The Centre has a long history of developing new techniques for medical imaging (particularly in magnetic resonance imaging), transforming them from a primarily diagnostic modality into an interventional and therapeutic platform. This is facilitated by the Centre's strong engineering background in practical imaging and image analysis platform development, as well as advances in minimal access and robotic assisted surgery. Hamlyn has a strong tradition in pursuing basic sciences and theoretical research, with a clear focus on clinical translation.

In response to the current paradigm shift and clinical demand in bringing cellular and molecular imaging modalities to an in vivo – in situ setting during surgical intervention, our recent research has also been focussed on novel biophotonics platforms that can be used for real-time tissue characterisation, functional assessment, and intraoperative guidance during minimally invasive surgery. This includes, for example, SMART confocal laser endomicroscopy, time-resolved fluorescence spectroscopy and flexible FLIM catheters.

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  • Journal article
    Cartucho J, Shapira D, Ashrafian H, Giannarou Set al., 2020,

    Multimodal mixed reality visualisation for intraoperative surgical guidance

    , International Journal of Computer Assisted Radiology and Surgery, Vol: 15, Pages: 819-826, ISSN: 1861-6410

    PurposeIn the last decade, there has been a great effort to bring mixed reality (MR) into the operating room to assist surgeons intraoperatively. However, progress towards this goal is still at an early stage. The aim of this paper is to propose a MR visualisation platform which projects multiple imaging modalities to assist intraoperative surgical guidance.MethodologyIn this work, a MR visualisation platform has been developed for the Microsoft HoloLens. The platform contains three visualisation components, namely a 3D organ model, volumetric data, and tissue morphology captured with intraoperative imaging modalities. Furthermore, a set of novel interactive functionalities have been designed including scrolling through volumetric data and adjustment of the virtual objects’ transparency. A pilot user study has been conducted to evaluate the usability of the proposed platform in the operating room. The participants were allowed to interact with the visualisation components and test the different functionalities. Each surgeon answered a questionnaire on the usability of the platform and provided their feedback and suggestions.ResultsThe analysis of the surgeons’ scores showed that the 3D model is the most popular MR visualisation component and neurosurgery is the most relevant speciality for this platform. The majority of the surgeons found the proposed visualisation platform intuitive and would use it in their operating rooms for intraoperative surgical guidance. Our platform has several promising potential clinical applications, including vascular neurosurgery.ConclusionThe presented pilot study verified the potential of the proposed visualisation platform and its usability in the operating room. Our future work will focus on enhancing the platform by incorporating the surgeons’ suggestions and conducting extensive evaluation on a large group of surgeons.

  • Journal article
    Clancy NT, Jones G, Maier-Hein L, Elson DS, Stoyanov Det al., 2020,

    Surgical spectral imaging.

    , Medical Image Analysis, Vol: 63, Pages: 1-18, ISSN: 1361-8415

    Recent technological developments have resulted in the availability of miniaturised spectral imaging sensors capable of operating in the multi- (MSI) and hyperspectral imaging (HSI) regimes. Simultaneous advances in image-processing techniques and artificial intelligence (AI), especially in machine learning and deep learning, have made these data-rich modalities highly attractive as a means of extracting biological information non-destructively. Surgery in particular is poised to benefit from this, as spectrally-resolved tissue optical properties can offer enhanced contrast as well as diagnostic and guidance information during interventions. This is particularly relevant for procedures where inherent contrast is low under standard white light visualisation. This review summarises recent work in surgical spectral imaging (SSI) techniques, taken from Pubmed, Google Scholar and arXiv searches spanning the period 2013-2019. New hardware, optimised for use in both open and minimally-invasive surgery (MIS), is described, and recent commercial activity is summarised. Computational approaches to extract spectral information from conventional colour images are reviewed, as tip-mounted cameras become more commonplace in MIS. Model-based and machine learning methods of data analysis are discussed in addition to simulation, phantom and clinical validation experiments. A wide variety of surgical pilot studies are reported but it is apparent that further work is needed to quantify the clinical value of MSI/HSI. The current trend toward data-driven analysis emphasises the importance of widely-available, standardised spectral imaging datasets, which will aid understanding of variability across organs and patients, and drive clinical translation.

  • Journal article
    Zhao M, Oude Vrielink TJC, Kogkas A, Runciman M, Elson D, Mylonas Get al., 2020,

    LaryngoTORS: a novel cable-driven parallel robotic system for transoral laser phonosurgery

    , IEEE Robotics and Automation Letters, Vol: 5, Pages: 1516-1523, ISSN: 2377-3766

    Transoral laser phonosurgery is a commonly used surgical procedure in which a laser beam is used to perform incision, ablation or photocoagulation of laryngeal tissues. Two techniques are commonly practiced: free beam and fiber delivery. For free beam delivery, a laser scanner is integrated into a surgical microscope to provide an accurate laser scanning pattern. This approach can only be used under direct line of sight, which may cause increased postoperative pain to the patient and injury, is uncomfortable for the surgeon during prolonged operations, the manipulability is poor and extensive training is required. In contrast, in the fiber delivery technique, a flexible fiber is used to transmit the laser beam and therefore does not require direct line of sight. However, this can only achieve manual level accuracy, repeatability and velocity, and does not allow for pattern scanning. Robotic systems have been developed to overcome the limitations of both techniques. However, these systems offer limited workspace and degrees-of-freedom (DoF), limiting their clinical applicability. This work presents the LaryngoTORS, a robotic system that aims at overcoming the limitations of the two techniques, by using a cable-driven parallel mechanism (CDPM) attached at the end of a curved laryngeal blade for controlling the end tip of the laser fiber. The system allows autonomous generation of scanning patterns or user driven freepath scanning. Path scan validation demonstrated errors as low as 0.054±0.028 mm and high repeatability of 0.027±0.020 mm (6×2 mm arc line). Ex vivo tests on chicken tissue have been carried out. The results show the ability of the system to overcome limitations of current methods with high accuracy and repeatability using the superior fiber delivery approach.

  • Conference paper
    He C, Chang J, He H, Liu S, Elson DS, Ma H, Booth MJet al., 2020,

    GRIN lens based polarization endoscope – from conception to application

    , Label-free Biomedical Imaging and Sensing (LBIS) 2020, Publisher: SPIE

    Graded index (GRIN) lenses focus light through a radially symmetric refractive index profile. It is not widely appreciated that the ion-exchange process that creates the index profile also causes a radially symmetric birefringence variation. This property is usually considered a nuisance, such that manufacturing processes are optimized to keep it to a minimum. Here, a new Mueller matrix (MM) polarimeter based on a spatially engineered polarization state generating array and GRIN lens cascade for measuring the MM of a region of a sample in a single-shot is presented. We explore using the GRIN lens cascade for a functional analyzer to calculate multiple Stokes vectors and the MM of the target in a snapshot. A designed validation sample is used to test the reliability of this polarimeter. To understand more potential biomedical applications, human breast ductal carcinoma slides at two pathological progression stages are detected by this polarimeter. The MM polar decomposition parameters then can be calculated from the measured MMs, and quantitatively compared with the equivalent data sampled by a MM microscope. The results indicate that the polarimeter and the measured polarization parameters are capable of differentiating the healthy and carcinoma status of human breast tissue efficiently. It has potential to act as a polarization detected fiber-based probe to assist further minimally invasive clinical diagnosis.

  • Conference paper
    Dryden S, Anastasova S, Satta G, Thompson AJ, Leff DR, Darzi AWet al., 2020,

    Toward point-of-care uropathogen detection using SERS active filters

    , Optical Diagnostics and Sensing XX: Toward Point-of-Care Diagnostics, Publisher: SPIE, Pages: 1124705-1-1124705-7

    150 million people worldwide suffer one or more urinary tract infections (UTIs) annually. UTIs are a significant health burden: societal costs of UTI exceed $3.5 billion in the U.S. alone; 5% of sepsis cases arise from a urinary source; and UTIs are a prominent contributor toward antimicrobial resistance (AMR). Current diagnostic frameworks exacerbate this burden by providing inaccurate and delayed diagnosis. Rapid point-of-care bacterial identification will allow for early precision treatment, fundamentally altering the UTI paradigm. Raman spectroscopy has a proven ability to provide rapid bacterial identification but is limited by weak bacterial signal and a susceptibility to background fluorescence. These limitations may be overcome using surface enhanced Raman spectroscopy (SERS), provided close and consistent application of bacteria to the SERS-active surface can be achieved. Physical filtration provides a means of capturing uropathogens, separating them from the background solution and acting as SERS-active surface. This work demonstrates that filters can provide a means of aggregating bacteria, thereby allowing subsequent enhancement of the acquired Raman signal using metallic nanoparticles. 60 bacterial suspensions of common uropathogens were vacuum filtered onto commercial polyvinylidene fluoride membrane filters and Raman signals were enhanced by the addition of silver nanoparticles directly onto the filter surface. SERS spectra were acquired using a commercial Raman spectrometer (Ocean Optics, Inc.). Principal Component – Linear Discriminant Analysis provided discrimination of infected from control samples (accuracy: 88.75%, 95% CI: 79.22-94.59%, p-value <0.05). Amongst infected samples uropathogens were classified with 80% accuracy. This study has demonstrated that combining Raman spectroscopy with membrane filtration and SERS can provide identification of infected samples and rapid bacterial classification.

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