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SIGNIFICANCE: Photodynamic therapy (PDT) could become a treatment option for nonmuscle invasive bladder cancer when the current high morbidity rate associated with red light PDT and variable PDT dose can be overcome through a combination of intravesical instillation of the photosensitizer and the use of green light creating a steep PDT dose gradient. AIM: To determine how a high PDT selectivity can be maintained throughout the bladder wall considering other efficacy determining parameters, in particular, the average optical properties of the mucosal layer governing the fluence rate multiplication factor, as well as the bladder shape and the position of the emitter in relationship to the bladder wall. APPROACH: We present three irradiance monitoring systems and evaluate their ability to enable selective bladder PDT considering previously determined photodynamic threshold values for the bladder cancer, mucosa and urothelium in a preclinical model, and the photosensitizer's specific uptake ratio. Monte Carlo-based light propagation simulations performed for six human bladders at the time of therapy for a range of tissue optical properties. The performance of one irradiance sensing device in a clinical phase 1B trial is presented to underline the impact of irradiance monitoring, and it is compared to the Monte Carlo-derived dose surface histogram. RESULTS: Monte Carlo simulations showed that irradiance monitoring systems need to comprise at least three sensors. Light scattering inside the bladder void needs to be minimized to prevent increased heterogeneity of the irradiance. The dose surface histograms vary significantly depending on the bladder shape and bladder volume but are less dependent on tissue optical properties. CONCLUSIONS: We demonstrate the need for adequate irradiance monitoring independent of a photosensitizer's specific uptake ratio.

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A fiber photo-catheter has been developed for surgical treatment of atrial fibrillation with laser radiation. Atrial fibrillation (AF) is a heart rhythm abnormality that involves irregular and rapid heartbeats. Recent studies demonstrate the superiority of treating AF disease with optical radiation of the near infrared region. To produce long continuous transmural lesions, solid-state lasers and laser diodes, along with end-emitting fiber catheters, have been used experimentally. The absence of side-emitting flexible catheters with the ability to produce long continuous lesions limits the further development of this technology. In this research, a prototype of an optical catheter, consisting of a flexible 10-cm fiber diffuser has been used to make continuous photocoagulation lesions for effective maze procedure treatments. The system also includes: a flexible optical reflector; a series of openings for rapid self-attachment to the tissue; and an optional closed-loop irrigating chamber with circulating saline to cool the optical diffuser and irrigate the tissue.

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Cylindrical fiber diffusers have become common tools for various medical therapies. However, their large outer diameters and short lengths restrict their clinical application in some newly developed light therapies. Here, a 250-microm outer-diameter diffuser with an active length that exceeds 5 cm is presented. Diffusers are created in photosensitive optical fibers with outer cladding diameters of 140 microm by use of a structured beam from an excimer laser. Predetermined emission profiles can be achieved. Photometric characteristics, including longitudinal, polar, and azimuthal emission diagrams, were determined by use of a goniometer to assess the light-emission performance of the diffuser. Longitudinal isotropy of better than +/- 10% was achieved. Polar and azimuthal emissions were within +/- 15% of those of an ideal linear Lambertian emitter. Polar uniformity could be improved by an insignificant increase in the outer diameter by use of a diffusing recoating compound. The residual leakage of light at the distal end of the diffuser can be as little as 1%. Other physical parameters tested include minimal bending radius after recoating (< 5 mm) and maximum power handling (> 1.0W cm(-1)). All materials employed were biocompatible.

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BACKGROUND AND OBJECTIVES: Cylindrical fiber diffusers are common tools in photodynamic therapy (PDT). However, large outer diameter and short length limit the indications to which they can be applied. Here a diffuser with an outer diameter of 250 microm and an active length exceeding 5 cm was developed. STUDY DESIGN/MATERIALS AND METHODS: Diffusers based on photosensitive quartz optical fibers with a cladding diameter of 140 microm were developed using a structured beam from an excimer laser. A complete set of photometric characteristics, including longitudinal, polar, and azimuth radiance emission diagrams were collected. RESULTS AND CONCLUSIONS: The longitudinal radiance emission is homogenous to within +/-10%. The ability to create custom designed longitudinal emission profiles was demonstrated. The variations of the polar and azimuth radiance emission diagrams were within +/- 15% from an ideal Lambertian emitter. The polar uniformity can be improved with a slight increase of the outer diameter using a diffusing recoating compound. The residual light leakage at the distal end of the fiber diffuser was suppressed to 2%. The minimal bending radius after recoating is approximately 5 mm. Maximum power distribution is > 0.5 W cm(-1).

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BACKGROUND AND OBJECTIVES: Dosimetry for intracavity and interstitial light delivery requires next to the knowledge of tissue optical properties and models describing light propagation in tissue also exact knowledge of the spatial light source emission characteristics. However, the emission characteristics of cylindrical diffusers are often ill defined by the manufacturer, and not regularly determined by the end user, thus limiting the attainable dosimetry accuracy. STUDY DESIGN/MATERIALS AND METHODS: Commercial cylindrical diffusers, with active diffusive lengths of 1-2 cm and outer diameters of

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