Tuesday, January 29, 2008

Looking into the Brain with Light

An Israeli company is working on a new device to monitor oxygen levels in the brain.

By Michael Chorost

Mind reader: The OrNim targeted oximetry probe (above) adheres to the scalp to monitor the oxygen levels of specific areas of the brain. Credit: OrNim

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.