Epi-optoacoustic (OA) imaging offers flexible clinical diagnostics of the human body when the irradiation optic is attached to or directly integrated into the acoustic probe. Epi-OA images, however, encounter clutter that deteriorates contrast and significantly limits imaging depth. This study elaborates clutter origin in clinical epi-optoacoustic imaging using a linear array probe for scanning the human forearm. We demonstrate that the clutter strength strongly varies with the imaging location but stays stable over time, indicating that clutter is caused by anatomical structures. OA transients which are generated by strong optical absorbers located at the irradiation spot were identified to be the main source of clutter. These transients obscure deep in-plane OA signals when detected by the transducer either directly or after being acoustically scattered in the imaging plane. In addition, OA transients generated in the skin below the probe result in acoustic reverberations, which cause problems in image interpretation and limit imaging depth. Understanding clutter origin allows a better interpretation of clinical OA imaging, helps to design clutter compensation techniques and raises the prospect of contrast optimization via the design of the irradiation geometry.
