Image-guided surgery using invisible near-infrared light: fundamentals of clinical translation.

TLDR

Biomedical optics has rapidly advanced, and wide‑field near‑infrared fluorescence imaging promises real‑time surgical guidance for resecting tumors while sparing critical structures, but requires optimized systems and contrast agents to become clinically viable. This review outlines the principles of NIR fluorescence imaging, evaluates current systems, and identifies key parameters for developing contrast agents, while previewing future optical techniques. The authors illustrate the challenges of clinical translation by detailing the Fluorescence‑Assisted Resection and Exploration (FLARE™) system and its associated technical and regulatory complexities.

Abstract

The field of biomedical optics has matured rapidly over the last decade and is poised to make a significant impact on patient care. In particular, wide-field (typically > 5 cm), planar, near-infrared (NIR) fluorescence imaging has the potential to revolutionize human surgery by providing real-time image guidance to surgeons for tissue that needs to be resected, such as tumors, and tissue that needs to be avoided, such as blood vessels and nerves. However, to become a clinical reality, optimized imaging systems and NIR fluorescent contrast agents will be needed. In this review, we introduce the principles of NIR fluorescence imaging, analyze existing NIR fluorescence imaging systems, and discuss the key parameters that guide contrast agent development. We also introduce the complexities surrounding clinical translation using our experience with the Fluorescence-Assisted Resection and Exploration (FLARE™) imaging system as an example. Finally, we introduce state-of-the-art optical imaging techniques that might someday improve image-guided surgery even further.