By Michael Chorost
A new noninvasive diagnostic technology could give doctors the single most important sign of brain health: oxygen saturation. Made by an Israeli company called OrNim and slated for trials on patients in U.S. hospitals later this year, the technology, called targeted oximetry, could do what standard pulse oximeters can't.
A standard pulse oximeter is clipped onto a finger or an earlobe to measure oxygen levels under the skin. It works by transmitting a beam of light through blood vessels in order to measure the absorption of light by oxygenated and deoxygenated hemoglobin. The information allows physicians to know immediately if oxygen levels in the patient's blood are rising or falling.
Prior to the development of pulse oximeters, the only way to measure oxygen saturation was to take a blood sample from an artery and analyze it in a lab. By providing an immediate, noninvasive measure of oxygenation, pulse oximeters revolutionized anesthesia and other medical procedures.
While pulse oximeters have become accurate and reliable, they have a key limitation: they can't measure oxygen saturation in specific areas deep inside the body. Because pulse oximeters measure only the blood's overall oxygen levels, they have no way of monitoring oxygen saturation in a specific region. This is especially problematic in the case of brain injuries, since the brain's oxygenation can then differ from the rest of the body's.
Information on oxygenation in specific regions of the brain would be valuable to neurologists monitoring a brain-injured patient, as it could be used to search for localized hematomas and give immediate notice of hemorrhagic strokes. When a stroke occurs, an area of the brain is deprived of blood and thus oxygen, but there is no immediate way to detect the attack's occurrence.
CT and MRI scans give a snapshot of tissue damage, but they can't be used for continuous monitoring. It can also be very difficult to conduct such scans on unconscious patients hooked up to life-support devices.
Wade Smith, a neurologist at the University of California, San Francisco, and an advisor to OrNim, points out that, while cardiologists have devices to monitor hearts in detail, neurologists have no equivalent tool. With brain-injured patients, Smith says, "the state of the art is flying blind."
OrNim's new device uses a technique called ultrasonic light tagging to isolate and monitor an area of tissue the size of a sugar cube located between 1 and 2.5 centimeters under the skin. The probe, which rests on the scalp, contains three laser light sources of different wavelengths, a light detector, and an ultrasonic emitter.
The laser light diffuses through the skull and illuminates the tissue underneath it. The ultrasonic emitter sends highly directional pulses into the tissue. The pulses change the optical properties of the tissue in such a way that they modulate the laser light traveling through the tissue. In effect, the ultrasonic pulses "tag" a specific portion of tissue to be observed by the detector. Since the speed of the ultrasonic pulses is known, a specific depth can be selected for monitoring.
The modulated laser light is picked up by the detector and used to calculate the tissue's color. Since color is directly related to blood oxygen saturation (for example, arterial blood is bright red, while venous blood is dark red), it can be used to deduce the tissue's oxygen saturation. The measurement is absolute rather than relative, because color is an indicator of the spectral absorption of hemoglobin and is unaffected by the scalp.
Deeper areas could be illuminated with stronger laser beams, but light intensity has to be kept at levels that will not injure the skin. Given the technology's current practical depth of 2.5 centimeters, it is best suited for monitoring the upper layers of the brain. Smith suggests that the technology could be used to monitor specific clusters of blood vessels.
While the technology is designed to monitor a specific area, it could also be used to monitor an entire hemisphere of the brain. Measuring any area within the brain could yield better information about whole-brain oxygen saturation than a pulse oximeter elsewhere on the body would. Hilton Kaplan, a researcher at the University of Southern California's Medical Device Development Facility, says, "If this technology allows us to actually measure deep inside, then that's a big improvement over the limitations of decades of cutaneous versions."
Michal Balberg, the CEO and cofounder of OrNim, thinks that it may ultimately be feasible to deploy arrays of probes on the head to get a topographic map of brain oxygenation. In time, brain oxygenation may be considered a critical parameter that should be monitored routinely. Balberg says, "Our development is directed toward establishing a new brain vital sign that will be used to monitor any patient [who's] unconscious or under anesthesia. We believe that this will affect patient management in the coming decade in a manner comparable to pulse oximeters."
Michael Chorost covers medical devices for Technology Review. His book about cochlear implants, Rebuilt: How Becoming Part Computer Made Me More Human, was published in 2005.
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