Towards in vivo laser coagulation and concurrent optical coherence tomography through double-clad fiber devices

There is a strong clinical need for an optical coherence tomography (OCT) system capable of delivering concurrent coagulation light enabling image-guided dynamic laser marking for targeted collection of biopsies, as opposed to a random sampling, to reduce false-negative findings. Here, we present a system based on double-clad fiber (DCF) capable of delivering pulsed laser light through the inner cladding while performing OCT through the core. A previously clinically validated commercial OCT system (NVisionVLE, Ninepoint Medical) was adapted to enable in vivo esophageal image-guided dynamic laser marking. An optimized DCF coupler was implemented into the system to couple both modalities into the DCF. A DCF-based rotary joint was used to couple light to the spinning DCF-based catheter for helical scanning. DCF-based OCT catheters, providing a beam waist diameter of 62μm at a working distance of 9.3mm, for use with a 17-mm diameter balloon sheath, were used for ex vivo imaging of a swine esophagus. Imaging results using the DCF-based clinical system show an image quality comparable with a conventional system with minimal crosstalk-induced artifacts. To further optimize DCF catheter optical design in order to achieve single-pulse marking, a Zemax model of the DCF output and its validation are presented.