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.