The goggles look like something a video gamer would wear. But these high-tech specs have a much higher purpose: They can see cancer cells. And they’re helping surgeons ensure that no traces of tumors get left behind after cancer surgery.
Called Medical Vision Goggles for short, the fluorescence imaging augmented reality RPi-based system (FAR-Pi) goggles build upon the use of fluorescence-guided surgery (FGS) technology for tumor removal.
With FGS, a contrast dye is injected into a patient’s blood vessels. The dye circulates through the body and attaches to cancer cells. Under special lighting, the dye makes the cancer cells glow like a Christmas tree, allowing a surgeon to spot and remove tiny traces of tumors while minimizing damage to healthy tissue.
Removing a small margin of healthy cells around tumors and any remnant cells reduces the risk of cancer recurrence and the need for future surgeries. But while FGS is effective, it is not widely used outside of highly resourced medical centers because:
- Typical FGS systems are bulky, with big machinery and a large computer screen that takes up valuable space in the operating room.
- FGS requires extra specialists to be involved in the procedure.
- The imaging equipment is expensive.
The Medical Vision Goggles, which my colleagues and I developed and have been tested in clinical trials, address these concerns.
The goggles deliver all of the visual capabilities of FGS in a cost-effective, single-user device small enough to fit comfortably on the surgeon’s head. Further, the surgeon can toggle the device view to see the patient’s surgical site, overlaid with a real-time array of remnant cancer cells through the goggles’ specialized camera system.
I was recently honored to be elected to the National Academy of Engineering, due in part to my work with the Medical Vision Goggles. I hope this recognition, along with my membership in the National Academy of Medicine and the National Academy of Inventors, will help to advance medical innovations that benefit patients around the world.
How do the Medical Vision Goggles work?
During a tumor removal procedure, the surgeon can activate the goggle system with the press of a button. A laser light on top of the device shines across the patient’s body like a flashlight, forcing dyes attached to tumors to give off distinct, invisible, near-infrared light that a multitasking camera detects. The light is sent to a small but fast processor, which converts the signal into visible images of tumor location.
Without delay, this creates a computer-generated overlay of the glowing red and purple cancer cells on top of the real-time view of the patient’s tissues. In other words, the head-mounted, augmented reality display lets the surgeon see the patient’s anatomy and the fluorescent overlay distinctly or simultaneously.
Along with the primary tumor cells, the goggles can also see satellite tumors – those that are in a different location near the prominent tumor – that may not have been detected through other testing. After removing all the tumors, if no areas light up after scanning the laser and camera in the surgery area, surgeons can feel confident they removed identifiable remnant cancer cells. And if a spot is illuminated, they can remove it to reduce the chances that the cancer will come back.
Medical Vision Goggles:
The origin story
The old saying, “If at first you don’t succeed, try, try again,” was certainly true when it came to developing the Medical Vision Goggles.
Early FGS systems were handheld, in which one person would shine a light around the surgical field. The surgeon would have to watch a screen to see if any cancer cells lit up and then redirect his or her attention to the surgical site to remove them. While effective, this system was not as efficient as it could be.
We knew there had to be a better way.
I came up with the idea for the Medical Vision Goggles while talking with a cohort of surgical fellows. They mentioned that traditional techniques require a lot of time to find all the remnant cancer cells. If there were a way to complete the surgeries faster and just as effectively, they said, they could help more patients every day.
So, my students, colleagues, and I began to explore existing technologies – and we started with night-vision goggles that became commercially popularized after the Gulf War. These cameras can detect objects and humans at night, allowing hunters to hunt at night and the military to find their enemies’ hiding places under darkness.
We wondered, “Could we use that same technology to make cancer the enemy we seek to find in the dark?”
With the first version of goggles, we used a see-through video display technology, similar to the virtual reality goggles popular with gamers. Real-time video of the patient’s anatomy was streamed like a movie inside a head-mounted device. While we thought it was great, the surgeons said they could operate more precisely if they could see the surgical site in real time, not through video.
After several more iterations, in 2017 we developed the wearable optical see-through device that became the Medical Vision Goggles. We most recently used a fluorescence imaging AR RPi-based system (FAR-Pi) equipped with battery-powered capability and other inexpensive materials, most of which can be purchased off the shelf or even 3D-printed.
For example, instead of using a $2,000 scientific camera, we are using a Raspberry Pi camera, which costs less than $50 but offers exquisite infrared visualization. Raspberry Pi is a handheld computer circuit board that can be used to power all sorts of devices. It’s popular with gamers because it is easy to program, inexpensive, and versatile.
In 2021, we received funding from the National Institutes of Health to support our work on the current Medical Vision Goggles technology. We are excited about the open-source, low-cost design, making it readily available for research purposes. We are collaborating with industry to transform the research-grade device into a clinically viable product, fulfilling our goal of making this potentially lifesaving technology accessible to surgeons worldwide. We are currently applying for grants to convert our research-grade into a product-grade prototype, which will be used to acquire clinical data for Food and Drug Administration approval.
An important goal of the device is to provide the surgeon with identical, real-time information for patients with similar diseases, transforming decision-making from subjective judgment to objective, data-driven guidance to achieve consistent surgical outcomes, irrespective of where cancer surgery is performed.
Which cancers is the device used for?
Along with breast cancer, UTSW surgeons have used the Medical Vision Goggles to treat:
- Liver cancer: Hearing surgeons discuss the challenges of removing remnant liver cancer cells was the impetus for using the device.
- Melanoma: The device helps surgeons identify the sentinel lymph node, which can indicate whether the cancer has spread.
- Head and neck cancer: Baran Sumer, M.D., is leading this implementation.
Dr. Sumer, who has used the goggles during surgery, said they “represent a transformative advancement in fluorescence-guided surgery.”
“This is a major improvement to other systems, which require surgeons to divert their attention between the operative field and a remote monitor,” he said. “The goggles provide an elegant solution for identifying cancerous margins during surgery – one of the most vital and technically challenging aspects of oncologic resection. Margins that harbor microscopic residual disease are a major cause of local recurrence, and standard techniques often rely on post-operative pathology, potentially requiring reoperation.
“With the goggles, surgeons can assess margins intraoperatively with immediate visual feedback, enabling more confident resections and reducing the likelihood of residual disease. This head-mounted, real-time imaging platform offers a practical, scalable, and powerful tool that could allow access to advanced fluorescence imaging in a wide range of surgical settings.”
Early results show the Medical Vision Goggles work just as well as existing bulky, expensive FGS systems at detecting remnant cancer cells during surgery. And early trials have shown the system enhances FGS without disrupting the surgical workflow in the operating room.
Through these goggles, surgeons can deliver precise, effective cancer surgery faster and easier than with traditional FGS. Every cancer patient should get the best care, and we hope the technology behind the Medical Vision Goggles will lead to more medical innovations.
