Real-time guidance of thermal and ultrashort pulsed laser ablation in hard tissue using inline coherent imaging

Background and Objective During tissue ablation, laser light can be delivered with high precision in the transverse dimensions but final incision depth can be difficult to control. We monitor incision depth as it progresses, providing feedback to ensure that material removal occurs within a localized target volume, reducing the possibility of undesirable damage to tissues below the incision. Materials and Methods Ex vivo cortical and cancellous bone was ablated using pulsed lasers with center wavelengths of 1,064 and 1,070 nm, while being imaged in real-time using inline coherent imaging (ICI) at rates of up to 300 kHz and axial resolution of ∼6 µm. With real-time feedback, laser exposure was terminated before perforating into natural inclusions of the cancellous bone and verified by brightfield microscopy of the crater cross-sections accessed via side-polishing. Results ICI provides direct information about incision penetration even in the presence of intense backscatter from the pulsed laser and plasma emissions. In this study, ICI is able to anticipate structures 176 ± 8 µm below the ablation front with signal intensity 9 ± 2 dB above the noise floor. As a result, the operator is able to terminate exposure of the laser sparing a 50 µm thick layer of bone between the bottom of the incision to a natural inclusion in the cancellous bone. Versatility of the ICI system was demonstrated over a wide range of light–tissue interactions from thermal regime to direct solid-plasma transition. Conclusions ICI can be used as non-contact real-time feedback to monitor the depth of an incision created by laser ablation, especially in heterogeneous tissue where ablation rate is less predictable. Furthermore, ICI can image below the ablation front making it possible to stop laser exposure to limit unintentional damage to subsurface structures such as blood vessels or nervous tissue. Lasers Surg. Med. 44:249–256, 2012. © 2012 Wiley Periodicals, Inc.