The non-invasive and, often, continuous measurement of the hemodynamics of the body, and for the main purposes of this thesis, the brain, is desired because both the instantaneous values and their changes over time constantly adapt to the conditions affecting the body and its environment. They are altered in pathological situations and in response to increased function. It is desirable for these measurements to be continuous, reliable, minimally invasive, and relatively inexpensive. In recent years, optical techniques that, by using diffusing and deep-reaching (up to few centimeters) light at skin-safe levels of intensity, combine the aforementioned characteristics, have increasingly become used in clinical and research settings. However, to date there is, on one side the need to expand the number and scope of translational studies, and, on the other, to address shortcomings like the contamination of signals from unwanted tissue volumes (partial volume effects). A further important goal is to increase the depth of penetration of light without affecting the non-invasive nature of diffuse optics.My PhD was aimed at several aspects of this problem; (i) the development of new, more advanced methods, i.e. the time/pathlength resolved, to improve the differentiation between superficial and deeper tissues layers, (ii) the exploration of new application areas, i.e. to characterize the microvascular status of bones, to study the functional response of the baby brain, and (iii) to improve the quality control of the systems , i.e. by introducing a long shelf-life dynamic phantom.In conceptual order, first I introduce long shelf-life reference standards for diffuse correlation spectroscopy. Secondly, I describe the use of an existing hybrid time domain and diffuse correlation spectroscopy system to monitor the changes that some pathological conditions, in this case osteoporosis and human immunodeficiency virus infection, may have on many aspects of the human bone tissue that are currently not easy to measure (i.e. invasively assessed) by conventional techniques. Thirdly, I describe the development of a novel time domain optical technique that intimately combines, introducing many previously unmet advancements, the two previously cited optical spectroscopy techniques. For the first time I was able to produce a time domain device and protocol that can monitor the blood flow in vivo in the head and muscles of healthy humans. Lastly, I describe a device and method that I have used to monitor changes in blood flow in healthy human infants of three to five months of age, for the first time in this age bracket, as a marker of activation following visual stimulation. Overall, this work pushes the limit of the technology that makes use of diffuse light to minimally invasively, continuously, and reliably monitor endogenous markers of pathological and physiological processes in the human body.

Jöbsis was the first to describe the in vivo application of near-infrared spectroscopy (NIRS), also called diffuse optical spectroscopy (DOS). NIRS was originally designed for the clinical monitoring of tissue oxygenation, and today it has also become a useful tool for neuroimaging studies (functional near-infrared spectroscopy, fNIRS). However, difficulties in the selective and quantitative measurements of tissue hemoglobin (Hb), which have been central in the NIRS field for over 40 years, remain to be solved. To overcome these problems, time-domain (TD) and frequency-domain (FD) measurements have been tried. Presently, a wide range of NIRS instruments are available, including commonly available commercial instruments for continuous wave (CW) measurements, based on the modified Beer–Lambert law (steady-state domain measurements). Among these measurements, the TD measurement is the most promising approach, although compared with CW and FD measurements, TD measurements are less common, due to the need for large and expensive instruments with poor temporal resolution and limited dynamic range. However, thanks to technological developments, TD measurements are increasingly being used in research, and also in various clinical settings. This Special Issue highlights issues at the cutting edge of TD DOS and diffuse optical tomography (DOT). It covers all aspects related to TD measurements, including advances in hardware, methodology, the theory of light propagation, and clinical applications.

Imaging of tissue blood flow (BF) distributions provides vital information for the diagnosis and therapeutic monitoring of various vascular diseases. The innovative near-infrared speckle contrast diffuse correlation tomography (scDCT) technique produces full 3D BF distributions. Many advanced features are provided over competing technologies including high sampling density, fast data acquisition, noninvasiveness, noncontact, affordability, portability, and translatability across varied subject sizes. The basic principle, instrumentation, and data analysis algorithms are presented in detail. The extensive applications are summarized such as imaging of cerebral BF (CBF) in mice, rat, and piglet animals with skull penetration into deep brain. Clinical human testing results are described by recovery of BF distributions on preterm infants (CBF) through incubator wall, and on sensitive burn tissues and mastectomy skin flaps without direct device-tissue interactions. Supporting activities outlined include integrated capability for acquiring surface curvature information, rapid 2D blood flow mapping, and optimizations via tissue-like phantoms and computer simulations. These applications and activities both highlight and guide the reader as to the expected abilities and limitations of scDCT for adapting into their own preclinical/clinical research, use in constrained environments (i.e., neonatal intensive care unit bedside), and use on vulnerable subjects and measurement sites.

Jöbsis was the first to describe the in vivo application of near-infrared spectroscopy (NIRS), also called diffuse optical spectroscopy (DOS). NIRS was originally designed for the clinical monitoring of tissue oxygenation, and today it has also become a useful tool for neuroimaging studies (functional near-infrared spectroscopy, fNIRS). However, difficulties in the selective and quantitative measurements of tissue hemoglobin (Hb), which have been central in the NIRS field for over 40 years, remain to be solved. To overcome these problems, time-domain (TD) and frequency-domain (FD) measurements have been tried. Presently, a wide range of NIRS instruments are available, including commonly available commercial instruments for continuous wave (CW) measurements, based on the modified Beer-Lambert law (steady-state domain measurements). Among these measurements, the TD measurement is the most promising approach, although compared with CW and FD measurements, TD measurements are less common, due to the need for large and expensive instruments with poor temporal resolution and limited dynamic range. However, thanks to technological developments, TD measurements are increasingly being used in research, and also in various clinical settings. This Special Issue highlights issues at the cutting edge of TD DOS and diffuse optical tomography (DOT). It covers all aspects related to TD measurements, including advances in hardware, methodology, the theory of light propagation, and clinical applications.

Noninvasive measurement of hemodynamics at the microvascular level may have a great impact on oncology in clinics for diagnosis, therapy planning and monitoring, and, in preclinical studies. To this end, diffuse optics is a strong candidate for noninvasive, repeated, deep tissue monitoring. In this multi-disciplinary, translational work, I have constructed and deployed hybrid devices which are the combination of two qualitatively different methods, near infrared diffuse optical spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS), for simultaneous measurement of microvascular total hemoglobin concentration, blood oxygen saturation and blood flow. In a preclinical study, I applied the hybrid device to monitor the response of renal cell carcinoma in mice to antiangiogenic therapy. The results suggest that we can predict the output of therapy from early hemodynamic changes, which provide us with valuable information for better understanding of the tumor resistance mechanism to antiangiogenic therapies. In two in vivo studies in human volunteers, I have developed protocols and probes to demonstrate the feasibility of noninvasive diffuse optical spectroscopy to investigate the pathophysiology of bone. First study was study on the physiology of the patella microvasculature, the other introduced the manubrium as a site that is rich in red bone mar- row and accessible to diffuse optics as a potential window to monitor the progression of hematological malignancies. Overall, during my Ph.D., I have developed instrumentation, algorithms and protocols and, then, applied this technique for preclinical and clinical investigations. My research is a link between preclinical and clinical studies and it opens new areas of applications in oncology.