

[0011] As the lithotripsy procedure proceeds and therapy (e.g., laser, ultrasonic, hot / cold, or the like) is delivered to the target, the anatomical or surgical environment can become more turbulent, occluded, or the like, which may result in low intensity or low quality signals (requiring a longer integration time). Similarly, the target itself can change as therapy is delivered or some event may occur such as ablation energy contacting non-target tissue that requires a quick decision to be made (e.g., stopping the ablation energy), which may require faster integration times.

[0012] A potential advantage to the presently described systems and methods is that they may result in easier collection of measurements and determination of target characteristics of specific anatomical targets, especially by automated algorithms. Furthermore, the presently described systems and methods may result in a better determination of when to collect the measurements of the target (e.g., at what points during the lithotripsy procedure to take measurements of the lithotripsy target or targets).BRIEF DESCRIPTION OF THE DRAWINGS

[0013] In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.

[0014] FIG. 1 illustrates an example of a lithotripsy system including an optical detector.

[0015] FIG. 2 illustrates an example of a flowchart for adjusting integration time of an optical detector included in the system illustrated in FIG. 1.

[0016] FIG. 3 illustrates an example of graphs of integration times for one or more optical detectors.

[0017] FIG. 4 illustrates an example of a method for adjusting integration time of an optical detector during a lithotripsy procedure.

[0018] FIG. 5 is a block diagram of an example of a machine upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform.

[0019] FIG. 6 illustrates a schematic diagram of an exemplary computer-based clinical decision support system (CDSS).DETAILED DESCRIPTION

[0020] In medical procedures such as lithotripsy procedures there is a desire to identify types of targets, such as a tumor or a calculus, such as a kidney stone, and one or more characteristics of a target such as material composition, density, or the like. These identifications may be made, at least in part, based on analysis of the spectra of signals from the target, for example, light reflected from or scattered by the target using an optical detector such as a spectrometer. Based on these identifications, decisions about the medical procedure may need to be made quickly. These decisions may include a type and intensity of ablation energy to deliver to the target, whether to interrupt or stop ablation energy, whether to alter a position of a medical device (e.g., an endoscope) being used during the procedure, whether to irrigate or suction the surgical site, or the like.

[0021] These identifications and decisions may be made using an automated system or algorithm. The algorithm may include an artificial intelligence (Al) or machine learning (ML) or other algorithm (e.g., a non-AI or non-ML deterministic algorithm) or process. Additionally, or alternatively, a portion of the identification and / or classification of targets or decisions regarding the procedure may be made using a hardware-based feedback loop or feedback control.

[0022] For decisions to be made quickly it may be desirable to use a short integration time for the optical detector. The integration time being the amount of time that the optical detector is collecting photons or light, or the amount of time that a signal (e.g., a voltage signal) is held until the signal stabilizes. For a signal that is low quality or low intensity, a longer integration time (e.g., greater than 100 ms) may be required. Often times, however, ablation energy such as from a laser included in or coupled to an endoscope is delivered in short pulses (e.g., 1 ms pulses) and data is collected when the ablation energy is pulsed OFF. A one millisecond pulse, however, is generally too short an amount of time for an integration time of the optical detector to receive a quality signal from the target. Therefore, the integration time of the optical detector may collect light without regard to the pulse width of the ablation energy and be adjusted based on other factors such as flashing during the procedure, which may indicate tissue is inadvertently being burned.

[0023] A system for adjusting integration time of an optical detector during a lithotripsy procedure may include a single optical detector (e.g., a single spectrometer or any device capable of measuring light intensity at one or over a range of wavelengths) or multiple optical detectors. In the case of multiple detectors, one of the detectors may be configured with a short integration time and the other detector may be configured with a longer integration time. Thus, signals requiring short integration times may be collected at the same time as signals requiring a longer integration time. The integration time of the optical detector may be set or adjusted by controller circuitry included in or coupled to the optical detector. Stated differently, the controller circuitry may be a component of (or a combination of components of ) the optical detector or external to and connected or coupled to the optical detector.

[0024] In the case of a single optical detector, the optical detector may be configured with a short integration time for one duration and a longer integration time for another duration. In such an example, data supporting decisions that are required to be made quickly (e.g., to disable ablation energy when the ablation energy does not strike the target or strikes an unintended target) may be collected before data supporting decisions that can be made more slowly and require a higher signal-to-noise ratio (e.g., predicting the composition of a kidney stone). That is, the actions that depend on predicting stone composition may not be as time sensitive as the actions that depend on predicting that tissue is being targeted during a stone ablation procedure and the two predictions or determinations can require or utilize different integration times. When training an algorithm, collecting data using an integration time that is appropriate for the quality or types of signals being analyzed may allow for increased confidence in decisions or recommendations being made by the algorithm and an overall better trained algorithm.

[0025] FIG. 1 illustrates an example of a lithotripsy system including an optical detector. The system 100 may include a surgical laser 102 and a graphical user interface 104 (GUI). The graphical user interface 104 may include a touchscreen or other input mechanism (e.g., a button, switch, or other similar actuation member on the handle of the endoscope) configured to operate, control, or the like, the surgical laser 102. The surgical laser 102 may include one or more laser sources configured to emit laser radiation. As shown in thedashed box in the example of FIG. 1, the laser sources may include an ablation laser 106 and / or an illumination source 108. The illumination source 108 may be a probe laser, a Light Emitting Diode (LED), a Xenon-based light source, or any similar source of visible light. The ablation laser 106 may emit infrared radiation while the illumination source 108 may emit an aiming beam of visible light to show where the tip of the scope (and therefore where the ablation energy from the ablation laser 106) is aimed. Additionally, or alternatively, the illumination source 108 may be used to illuminate a target 126, such as to permit a viewer to view a lighted region about the target 126. The target 126 can be a piece of tissue, debris, or an object, such as a kidney stone which is to be ablated, or the like. The emitted light 128 from the ablation laser 106 or the illumination source 108, may be emitted through an optical fiber 116 such as can be connected to a surgical fiber 118 via an optical connector 120. In an example, the structure of the surgical fiber 118 may be the same or different from that of the optical fiber 116. The surgical fiber 118 may be located wholly or partially outside the surgical laser 102. The emitted light 128 may thus be emitted from illumination source 108, through the optical fiber 116, the optical connector 120, and the surgical fiber 118, to a distal end of the surgical fiber 118. The distal end of the surgical fiber 118 may be inserted into a scope 124, such as an endoscope, a ureteroscope, laryngoscope, or the like. In an example, at least a portion of the emitted light 128 emitted from the distal end of the surgical fiber 118 and the scope 124 may be reflected off of, scattered by, or the like, the target 126 (reflected light 130) through a medium between the tip of the scope 124 and the target 126.

[0026] The surgical laser 102 may further include or couple to an optical component such as optical splitter 110, configured to collect at least a portion of the reflected light 130 passing through the aperture of the surgical fiber 118. In an example, the optical splitter 110 may be replaced with a dedicated fiber configured to collect at least a portion of the reflected light 130. The portion of reflected light 130 collected by the optical splitter 110 or dedicated fiber may be sent to a processor 112 in connection with or coupled to the surgical laser 102. An optical detector 132 (e.g., a spectrometer or other similar light detector) may be located between the optical splitter 110 and the processor 112, so that spectral analysis of the reflected light 130 may be performed in order to determine one ormore characteristics of the target 126 and a determination can be made (e.g., by the processor 112) whether to adjust the integration time of the optical detector 132 or to adjust one or more laser settings. Before a medical procedure, an initial or first integration time of the optical detector 132 may be determined by the processor 112. The initial integration time may be determined based on one or more factors known before the medical procedure begins. For example, the initial integration time may be based on at least one of: a type of anatomy that the scope 124 is in proximity to (e.g., whether the scope is in a kidney or outside a kidney, a characteristic of the anatomy that the scope 124 and / or the surgical fiber 118 is in proximity to (e.g., whether the anatomy includes healthy tissue or a target to be ablated), a type of laser fiber included in the surgical laser 102 (or any other ablation source) to be used during the medical procedure, or a type of medical procedure for which the system 100 is being used. Alternatively, the processor 112 may be communicatively coupled to a database containing patient information (such as the databases discussed below for FIG. 5 and FIG. 6), and the type of medical procedure, information about the target 126, etc., may be determined from the patient information in the database.

[0027] The processor 112 and / or optical detector 132 may analyze the portion of the reflected light 130 collected by the optical splitter 110 (or receive an analysis by a spectrometer connected or coupled to the processor 112 and / or the optical detector 132), and determine, based on the analysis of the reflected light 130, a proposed updated integration time to be used by the optical detector 132. Additionally or alternatively, the determination may be made based on an environmental condition measured by a sensor coupled to the processor 112. The environmental condition may include a temperature value at the tip of the scope 124 measured by a temperature sensor coupled to or included on the scope 124. Additionally, or alternatively, the environmental condition may be a pressure value, such as the pressure in a medium in which the scope 124 is located. In an example, the determination may be made based on a characteristic of the target 126. For example, the processor 112 and / or the optical detector 132 may analyze the reflected light 130 from the target 126 to determine a characteristic of the target 126 at a first time. The characteristic can be a composition (a material composition) or a size of the target 126 at the first time. The processor 112 may then analyze the reflected light 130 from the target 126 at a second time duringthe procedure and determine a change in the characteristic of the target 126 at the second time by comparing the characteristic of the target 126 at the first time and the characteristic of the target 126 at the second time. For example, when the target is a stone or other calculus, at the second time the composition of the target 126 may change such as from a harder material to a softer material, or the target 126 may be substantially smaller at the second time than at the first time, such that less ablation energy is needed to ablate or break up the target 126. Based on the determination of the change in the characteristic of the target at the second time, which may in turn affect the quality of the return signal from the target, the system may determine a proposed updated integration time. The updated integration time may also be based at least in part on conditions of the surgical scene, such as surgical scene clarity, which may change during the medical procedure such as when the target 126 is being ablated.

[0028] The proposed updated integration time can be indicated, and an option to accept or reject the proposed updated value can be provided, on the graphical user interface 104. For example, when the processor 112 determines a need for a change to the integration time, an indication or notification, such as in the form of a pop-up box or menu, can be sent to the graphical user interface 104 informing the physician that an updated integration time is recommended, or that an updated setting of the surgical laser 102 or the ablation laser 106 will be implemented. In an example, the notification may include a button, link, or the like on the pop-up screen or somewhere else on the graphical user interface 104 for the physician to accept or reject the proposed updated integration time. For example, the pop-up screen with the proposed change may include an “accept” button and / or a “reject” button, that a user can click on. In another example, the acceptance or rejection of the updated integration time may be initiated via a voice command, or activation of an actuation member. The actuation member may include a button or a switch on the scope 124 or a handpiece of (or connected to) the scope 124, or a footswitch or foot pedal connected to the system 100, such as connected to the surgical laser 102 and / or the scope 124.

[0029] In an example, the updated integration time may be automatically implemented by the processor 112. In such an example, the system 100 may include a feedback mechanism to provide an indication or notification to notify or warn the physician that the proposed updated integration time has beendetermined and adjusted. The indication may be through a haptic feedback mechanism, such as vibration of the handpiece of the scope 124, an audible feedback mechanism, such as a beep or chime through a speaker or similar output device, or an illumination feedback mechanism, such as changing a characteristic of a user-visible targeting illumination beam emitted toward the target. For example, when the processor 112 determines a need for an updated integration time, the processor 112 may cause a chime or beep to be emitted through a speaker included in the graphical user interface 104, can cause the handpiece of the scope 124 to vibrate, may cause a button on the handpiece of the scope 124 to illuminate or light up, or may cause a visible light beam emitted through the scope 124 to blink, change color, or the like.

[0030] This notification or warning may be especially useful when the system changes the integration time (or any other settings) automatically without interaction or approval from the user (e.g., in a fully automatic system) so that the user can make any adjustments desired or appropriate.

[0031] The surgical laser 102 may optionally or additionally include a controller 114 (or controller circuitry) communicatively coupled to the processor 112. In response to the acceptance of the proposed updated integration time, the controller 114 may adjust the optical detector 132 to the updated integration time (or in the case in which two or more optical detectors are being used, switch to a second optical detector with a different (longer or shorter) integration time than the currently selected optical detector.

[0032] As discussed above, along with adjusting the integration time, one or more settings of the surgical laser 102 or the components coupled to the surgical laser may also be adjusted. These changed settings may be based at least in part on what the integration time is adjusted to. The changed setting can include causing a change in the intensity of the emitted light 128 or emitted laser radiation (e.g., stopping, reducing, lowering, or the like when the integration time is reduced, for example, below a threshold value), a change in composition of the target 126 or any relevant factor warranting an adjustment to the intensity of the emitted laser radiation or light 128. In another example, the adjustment of the setting can include a change in one or more other parameters (e.g., duty cycle, pulse width, or the like) of the light or radiation emitted from one of the lasers. Additionally, or alternatively, the controller 114 can cause a surgical fiberactuator 122 configured to be connected to the surgical fiber 118 to adjust a location of at least a portion of the surgical fiber 118. For example, the surgical fiber actuator 122 can cause the surgical fiber 118, such as the portion of the surgical fiber 118 connected to the scope 124 to change its location (e.g., move closer to or away from the target).

[0033] More than one setting may be adjusted, and the adjustments may be applied independently or in conjunction with each other or independently or in conjunction with a change to the integration time of the optical detector 132 as desired or appropriate. By configuring the processor 112 and / or the controller 114 to automatically select and cause a setting adjustment to be applied based on the analysis of the reflected light 130 or the change to the integration time, the system may provide increased ablation or surgical efficiency as the processor 112 and / or the controller 114 can cause the adjustment to be applied faster than a human can react to changing conditions during the medical procedure, resulting in more efficient and effective laser procedures.

[0034] FIG. 2 illustrates an example of a flowchart for adjusting integration time of an optical detector (such as optical detector 132) included in the system illustrated in FIG. 1. At 200, an integration time may be determined (e.g., by the processor 112 or the controller 114). The optical detector may be set (e.g., by the processor 112 or controller 114) to the determined integration time. This integration time may be an initial integration time that may depend on or be determined based on factors known before or at the beginning of a medical procedure. For example, the initial integration time may be determined based on the type of procedure being performed or the type of target to be treated during the procedure, a darkness level of the target, a location of the target, or the like. For example, a darker-colored stone, such as a COM stone may provide a return signal with a low intensity requiring a longer integration time whereas a lightercolored stone such as a cystine stone may provide a return signal with a high intensity allowing for a shorter integration time. Additionally, or alternatively, the initial integration time may be based on the equipment to be used during the procedure (e.g., the type of illumination source to be used, the type of ablation source to be used, or any other appropriate or sufficient factor).

[0035] At 202, a determination may be made to update the integration time. The determination may be made based on conditions that occur or change duringthe procedure. For example, the determination may be made on factors such as whether the ablation energy is contacting the target or non-target tissue, an amount or level of surgical scene clarity or a turbidity level at the tip of the scope, a temperature or pressure level at or near the tip of the scope, the intensity of the illumination light, an intensity or quality of a signal from the target, or a change in the target, such as a change in size, location, or composition of the target as it is being reduced or ablated. Further, at 202 a user may be notified, such as on a graphical user interface, that an adjustment of the integration time is recommended. The recommendation may include the updated integration time and any additional relevant information such as a reason for the recommendation to update the integration time.

[0036] When the system is in a prompted adjustment mode, at 204B, if the user accepts the recommendation to adjust the integration time, at 206, the integration time is adjusted to the updated duration. If the user rejects the recommended adjustment or does not respond to the recommendation within a period of time (e.g., within five seconds or any desired or appropriate period of time), the system may continue with the optical detector using the integration time initially determined at 200.

[0037] When the system is in automatic adjustment mode, at 204A, the user may be given the opportunity to override the updated adjustment. If the adjustment is overridden, the system may continue with the optical detector using the integration time determined at 200. If the adjustment is not overridden or the user does not override the adjustment within a period of time, at 206 the integration time is adjusted to the updated duration.

[0038] Thus, adjustment of the integration time may be fully automatic (without input, intervention, or the like, by a user), may be partially automatic (allowing the user to override adjustment), or done after prompting the user and acceptance by the user. In an example, in the prompted adjustment mode, the system may communicate a prediction confidence level (e.g., a confidence level for predicted target information) to the user. When the confidence level is low, or lower than the user desires, the user can accept a recommended adjusted integration time, reject the recommended adjusted integration time, or manually set a desired integration time in order to get a higher prediction confidence level.

[0039] Once the integration time is updated at 206, the system may optionally proceed to 208, and change (or recommend a change to) additional settings. For example, the system can change or recommend a change to ablation energy settings, a change to suction or irrigation settings, or the like. Regardless of whether additional settings are updated, the system may then return to 200 using the newly determined integration time.

[0040] FIG. 3 illustrates an example of graphs of integration times for one or more optical detectors. As discussed above, a system may include one or more optical detectors, such as a spectrometer. The optical detectors may include or be coupled to signal -processing circuitry, which can include an integration circuit for integrating the output signal from a corresponding detector over a specified integration time. Alternatively or additionally, the integration may be performed at least in part by the optical detector itself, which can accumulate photons for a specified “integration” time period. The integration circuit associated with the corresponding optical detector can have an adjustable integration time. For example, the integration times may be adjusted from a relatively shorter integration time to a relatively longer integration time). In another example, one optical detector may have a short integration time (e.g., less than 100 milliseconds) and another may have a longer integration time (e.g., 100 milliseconds or longer). When two optical detectors are used, one may be used instead of the other, or both may be used in conjunction with each other.

[0041] FIG. 3 shows control signal amplitude vs. time graphs 300, 302, and 304. In FIG. 3, the integration times (illustrated by the binary “high” control signal pulse widths) can be specified or adjusted to be shorter or longer in duration. As shown in graph 300, the integration time can alternate from short to long. Alternatively, as shown in graph 302 the integration time can be kept short and then changed to long, or as shown in graph 304 can be kept long and changed to short. Alternatively, when two optical detectors are used, the integration time of each detector may remain the same (e.g., one detector may constantly use a short integration time and the other may constantly use a long integration time). In such an example, the detector using the short integration time may provide information about whether soft or hard tissue such as urinary stores are being targeted by a surgical device. The second detector using the longer integration time may provide more detailed information about a specifictarget being treated. For example, the second detector may provide information about the composition of the target tissue or a target such as a stone. The results from the detector collecting data at a short integration time may be used to configure how the second detector collects data, if the second detector collects data, or how the data from the second detector is either analyzed or used in other processes such as developing algorithms or models.

[0042] Thus, the results from both detectors may be used independently to support different decisions or to communicate different information, or the results from each detector may be collectively evaluated to support a decision or to communicate information. For example, detector 1 may determine that soft tissue is being targeted by the laser and that the light source is being pulsed. This information may be used to configure how detector 2 collects information such as when data is collected, the integration time, or to set other data collection configuration variables. For example, when the treatment site is the prostate, the results from detector 1 (tissue is being targeted, and the light source is a pulsed LED) may be used along with other information provided by user interfaces from other equipment or other systems to select the appropriate algorithm to analyze the results from detector 2 (e.g., an algorithm expecting data from an LED light source for selecting between a prostatic capsule and the prostatic adenoma) which may finally determine that the soft tissue is the prostatic capsule and emission should be paused or stopped until the target becomes the adenoma.

[0043] A signal from a target, such as a return signal from light reflected or scattered from the target may be collected and analyzed for the occurrence of an event. Based at least in part on the occurrence of the event, one or more systems or settings of a medical scope may be changed or adjusted. The event may include, for example, when the scope includes or is connected to a laser, if the system detects that laser energy is not contacting the target or is contacting unintended tissue, the laser energy may be stopped or turned off.

[0044] FIG. 4 illustrates an example of a method 400 for adjusting integration time of an optical detector during a lithotripsy procedure. The method 400 can include or comprise a number of Operations or Steps (402-410). These Operations are examples only, and the executed method can omit one or more of the listed Operations, can repeat Operations, can include other Operations, or canexecute the Operations concurrently, substantially simultaneously, or in another order, as appropriate or desired. The operations can be performed automatically by the processor 112 or controller 114 of the system described in FIG. 1, or the processor or controller of a machine or computer, such as described below for FIG. 5.

[0045] At 402, the method 400 may include establishing an integration time for an optical detector. The integration time established at 402 may be an initial integration time and may be established or determined based on one or more factors. In an example, the factors may include a type of the illumination source or an intensity of the illumination source. The illumination source may include one or more of an LED, a laser, a broadband illumination source, a Xenon-based illumination source, or any similar, appropriate, sufficient, or desired illumination source. The illumination source may be included on or within or coupled to a medical scope, such as an endoscope, used in the lithotripsy procedure. The optical detector may include a spectrometer or any similar light collection or light analysis device. The optical detector may be configured for multiple integration times which can be selected or adjusted to as appropriate or desired.

[0046] At 404 the method 400 may include emitting an illumination signal from the illumination source toward a target. The illumination signal may be a light in the visible light spectrum, and the target may be a calculus, such as a stone (e.g., a kidney stone or a gall stone), a tumor, tissue to be treated, or the like. At 406 the method 400 may include receiving a response signal from the target. The response signal may be a signal from the target in response to the emitted illumination signal. For example, the response signal may be a reflected signal, a scattered signal (e.g., via RAMAN scattering), or the like, and be received at or sent to the optical detector.

[0047] At 408 the method 400 may include analyzing the response signal received at the optical detector. The analysis may include spectral analysis of the response signal to determine one or more characteristics of the target (e.g., size, material composition, or the like) or a change in the one or more characteristics of the target. The analysis may also include determining a signal-to-noise characteristic such as a signal-to-noise ratio.

[0048] At 410 the method 400 may include adjusting the integration time for the optical detector based at least in part on the analyzed response signal. In an example, the integration time may be adjusted based on a color of the target (e.g., whether the target is light or dark) or how much of the emitted illumination light reflects off of or is scattered by the target. The integration time may further be adjusted based on a surface feature of the target, an environmental condition (e.g., a temperature or pressure) or a clarity level of a surgical scene or site at or near the target. For example a target with a sloped or curved surface feature or texture may reflect incident light away from the face of the collecting fiber reducing the amount of light the fiber collects and thereby reducing the signal - to-noise ratio in the spectral measurement. The integration time may also be adjusted based on a flashing of a laser signal emitted from the laser source (such as caused by the laser signal contacting a non-target) or whether the laser signal emitted from the laser source contacts the target. The integration time may further be adjusted based at least in part on an intensity level or signal quality of the received response signal or the signal -to-noise characteristic determined at 408.

[0049] FIG. 5 is a block diagram of an example of a machine 500 upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform. The machine 500 may operate as a standalone device or may be connected (e.g., networked) to other machines. For example, the machine 500 may be included in or connected to the surgical laser 102 and / or the scope 124 and may include components such as the graphical user interface 104, the processor 112, the controller 114, or the surgical fiber actuator 122, discussed above. Additionally, or alternatively, the machine 500 may operate the flow discussed above for FIG. 2, the method steps or operations illustrated in FIG. 4, or the computer-based clinical decision support system (CDSS) discussed below for FIG. 6. In a networked deployment, the machine 500 may operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example, the machine 500 may act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment. The machine 500 may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential orotherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations.

[0050] Examples, as described herein, may include, or may operate by, logic or a number of components, or mechanisms. Circuit sets are a collection of circuits implemented in tangible entities that include hardware (e.g., simple circuits, gates, logic, etc.). Circuit set membership may be flexible over time and underlying hardware variability. Circuit sets include members that may, alone or in combination, perform specified operations when operating. In an example, hardware of the circuit set may be immutably designed to carry out a specific operation (e.g., hardwired). In an example, the hardware of the circuit set may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) including a computer readable medium physically modified (e.g., magnetically, electrically, moveable placement of invariant massed particles, etc.) to encode instructions of the specific operation. In connecting the physical components, the underlying electrical properties of a hardware constituent are changed, for example, from an insulator to a conductor or vice versa. The instructions enable embedded hardware (e.g., the execution units or a loading mechanism) to create members of the circuit set in hardware via the variable connections to carry out portions of the specific operation when in operation. Accordingly, the computer readable medium is communicatively coupled to the other components of the circuit set member when the device is operating. In an example, any of the physical components may be used in more than one member of more than one circuit set. For example, under operation, execution units may be used in a first circuit of a first circuit set at one point in time and reused by a second circuit in the first circuit set, or by a third circuit in a second circuit set at a different time.

[0051] Machine 500 (e.g., computer system) may include a hardware processor 502 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, field programmable gate array (FPGA), or any combination thereof), a main memory 504 and a static memory 506, some orall of which may communicate with each other via an interlink (e.g., bus) 530. The machine 500 may further include a display unit 510, an alphanumeric input device 512 (e.g., a keyboard), and a user interface (UI) navigation device 514 (e.g., a mouse). In an example, the display unit 510, input device 512 and UI navigation device 514 may be a touch screen display. The machine 500 may additionally include a storage device 508 (e.g., drive unit), a signal generation device 518 (e.g., a speaker), a network interface device 520, and one or more sensors 516, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensor. The machine 500 may include an output controller 528, such as a serial (e.g., universal serial bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.).

[0052] The storage device 508 may include a machine readable medium 522 (e.g., a non-transitory medium) on which is stored one or more sets of data structures or instructions 524 (e.g., software) embodying or used by any one or more of the techniques or functions described herein. The instructions 524 may also reside, completely or at least partially, within the main memory 504, within static memory 506, or within the hardware processor 502 during execution thereof by the machine 500. In an example, one or any combination of the hardware processor 502, the main memory 504, the static memory 506, or the storage device 508 may constitute machine readable media.

[0053] While the machine readable medium 522 is illustrated as 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) configured to store the one or more instructions 524. The term “machine readable medium” may include any non-transitory medium that is capable of storing, encoding, or carrying instructions for execution by the machine 500 and that cause the machine 500 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding, or carrying data structures used by or associated with such instructions. Nonlimiting machine readable medium examples may include solid-state memories, and optical and magnetic media. In an example, a massed machine readable medium comprises a machine readable medium with a plurality of particleshaving invariant (e.g., rest) mass. Accordingly, massed machine-readable media are not transitory propagating signals. Specific examples of massed machine readable media may include: non-volatile memory, such as semiconductor memory devices (e.g., Electrically 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 CD-ROM and DVD- ROM disks.

[0054] FIG. 6 illustrates a schematic diagram of an exemplary computer-based clinical decision support system (CDSS) 600 that is configured to implement or recommend integration times or adjust integration times of an optical detector during a lithotripsy procedure. In various embodiments, the CDSS 600 may include an input interface 602 through which one or more laser setting ranges, which are specific to a patient, may be provided as input features to an artificial intelligence (Al) model 604, a processor, such as processor 112 or 502, to perform an inference operation in which the information regarding the target or a piece or portion of tissue are applied to the Al model to generate an adjusted integration time and / or one or more changed laser settings, and a user interface (UI) through which the adjusted integration time or the one or more changed laser settings is communicated to a user, e.g., a clinician.

[0055] In some embodiments, the input interface 602 may be a direct data link between the CDSS 600 and one or more medical devices that generate at least some of the input features. For example, the input interface 602 may transmit information about the target, such as composition or density of the target, directly to the CDSS 600 during a therapeutic and / or diagnostic medical procedure. Additionally, or alternatively, the input interface 602 may be a classical user interface that facilitates interaction between a user and the CDSS 600. For example, the input interface 602 may facilitate a user interface through which the user may manually enter a first or initial integration time to be used by the optical detector. Alternatively, the user may manually enter factors such as target type, target size, information about the medical devices to be used during the procedure or the type of procedure to be performed from which the initial integration time may be determined. Additionally, or alternatively, the input interface 602 may provide the CDSS 600 with access to an electronic patientrecord from which one or more input features may be extracted. In any of these cases, the input interface 602 may be configured to collect one or more of the following input features in association with a specific patient on or before a time at which the CDSS 600 is used to assess:

[0056] Information regarding target characteristics 610, which can include information regarding the composition of the target, information regarding the density of the target, or information regarding the size of the target;

[0057] Information regarding a change in the target characteristics 612 (e.g., a change in composition or a change in density of the target);

[0058] An environmental condition;

[0059] Information about the medical procedure;

[0060] An indication of non-target tissue;

[0061] A type of illumination source;

[0062] An intensity of the illumination source;

[0063] Spectral analysis of a signal from the target;

[0064] A quality or intensity of the signal from the target; and / or

[0065] a signal -to-noise characteristic of the signal from the target.

[0066] Based on one or more of the above input features, the processor 112 or 502 may perform an inference operation using the Al model to generate an updated integration time for the optical detector 132 and / or a change in one or more laser settings to be implemented or a recommended change in one or more laser settings to be proposed to the user. For example, input interface 602 may deliver the target characteristics, determined changes in the target characteristics, the analysis of the signal from the target, or the like into an input layer of the Al model which propagates these input features through the Al model to an output layer. The Al model may provide a computer system the ability to perform tasks, without explicitly being programmed, by making inferences based on patterns found in the analysis of data. The Al model may explore the study and construction of algorithms (e.g., machine-learning algorithms) that may learn from existing data and make predictions about new data. Such algorithms operate by building an Al model from example training data in order to make data-driven predictions or decisions expressed as outputs or assessments.

[0067] Two modes for machine learning (ML) may include: supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples thatcorrelate inputs to outputs or outcomes) to learn the relationships between the inputs and the outputs. The goal of supervised ML is to learn a function that, given some training data, best approximates the relationship between the training inputs and outputs so that the ML model can implement the same relationships when given inputs to generate the corresponding outputs. Unsupervised ML is the training of an ML algorithm using information that is neither classified nor labeled and allowing the algorithm to act on that information without guidance. Unsupervised ML is useful in exploratory analysis because it can automatically identify structure in data.

[0068] Certain tasks for supervised ML may include classification problems and regression problems. Classification problems, also referred to as categorization problems, may classify items into one of several category values (for example, is this object an apple or an orange?). Regression algorithms may quantify some items (for example, by providing a score to the value of some input). Some examples of commonly used supervised-ML algorithms are Logistic Regression (LR), Naive-Bayes, Random Forest (RF), neural networks (NN), deep neural networks (DNN), matrix factorization, and Support Vector Machines (SVM).

[0069] Some tasks for unsupervised ML may include clustering, representation learning, and density estimation. Some examples of unsupervised-ML algorithms are K-means clustering, principal component analysis, and autoencoders.

[0070] Another type of ML may include federated learning (also referred to as collaborative learning) that trains an algorithm across multiple decentralized devices holding local data, without exchanging the data. This approach stands in contrast to centralized machine-learning techniques where all the local datasets are uploaded to one server, as well as to more classical decentralized approaches which often assume that local data samples are identically distributed. Federated learning may enable multiple actors to build a common, robust machine learning model without sharing data, thus allowing to address critical issues such as data privacy, data security, data access rights and access to heterogeneous data.

[0071] In some examples, the Al model may be trained continuously, recurrently, or periodically prior to performance of the inference operation by the processor 502. Then, during the inference operation, the patient specificinput features provided to the Al model may be propagated from an input layer, through one or more hidden layers, and ultimately to an output layer that corresponds to the changes to one or more of the laser settings. For example, when the target is a kidney stone, based on the characteristics of the stone and a determined change in the target characteristics (e.g., a change in composition of the stone), a change to the integration time of the optical detector 132 may be propagated to the output layer.

[0072] During and / or subsequent to the inference operation, the change in the integration time may be communicated to the user via the user interface (UI) and / or automatically cause the processor 502 to automatically adjust the laser settings and proceed with the laser procedure using the new settings.ADDITIONAL NOTES AND EXAMPLES

[0073] Example l is a system for adjusting integration time of an optical detector during a lithotripsy procedure involving illumination of a target by an illumination source, the system comprising: the optical detector; and controller circuitry to: establish an integration time for the optical detector; cause the optical detector to receive a response signal from the target in response to the illumination of the target by the illumination source; analyze the response signal received at the optical detector to determine an occurrence of an event; and adjust the integration time of the optical detector based at least in part on the occurrence of the event.

[0074] In Example 2, the subject matter of Example 1 optionally includes subject matter wherein the integration time is established based on one or more of a type of the illumination source, an intensity of the illumination source, or a type of lithotripsy procedure.

[0075] In Example 3, the subject matter of any one or more of Examples 1-2 optionally include subject matter wherein the illumination source includes at least one of a Light Emitting Diode (LED), a laser, a broadband illumination source, or a Xenon-based light source.

[0076] In Example 4, the subject matter of any one or more of Examples 1-3 optionally include subject matter wherein the optical detector includes a spectrometer with an adjustable integration time.

[0077] In Example 5, the subject matter of any one or more of Examples 1-4 optionally include subject matter wherein the integration time is further adjusted based on one or more of: a color of the target, a surface feature of the target, or a clarity level of a surgical scene at or near the target.

[0078] In Example 6, the subject matter of any one or more of Examples 1-5 optionally include subject matter wherein the controller circuitry is further to: adjust at least one setting of a medical device based at least in part on the occurrence of the event, wherein the medical device includes or is coupled to a laser source and wherein the integration time is adjusted based on a flashing of a laser signal, wherein the event includes whether the laser signal emitted from the laser source contacts the target, and wherein adjusting at least one setting of the medical device includes adjusting at least one of an intensity of the laser signal or a duration of the laser signal.

[0079] In Example 7, the subject matter of any one or more of Examples 1-6 optionally include subject matter wherein the optical detector is a first optical detector and the system further comprising: a second optical detector, wherein the first optical detector has a first integration time, and wherein the second optical detector has a second integration time that is independently specifiable from the first integration time.

[0080] In Example 8, the subject matter of Example 7 optionally includes subject matter wherein the integration time is the first integration time and wherein adjusting the integration time includes switching from the first optical detector to the second optical detector, or vice-versa.

[0081] In Example 9, the subject matter of Example 8 optionally includes subject matter wherein the first integration time is shorter in duration than the second integration time.

[0082] In Example 10, the subject matter of any one or more of Examples 1-9 optionally include subject matter wherein the integration time is adjusted based at least in part on an intensity level of the received response signal.

[0083] In Example 11, the subject matter of any one or more of Examples 1- 10 optionally include subject matter wherein to analyze the received response signal includes determining a signal-to-noise characteristic of the received response signal and wherein the integration time is adjusted based on the signal- to-noise characteristic.

[0084] Example 12 is a computer implemented method for adjusting integration time of an optical detector during a lithotripsy procedure, the computer implemented method comprising: establishing an integration time for an optical detector; emitting an illumination signal from an illumination source toward a target; receiving at the optical detector a response signal from the target in response to the emitted illumination signal at the optical detector; analyzing the response signal received at the optical detector to determine an occurrence of an event; and adjusting the integration time for the optical detector based at least in part on the occurrence of the event.

[0085] In Example 13, the subject matter of Example 12 optionally includes subject matter wherein the integration time is established based on one or more of a type of illumination source, an intensity of the illumination source, or a type of lithotripsy procedure.

[0086] In Example 14, the subject matter of any one or more of Examples 12-13 optionally include subject matter wherein the optical detector includes a spectrometer with an adjustable integration time.

[0087] In Example 15, the subject matter of any one or more of Examples 12-14 optionally include subject matter wherein the optical detector includes a spectrometer with an adjustable integration time.

[0088] In Example 16, the subject matter of Example 15 optionally includes subject matter wherein the integration time is adjusted based at least in part on a spectral analysis of the analyzed response signal.

[0089] Example 17 is a system for adjusting a setting of a medical device during a lithotripsy procedure, the system comprising: a first optical detector having a first integration time; a second optical detector having a second integration time that is independently specifiable from the first integration time; an illumination source; and controller circuitry to: cause an illumination signal to be emitted from the illumination source toward a target; cause at least one of the first optical detector or the second optical detector to receive a response signal from the target in response to the emitted illumination signal; analyze the response signal using either of the first integration time or the second integration time to determine an occurrence of an event; and adjust at least one setting of the medical device based at least in part on the occurrence of the event.

[0090] In Example 18, the subject matter of Example 17 optionally includes subject matter wherein the medical device includes or is coupled to a laser source and the controller circuitry is to: emit a laser signal from the laser source, and wherein the event includes whether the laser signal emitted from the laser source contacts the target.

[0091] In Example 19, the subject matter of Example 18 optionally includes subject matter wherein adjusting at least one setting of the medical device includes adjusting at least one of an intensity of the laser signal or a duration of the laser signal.

[0092] In Example 20, the subject matter of any one or more of Examples 17- 19 optionally include subject matter wherein the first integration time is shorter in duration than the second integration time.

[0093] In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the term “and / or” is used to refer to a nonexclusive or, such that “A and / or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall 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.

[0094] The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is to allow the reader to quickly ascertain the nature of the technical disclosure and 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 aboveDetailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment. The scope of the embodiments should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

Claims

CLAIMSWHAT IS CLAIMED IS:

1. A system for adjusting integration time of an optical detector during a lithotripsy procedure involving illumination of a target by an illumination source, the system comprising: the optical detector; and controller circuitry to: establish an integration time for the optical detector; cause the optical detector to receive a response signal from the target in response to the illumination of the target by the illumination source; analyze the response signal received at the optical detector to determine an occurrence of an event; and adjust the integration time of the optical detector based at least in part on the occurrence of the event.

2. The system of claim 1, wherein the integration time is established based on one or more of a type of the illumination source, an intensity of the illumination source, or a type of lithotripsy procedure.

3. The system of claim 1, wherein the illumination source includes at least one of a Light Emitting Diode (LED), a laser, a broadband illumination source, or a Xenon-based light source.

4. The system of claim 1, wherein the optical detector includes a spectrometer with an adjustable integration time.

5. The system of claim 1, wherein the integration time is further adjusted based on one or more of: a color of the target, a surface feature of the target, or a clarity level of a surgical scene at or near the target.

6. The system of claim 1, wherein the controller circuitry is further to:adjust at least one setting of a medical device based at least in part on the occurrence of the event, wherein the medical device includes or is coupled to a laser source and wherein the integration time is adjusted based on a flashing of a laser signal, wherein the event includes whether the laser signal emitted from the laser source contacts the target, and wherein adjusting at least one setting of the medical device includes adjusting at least one of an intensity of the laser signal or a duration of the laser signal.

7. The system of claim 1, wherein the optical detector is a first optical detector and the system further comprising: a second optical detector, wherein the first optical detector has a first integration time, and wherein the second optical detector has a second integration time that is independently specifiable from the first integration time.

8. The system of claim 7, wherein the integration time is the first integration time and wherein adjusting the integration time includes switching from the first optical detector to the second optical detector, or vice-versa.

9. The system of claim 8, wherein the first integration time is shorter in duration than the second integration time.

10. The system of claim 1, wherein the integration time is adjusted based at least in part on an intensity level of the received response signal.

11. The system of claim 1, wherein to analyze the received response signal includes determining a signal -to-noise characteristic of the received response signal and wherein the integration time is adjusted based on the signal -to-noise characteristic.

12. A computer implemented method for adjusting integration time of an optical detector during a lithotripsy procedure, the computer implemented method comprising: establishing an integration time for an optical detector;emitting an illumination signal from an illumination source toward a target; receiving at the optical detector a response signal from the target in response to the emitted illumination signal at the optical detector; analyzing the response signal received at the optical detector to determine an occurrence of an event; and adjusting the integration time for the optical detector based at least in part on the occurrence of the event.

13. The method of claim 12, wherein the integration time is established based on one or more of a type of illumination source, an intensity of the illumination source, or a type of lithotripsy procedure.

14. The method of claim 12, wherein the optical detector includes a spectrometer with an adjustable integration time.

15. The method of claim 12, wherein the optical detector includes a spectrometer with an adjustable integration time.

16. The method of claim 15, wherein the integration time is adjusted based at least in part on a spectral analysis of the analyzed response signal.

17. A system for adjusting a setting of a medical device during a lithotripsy procedure, the system comprising: a first optical detector having a first integration time; a second optical detector having a second integration time that is independently specifiable from the first integration time; an illumination source; and controller circuitry to: cause an illumination signal to be emitted from the illumination source toward a target; cause at least one of the first optical detector or the second optical detector to receive a response signal from the target in response to the emitted illumination signal;analyze the response signal using either of the first integration time or the second integration time to determine an occurrence of an event; and adjust at least one setting of the medical device based at least in part on the occurrence of the event.

18. The system of claim 17, wherein the medical device includes or is coupled to a laser source and the controller circuitry is to: emit a laser signal from the laser source, and wherein the event includes whether the laser signal emitted from the laser source contacts the target.

19. The system of claim 18, wherein adjusting at least one setting of the medical device includes adjusting at least one of an intensity of the laser signal or a duration of the laser signal.

20. The system of claim 17, wherein the first integration time is shorter in duration than the second integration time.

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