Photonic Therapeutics and Diagnostics XII

Front Matter: Volume 9689

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This PDF file contains the front matter associated with SPIE Proceedings Volume 9689, including the Title Page, Copyright information, Table of Contents, Invited Panel Discussion, and Conference Committee listing.

Diagnosis and staging of female genital tract melanocytic lesions using pump-probe microscopy (Conference Presentation)

Francisco E. Robles, Maria A. Selim, Warren S. Warren

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Melanoma of the vulva is the second most common type of malignancy afflicting that organ. This disease caries poor prognosis, and shows tendencies to recur locally and develop distant metastases through hematogenous dissemination. Further, there exists significant clinical overlap between early-stage melanomas and melanotic macules, benign lesions that are believed to develop in about 10% of the general female population. In this work we apply a novel nonlinear optical method, pump-probe microscopy, to quantitatively analyze female genitalia tract melanocytic lesions. Pump-probe microscopy provides chemical information of endogenous pigments by probing their electronic excited state dynamics, with subcellular resolution. Using unstained biopsy sections from 31 patients, we find significant differences between melanin type and structure in tissue regions with invasive melanoma, melanoma in-situ and non-malignant melanocytic proliferations (e.g., nevi, melanocytic macules). The molecular images of non-malignant lesion have a well-organized structure, with relatively homogenous pigment chemistry, most often consistent with that of eumelanin with large aggregate size or void of metals, such as iron. On the other hand, pigment type and structure observed in melanomas in-situ and invasive melanomas is typically much more heterogeneous, with larger contributions from pheomelanin, melanins with larger metal content, and/or melanins with smaller aggregate size. Of most significance, clear differences can be observed between melanocytic macules and vulvar melanoma in-situ, which, as discussed above, can be difficult to clinically distinguish. This initial study demonstrates pump-probe microscopy’s potential as an adjuvant diagnostic tool by revealing systematic chemical and morphological differences in melanin pigmentation among invasive melanoma, melanoma in-situ and non-malignant melanocytic lesions.

New imaging-based biomarkers for melanoma diagnosis using coherent Raman Scattering microscopy (Conference Presentation)

Hequn Wang, Sam Osseiran, Elisabeth Roider, et al.

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Recently, pheomelanin has been found to play a critical role in melanoma progression given its pro-oxidant chemical properties as well as its marked presence in pre-cancerous and malignant melanoma lesions, even in the absence of ultraviolet radiation. In addition, epidemiological evidence indicates a strong correlation between melanoma incidence and skin type, with the highest incidence occurring in individuals of the red-haired/fair-skinned phenotype. Interestingly, nevus count correlates well with melanoma incidence and skin type, except in the population most prone to developing melanoma, where nevus count strikingly drops. As such, a current hypothesis proposes that fair-skinned red-haired individuals, who are unable to stimulate production of eumelanin due to a mutation in MC1R in melanocytes, may actually harbor numerous “invisible”, pheomelanin-rich nevi that evade clinical detection, supporting the high incidence of melanoma in that population. Here, we show for the very first time that melanocytes extracted from genetically modified MC1R-mutant, red-haired mice displayed bright perinuclear distributions of signal within the cells under coherent anti-Stokes Raman scattering (CARS) microscopy. Changes in pheomelanin production in siRNA knockdowns of cultured human melanoma cells were also sensed. We then successfully imaged pheomelanin distributions in both ex vivo and in vivo mouse ear skin. Finally, melanosomes within amelanotic melanoma patient tissue sections were found to show bright pheomelanin signals. This is the first time, to our knowledge, that pheomelanin has been found spatially localized in a human amelanotic melanoma sample. These pheomelanotic CARS features may be used as potential biomarkers for melanoma detection, especially for amelanotic melanomas.

Noninvasive skin cancer diagnosis using multimodal optical spectroscopy

Austin J. Moy, Xu Feng, Mia K. Markey, et al.

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Skin cancer is the most common form of cancer in the United States and is a recognized public health issue. Diagnosis of skin cancer involves biopsy of the suspicious lesion followed by histopathology. Biopsies, which involve excision of the lesion, are invasive, at times unnecessary, and are costly procedures (~$2.8B/year in the US). An unmet critical need exists to develop a non-invasive and inexpensive screening method that can eliminate the need for unnecessary biopsies. To address this need, our group has reported on the continued development of a multimodal spectroscopy (MMS) system towards the goal of a spectral biopsy of skin. Our approach combines Raman spectroscopy, fluorescence spectroscopy, and diffuse reflectance spectroscopy to collect comprehensive optical property information from suspicious skin lesions. We describe our present efforts to develop an updated MMS system composed of OEM components that will be smaller, less expensive, and more clinic-friendly than the previous system. Key system design choices include the selection of miniature spectrometers, a fiber-coupled broadband light source, a fiber coupled diode laser, and a revised optical probe. Selection of these components results in a ~50% reduction in system footprint, resulting in a more clinic-friendly system. We also present preliminary characterization data from the updated MMS system, showing similar performance with our revised optical probe design. Finally, we present in vivo skin measurements taken with the updated MMS system. Future work includes the initiation of a clinical study (n = 250) of the MMS system to characterize its performance in identifying skin cancers.

Towards label-free evaluation of oxidative stress in human skin exposed to sun filters (Conference Presentation)

Sam Osseiran, Hequn Wang, Yusuke Suita, et al.

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Skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma, is the most common form of cancer in North America. Paradoxically, skin cancer incidence is steadily on the rise even despite the growing use of sunscreens over the past decades. One potential explanation for this discrepancy involves the sun filters in sunscreen, which are responsible for blocking harmful ultraviolet radiation. It is proposed that these agents may produce reactive oxygen species (ROS) at the site of application, thereby generating oxidative stress in skin that gives rise to genetic mutations, which may explain the rising incidence of skin cancer. To test this hypothesis, ex vivo human skin was treated with five common chemical sun filters (avobenzone, octocrylene, homosalate, octisalate, and oxybenzone) as well as two physical sun filters (zinc oxide compounds), both with and without UV irradiation. To non-invasively evaluate oxidative stress, two-photon excitation fluorescence (2PEF) and fluorescence lifetime imaging microscopy (FLIM) of the skin samples were used to monitor levels of NADH and FAD, two key cofactors in cellular redox metabolism. The relative redox state of the skin was assessed based on the fluorescence intensities and lifetimes of these endogenous cofactors. While the sun filters were indeed shown to have a protective effect from UV radiation, it was observed that they also generate oxidative stress in skin, even in the absence of UV light. These results suggest that sun filter induced ROS production requires more careful study, especially in how these reactive species impact the rise of skin cancer.

Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective (Conference Presentation)

Kishwer S. Nehal, Milind Rajadhyaksha

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Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon’s review and perspective About 350 publications worldwide have reported the ability of reflectance confocal microscopy (RCM) imaging to detect melanocytic skin lesions in vivo with specificity of 84-88% and sensitivity of 71-92%, and non-melanocytic skin lesions with specificity of 85-97% and sensitivity 100-92%. Lentigo maligna melanoma can be detected with sensitivity of 93% and specificity 82%. While the sensitivity is comparable to that of dermoscopy, the specificity is 2X superior, especially for lightly- and non-pigmented lesions. Dermoscopy combined with RCM imaging is proving to be both highly sensitive and highly specific. Recent studies have reported that the ratio of equivocal (i.e., would have been biopsied) lesions to detected melanomas dropped by ~2X when guided by dermoscopy and RCM imaging, compared to that with dermoscopy alone. Dermoscopy combined with RCM imaging is now being implemented to guide noninvasive diagnosis (to rule out malignancy and biopsy) and to also guide treatment, with promising initial impact: thus far, about 3,000 patients have been saved from biopsies of benign lesions. These are currently under follow-up monitoring. With fluorescence confocal microscopy (FCM) mosaicing, residual basal cell carcinomas can be detected in Mohs surgically excised fresh tissue ex vivo, with sensitivity of 94-97% and specificity 89-94%. FCM mosaicing is now being implemented for guiding Mohs surgery. To date, about 600 Mohs procedures have been performed, guided with mosaicing, and with pathology being performed in parallel to confirm the final outcome. These latest advances demonstrate the promising ability of RCM and FCM to guide patient care.

A machine learning method for identifying morphological patterns in reflectance confocal microscopy mosaics of melanocytic skin lesions in-vivo

Kivanc Kose, Christi Alessi-Fox, Melissa Gill, et al.

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We present a machine learning algorithm that can imitate the clinicians qualitative and visual process of analyzing reflectance confocal microscopy (RCM) mosaics at the dermal epidermal junction (DEJ) of skin. We divide the mosaics into localized areas of processing, and capture the textural appearance of each area using dense Speeded Up Robust Feature (SURF). Using these features, we train a support vector machine (SVM) classifier that can distinguish between meshwork, ring, clod, aspecific and background patterns in benign conditions and melanomas. Preliminary results on 20 RCM mosaics labeled by expert readers show classification with 55 − 81% sensitivity and 81 − 89% specificity in distinguishing these patterns.

If I had a magic wand....Wish list of a dermatologist (Conference Presentation)

Kristen M. Kelly M.D.

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Challenges in dermatology that can be addressed by photonics research will be explored. Non-invasive, real-time diagnosis of skin lesions would eliminate biopsy risks, minimize patient anxiety by providing more rapid answers and allow diagnosis and treatment in a single visit. Multiple approaches have been tried, but significant limitations of current technologies make them impractical for routine clinic implementation. Photonics can also be used for treatment assessment to determine if intervention is adequate or if further treatment is needed. Ideal feedback should be non-invasive, rapid and accurate. Monitoring for potential adverse effects can greatly improve treatment safety, allowing clinicians to push the limits of therapy while preventing serious complications. Light based therapies can also be improved by increasing photon penetration and selectivity for targeted cells or skin structures. Current light based treatments are in many cases limited by photon penetration. In addition, we often seek to damage a specific chromophore but are not able to distinguish between targeted disease and non-targeted normal structures such as the cells of a melanoma and normal melanocytes and port wine stain versus normal vasculature. Scientist and clinician collaboration can address these and other issues and greatly improve patient care.

Polarized light in birefringent samples (Conference Presentation)

Joseph Chue-Sang, Yuqiang Bai, Jessica Ramella-Roman

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Full-field polarized light imaging provides the capability of investigating the alignment and density of birefringent tissue such as collagen abundantly found in scars, the cervix, and other sites of connective tissue. These can be indicators of disease and conditions affecting a patient. Two-dimensional polarized light Monte Carlo simulations which allow the input of an optical axis of a birefringent sample relative to a detector have been created and validated using optically anisotropic samples such as tendon yet, unlike tendon, most collagen-based tissues is significantly less directional and anisotropic. Most important is the incorporation of three-dimensional structures for polarized light to interact with in order to simulate more realistic biological environments. Here we describe the development of a new polarization sensitive Monte Carlo capable to handle birefringent materials with any spatial distribution. The new computational platform is based on tissue digitization and classification including tissue birefringence and principle axis of polarization. Validation of the system was conducted both numerically and experimentally.

Clinical skin imaging using color spatial frequency domain imaging (Conference Presentation)

Bin Yang, John Lesicko, Austin J. Moy, et al.

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Skin diseases are typically associated with underlying biochemical and structural changes compared with normal tissues, which alter the optical properties of the skin lesions, such as tissue absorption and scattering. Although widely used in dermatology clinics, conventional dermatoscopes don’t have the ability to selectively image tissue absorption and scattering, which may limit its diagnostic power. Here we report a novel clinical skin imaging technique called color spatial frequency domain imaging (cSFDI) which enhances contrast by rendering color spatial frequency domain (SFD) image at high spatial frequency. Moreover, by tuning spatial frequency, we can obtain both absorption weighted and scattering weighted images. We developed a handheld imaging system specifically for clinical skin imaging. The flexible configuration of the system allows for better access to skin lesions in hard-to-reach regions. A total of 48 lesions from 31 patients were imaged under 470nm, 530nm and 655nm illumination at a spatial frequency of 0.6mm^(-1). The SFD reflectance images at 470nm, 530nm and 655nm were assigned to blue (B), green (G) and red (R) channels to render a color SFD image. Our results indicated that color SFD images at f=0.6mm-1 revealed properties that were not seen in standard color images. Structural features were enhanced and absorption features were reduced, which helped to identify the sources of the contrast. This imaging technique provides additional insights into skin lesions and may better assist clinical diagnosis.

Imaging of skin surface architecture with out of plane polarimetry (Conference Presentation)

Joseph Chue-Sang, Jessica C. Ramella-Roman

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Knowledge of skin surface topography is of great importance when establishing environmental and age related skin damage. Furthermore an effective treatment protocol cannot be established without a quantitative measuring tool that is able to establish significant improvement in skin texture. We utilized an out-of-plane polarimeter for the characterization of skin surface profile non-invasively. The system consists of an imaging Stokes vector polarimeter where the light source and imaging apparatus are arranged at an angle equal to forty degrees with respect to the tissue normal. The light source is rotated at various azimuth angles about the tissue normal. For each position of the incident beam the principal angle of polarization is calculated. This parameter relates indirectly to surface profile and architecture. The system was used to image the forehead and hands of healthy volunteers between eighteen and sixty years of age. A clear separation appeared among different age groups, establishing out-of-plane polarimetry as a promising technique for skin topography quantification.

Modeling laser speckle imaging of perfusion in the skin (Conference Presentation)

Caitlin Regan, Carole K. Hayakawa, Bernard Choi

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Laser speckle imaging (LSI) enables visualization of relative blood flow and perfusion in the skin. It is frequently applied to monitor treatment of vascular malformations such as port wine stain birthmarks, and measure changes in perfusion due to peripheral vascular disease. We developed a computational Monte Carlo simulation of laser speckle contrast imaging to quantify how tissue optical properties, blood vessel depths and speeds, and tissue perfusion affect speckle contrast values originating from coherent excitation. The simulated tissue geometry consisted of multiple layers to simulate the skin, or incorporated an inclusion such as a vessel or tumor at different depths. Our simulation used a 30x30mm uniform flat light source to optically excite the region of interest in our sample to better mimic wide-field imaging. We used our model to simulate how dynamically scattered photons from a buried blood vessel affect speckle contrast at different lateral distances (0-1mm) away from the vessel, and how these speckle contrast changes vary with depth (0-1mm) and flow speed (0-10mm/s). We applied the model to simulate perfusion in the skin, and observed how different optical properties, such as epidermal melanin concentration (1%-50%) affected speckle contrast. We simulated perfusion during a systolic forearm occlusion and found that contrast decreased by 35% (exposure time = 10ms). Monte Carlo simulations of laser speckle contrast give us a tool to quantify what regions of the skin are probed with laser speckle imaging, and measure how the tissue optical properties and blood flow affect the resulting images.

Use of a smart phone based thermo camera for skin prick allergy testing: a feasibility study (Conference Presentation)

Lindi Barla, Rudolf M. Verdaasdonk, Thomas Rustemeyer, et al.

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Allergy testing is usually performed by exposing the skin to small quantities of potential allergens on the inner forearm and scratching the protective epidermis to increase exposure. After 15 minutes the dermatologist performs a visual check for swelling and erythema which is subjective and difficult for e.g. dark skin types. A small smart phone based thermo camera (FLIR One) was used to obtain quantitative images in a feasibility study of 17 patients Directly after allergen exposure on the forearm, thermal images were captured at 30 seconds interval and processed to a time lapse movie over 15 minutes. Considering the 'subjective' reading of the dermatologist as golden standard, in 11/17 pts (65%) the evaluation of dermatologist was confirmed by the thermo camera including 5 of 6 patients without allergic response. In 7 patients thermo showed additional spots. Of the 342 sites tested, the dermatologist detected 47 allergies of which 28 (60%) were confirmed by thermo imaging while thermo imaging showed 12 additional spots. The method can be improved with user dedicated acquisition software and better registration between normal and thermal images. The lymphatic reaction seems to shift from the original puncture site. The interpretation of the thermal images is still subjective since collecting quantitative data is difficult due to motion patient during 15 minutes. Although not yet conclusive, thermal imaging shows to be promising to improve the sensitivity and selectivity of allergy testing using a smart phone based camera.

Spectral-spatial classification combined with diffusion theory based inverse modeling of hyperspectral images

Lukasz A. Paluchowski, Asgeir Bjorgan, Håvard B. Nordgaard M.D., et al.

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Hyperspectral imagery opens a new perspective for biomedical diagnostics and tissue characterization. High spectral resolution can give insight into optical properties of the skin tissue. However, at the same time the amount of collected data represents a challenge when it comes to decomposition into clusters and extraction of useful diagnostic information. In this study spectral-spatial classification and inverse diffusion modeling were employed to hyperspectral images obtained from a porcine burn model using a hyperspectral push-broom camera. The implemented method takes advantage of spatial and spectral information simultaneously, and provides information about the average optical properties within each cluster. The implemented algorithm allows mapping spectral and spatial heterogeneity of the burn injury as well as dynamic changes of spectral properties within the burn area. The combination of statistical and physics informed tools allowed for initial separation of different burn wounds and further detailed characterization of the injuries in short post-injury time.

Fluorescence imaging of tryptophan and collagen cross-links to evaluate wound closure ex vivo

Ying Wang, Antonio Ortega-Martinez, Bill Farinelli, et al.

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Wound size is a key parameter in monitoring healing. Current methods to measure wound size are often subjective, time-consuming and marginally invasive. Recently, we developed a non-invasive, non-contact, fast and simple but robust fluorescence imaging (u-FEI) method to monitor the healing of skin wounds. This method exploits the fluorescence of native molecules to tissue as functional and structural markers. The objective of the present study is to demonstrate the feasibility of using variations in the fluorescence intensity of tryptophan and cross-links of collagen to evaluate proliferation of keratinocyte cells and quantitate size of wound during healing, respectively. Circular dermal wounds were created in ex vivo human skin and cultured in different media. Two serial fluorescence images of tryptophan and collagen cross-links were acquired every two days. Histology and immunohistology were used to validate correlation between fluorescence and epithelialization. Images of collagen cross-links show fluorescence of the exposed dermis and, hence, are a measure of wound area. Images of tryptophan show higher fluorescence intensity of proliferating keratinocytes forming new epithelium, as compared to surrounding keratinocytes not involved in epithelialization. These images are complementary since collagen cross-links report on structure while tryptophan reports on function. HE and immunohistology show that tryptophan fluorescence correlates with newly formed epidermis. We have established a fluorescence imaging method for studying epithelialization processes during wound healing in a skin organ culture model, our approach has the potential to provide a non-invasive, non-contact, quick, objective and direct method for quantitative measurements in wound healing in vivo.

Noninvasive measurement of burn wound depth applying infrared thermal imaging (Conference Presentation)

Mariëlle E. Jaspers, Ilse M. Maltha, John H. Klaessens, et al.

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In burn wounds early discrimination between the different depths plays an important role in the treatment strategy. The remaining vasculature in the wound determines its healing potential. Non-invasive measurement tools that can identify the vascularization are therefore considered to be of high diagnostic importance. Thermography is a non-invasive technique that can accurately measure the temperature distribution over a large skin or tissue area, the temperature is a measure of the perfusion of that area. The aim of this study was to investigate the clinimetric properties (i.e. reliability and validity) of thermography for measuring burn wound depth. In a cross-sectional study with 50 burn wounds of 35 patients, the inter-observer reliability and the validity between thermography and Laser Doppler Imaging were studied. With ROC curve analyses the ΔT cut-off point for different burn wound depths were determined. The inter-observer reliability, expressed by an intra-class correlation coefficient of 0.99, was found to be excellent. In terms of validity, a ΔT cut-off point of 0.96°C (sensitivity 71%; specificity 79%) differentiates between a superficial partial-thickness and deep partial-thickness burn. A ΔT cut-off point of -0.80°C (sensitivity 70%; specificity 74%) could differentiate between a deep partial-thickness and a full-thickness burn wound. This study demonstrates that thermography is a reliable method in the assessment of burn wound depths. In addition, thermography was reasonably able to discriminate among different burn wound depths, indicating its potential use as a diagnostic tool in clinical burn practice.

Investigation of an angiogenesis-promoting topical treatment for diabetic wounds using multimodal microscopy (Conference Presentation)

Joanne Li, Andrew J. Bower, Zane A. Arp, et al.

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Impaired skin wound healing is a significant co-morbid condition of diabetes that is caused by poor microcirculation among other factors. Hypoxia-inducible factors (HIFs) are transcription factors that mediate the effects of decreased levels of oxygen in biological environments. Inducing mild hypoxia in the tissue could promote angiogenesis, a critical step in the wound healing process in diabetic wounds. To investigate the relationship between hypoxia and diabetic wound healing, a topical treatment consisting of a HIF-activating prolyl-hydroxylase inhibitor was administered to the wounded skin of diabetic (db/db) mice. Studies were conducted in accordance with the GSK Policy on the Care, Welfare and Treatment of Laboratory Animals and were reviewed at GSK or by the ethical review process at the institution where the work was performed. The wounded area was tracked in vivo for 28 days utilizing a custom-built multimodal microscopy system. An increase in vascular density around the wounds of treated animals was observed using phase-variance optical coherence tomography (PV-OCT), in comparison to normal controls. In addition, second harmonic generation (SHG) and fluorescence lifetime imaging microscopy (FLIM) were utilized to examine the collagen regeneration and cellular metabolic activity, respectively, in the wounded skin. The utilization of these light based methods can follow metabolic and morphologic changes in the wound healing process in ways not possible with current evaluation processes. Insights demonstrated in these studies could lead to new endpoints for evaluation of the efficacy of drugs and lead to more direct ways of detecting patient response to treatment.

Advances in skin optical clearing (Conference Presentation)

Valery V. Tuchin

Optical coherence tomography based microangiography: A tool good for dermatology applications (Conference Presentation)

Ruikang K. Wang, Utku Baran, Woo J. Choi

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Optical coherence tomography (OCT) based microangiography (OMAG) is a new imaging technique enabling the visualization of blood flow within microcirculatory tissue beds in vivo with high resolution. In this talk, the concept and advantages of OMAG will be discussed and its potential clinical applications in the dermatology will be shown, demonstrating its usefulness in the clinical monitoring and therapeutic treatment of various skin pathologies, e.g. acne, port wine stain and wound healing.

High-resolution label-free vascular imaging using a commercial, clinically approved dermatological OCT scanner

R. A. Byers, G. Tozer, N. J. Brown, et al.

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Background and Aim: Recently developed decorrelative techniques such as speckle-variance optical coherence tomography (svOCT) have demonstrated non-invasive depth-resolved imaging of the microcirculation in-vivo. However, bulk tissue motion (BTM) originating from the subject's breathing or heartbeat remains problematic at low imaging speeds, often resulting in full frame decorrelation and a loss of vascular contrast. The aim of this study was to build upon existing svOCT techniques through utilisation of a commercially available, probe-based VivoSight OCT system running at 20 kHz Axial-scan rate. Methods and results: Custom four-dimensional scanning strategies were developed and utilised in order to maximise the interframe correlation during image acquisition. Volumes of structural OCT data were collected from various anatomical regions and processed using the aforementioned svOCT algorithm to reveal angiographic information. Following data collection, three dimensional image registration and novel filtering algorithms were applied to each volume in order to ensure that BTM artefacts were sufficiently suppressed. This enabled accurate visualisation of the microcirculation within the papillary dermis, to a depth of approximately 2mm. Applications of this technique, including quantitative capillary loop density measurement and visualisation of wound healing are demonstrated and enhanced through widefield mosaicing of the svOCT data. Conclusions: Non-invasive microcirculation imaging using an FDA 510(k) approved OCT scanner such as the VivoSight allows direct clinical utilisation of these techniques, in particular for the pathological analysis of skin diseases. This research was supported by BBSRC Doctoral Training Grant: BB/F016840/1. The authors also gratefully acknowledge the use of equipment funded by MRC grant: MR/L012669/1.

Three-dimensional multifunctional optical coherence tomography for skin imaging

En Li, Shuichi Makita, Young-Joo Hong, et al.

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Optical coherence tomography (OCT) visualizes cross-sectional microstructures of biological tissues. Recent developments of multifunctional OCT (MF-OCT) provides multiple optical contrasts which can reveal currently unknown tissue properties. In this contribution we demonstrate multifunctional OCT specially designed for dermatological investigation. And by utilizing it to measure four different body parts of in vivo human skin, three-dimensional scattering OCT, OCT angiography, polarization uniformity tomography, and local birefringence tomography images were obtained by a single scan. They respectively contrast the structure and morphology, vasculature, melanin content and collagen traits of the tissue.

Towards the use of OCT angiography in clinical dermatology

Utku Baran, Woo June Choi, Ruikang K. Wang

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Optical coherence tomography (OCT) is a popular imaging technique used in ophthalmology, and on the way to become clinically viable alternative in dermatology due to its capability of acquiring histopathology level images of in vivo tissue, noninvasively. In this study, we demonstrate the capabilities of OCT-based angiography (OMAG) in detecting high-resolution, volumetric structural and microvascular features of in vivo human skin with various conditions using a swept source OCT system that operates on a central wavelength of 1310 nm with an A-line rate of 100 kHz. OMAG images provide detailed in vivo visualization of microvasculature of abnormal human skin conditions from face, chest and belly. Moreover, the progress of wound healing on human skin from arm is monitored during longitudinal wound healing process. The presented results promise the clinical use of OCT angiography in treatment of prevalent cutaneous diseases within human skin, in vivo.

Monitoring femtosecond laser microscopic photothermolysis with multimodal microscopy (Conference Presentation)

Yimei Huang, Harvey Lui, Jianhua Zhao, et al.

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Photothermolysis induced by femtosecond (fs) lasers may be a promising modality in dermatology because of its advantages of high precision due to multiphoton absorption and deeper penetration due to the use of near infrared wavelengths. Although multiphoton absorption nonlinear effects are capable of precision targeting, the femtosecond laser photothermolysis could still have effects beyond the targeted area if a sufficiently high dose of laser light is used. Such unintended effects could be minimized by real time monitoring photothermolysis during the treatment. Targeted photothermolytic treatment of ex vivo mouse skin dermis was performed with tightly focused fs laser beams. Images of reflectance confocal microscopy (RCM), second harmonic generation (SHG), and two-photon fluorescence (TPF) of the mouse skins were obtained with integrated multimodal microscopy before, during, and after the laser treatment. The RCM, SHG, and TPF signal intensities of the treatment areas changed after high power femtosecond laser irradiation. The intensities of the RCM and SHG signals decreased when the tissue was damaged, while the intensity of the TPF signal increased when the photothermolysis was achieved. Moreover, the TPF signal was more susceptible to the degree of the photothermolysis than the RCM and SHG signals. The results suggested that multimodal microscopy is a potentially useful tool to monitor and assess the femtosecond laser treatment of the skin to achieve microscopic photothermolysis with high precision.

New insights into photodynamic therapy treatment through the use of 3D Monte Carlo radiation transfer modelling

C. Louis Campbell, Kenneth Wood, C. Tom A. Brown, et al.

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Photodynamic therapy (PDT) has been theoretically investigated using a Monte Carlo radiation transfer (MCRT) model. By including complex three dimensional (3D) tumour models a more appropriate representation of the treatment was achieved. The 3D clustered tumour model was compared to a smooth model, resulting in a significantly deeper penetration associated with the clustered model. The results from the work presented here indicates that light might penetrate deeper than suggested by 2D or simple layered models.

Laser ablation of basal cell carcinomas guided by confocal microscopy

Heidy Sierra, Miguel Cordova, Kishwer Nehal, et al.

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Laser ablation offers precise and fast removal of superficial and early nodular types of basal cell carcinomas (BCCs). Nevertheless, the lack of histological confirmation has been a limitation. Reflectance confocal microscopy (RCM) imaging combined with a contrast agent can offer cellular-level histology-like feedback to detect the presence (or absence) of residual BCC directly on the patient. We conducted an ex vivo bench-top study to provide a set of effective ablation parameters (fluence, number of passes) to remove superficial BCCs while also controlling thermal coagulation post-ablation to allow uptake of contrast agent. The results for an Er:YAG laser (2.9 um and pulse duration 250us) show that with 6 passes of 25 J/cm², thermal coagulation can be effectively controlled, to allow both the uptake of acetic acid (contrast agent) and detection of residual (or absence) BCCs. Confirmation was provided with histological examination. An initial in vivo study on 35 patients shows that the uptake of contrast agent aluminum chloride) and imaging quality is similar to that observed in the ex vivo study. The detection of the presence of residual tumor or complete clearance was confirmed in 10 wounds with (additional) histology and in 25 lesions with follow-up imaging. Our results indicate that resolution is sufficient but further development and use of appropriate contrast agent are necessary to improve sensitivity and specificity. Advances in RCM technology for imaging of lateral and deep margins directly on the patient may provide less invasive, faster and less expensive image-guided approaches for treatment of BCCs.

Dermoscopy-guided reflectance confocal microscopy of skin using high-NA objective lens with integrated wide-field color camera

David L. Dickensheets, Seth Kreitinger, Gary Peterson, et al.

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Reflectance Confocal Microscopy, or RCM, is being increasingly used to guide diagnosis of skin lesions. The combination of widefield dermoscopy (WFD) with RCM is highly sensitive (~90%) and specific (~ 90%) for noninvasively detecting melanocytic and non-melanocytic skin lesions. The combined WFD and RCM approach is being implemented on patients to triage lesions into benign (with no biopsy) versus suspicious (followed by biopsy and pathology). Currently, however, WFD and RCM imaging are performed with separate instruments, while using an adhesive ring attached to the skin to sequentially image the same region and co-register the images. The latest small handheld RCM instruments offer no provision yet for a co-registered wide-field image. This paper describes an innovative solution that integrates an ultra-miniature dermoscopy camera into the RCM objective lens, providing simultaneous wide-field color images of the skin surface and RCM images of the subsurface cellular structure. The objective lens (0.9 NA) includes a hyperhemisphere lens and an ultra-miniature CMOS color camera, commanding a 4 mm wide dermoscopy view of the skin surface. The camera obscures the central portion of the aperture of the objective lens, but the resulting annular aperture provides excellent RCM optical sectioning and resolution. Preliminary testing on healthy volunteers showed the feasibility of combined WFD and RCM imaging to concurrently show the skin surface in wide-field and the underlying microscopic cellular-level detail. The paper describes this unique integrated dermoscopic WFD/RCM lens, and shows representative images. The potential for dermoscopy-guided RCM for skin cancer diagnosis is discussed.

Investigation of the effect of hydration on dermal collagen in ex vivo human skin tissue using second harmonic generation microscopy

Ravikant Samatham, Nicholas K. Wang, Steven L. Jacques

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Effect of hydration on the dermal collagen structure in human skin was investigated using second harmonic generation microscopy. Dog ears from the Mohs micrographic surgery department were procured for the study. Skin samples with subject aged between 58-90 years old were used in the study. Three dimensional Multiphoton (Two-photon and backward SHG) control data was acquired from the skin samples. After the control measurement, the skin tissue was either soaked in deionized water for 2 hours (Hydration) or kept at room temperature for 2 hours (Desiccation), and SHG data was acquired. The data was normalized for changes in laser power and detector gain. The collagen signal per unit volume from the dermis was calculated. The desiccated skin tissue gave higher backward SHG compared to respective control tissue, while hydration sample gave a lower backward SHG. The collagen signal decreased with increase in hydration of the dermal collagen. Hydration affected the packing of the collagen fibrils causing a change in the backward SHG signal. In this study, the use of multiphoton microscopy to study the effect of hydration on dermal structure was demonstrated in ex vivo tissue.

Comparing Yb-fiber and Ti:Sapphire lasers for depth resolved imaging of human skin (Conference Presentation)

Mihaela Balu, Ilyas Saytashev, Jue Hou, et al.

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We report on a direct comparison between Ti:Sapphire and Yb fiber lasers for depth-resolved label-free multimodal imaging of human skin. We found that the penetration depth achieved with the Yb laser was 80% greater than for the Ti:Sapphire. Third harmonic generation (THG) imaging with Yb laser excitation provides additional information about skin structure. Our results indicate the potential of fiber-based laser systems for moving into clinical use.

In vivo multimodality video microscopy of human skin in the vertical plane (Conference Presentation)

Zhenguo Wu, Yunxian Tian, Jianhua Zhao, et al.

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Reflectance confocal microscopy (RCM) and multiphoton microscopy (MPM) are non-invasive methods of acquiring morphological images of the skin in vivo. Most research in this area focuses on instruments that are configured for two-dimensional imaging in a horizontal plane parallel to the skin surface. In contrast, conventional histopathologic evaluation of the skin is based on vertical tissue sections that show microscopic features and their interrelationships according to their depth within the skin. The ability to similarly depict the skin in the vertical plane during in vivo microscopic imaging poses several significant challenges with respect to imaging speed, resolution and extractable information. Aiming to address above challenges, we developed a laser scanning multimodal microscopy system which combines RCM and MPM, and has the ability to do fast xz scanning to achieve high resolution vertical “optical sectioning” of in vivo human skin at video rates. RCM and MPM images are obtained simultaneously and co-registered thereby providing complementary morphological information. To validate the performance of this system vertical section RCM and MPM microscopic images of normal human skin in vivo were obtained at half video rates (15 frames/s). Using our system it is possible to discern the following structures: all layers of the epidermis including the stratum lucidum, the dermal-epidermal junction, and the papillary dermis. Blood flow is also visible as evidenced by blood cell movement within vessels. The effective imaging depth is about 200 micrometers. This system provides a means of interrogating human skin noninvasively at an orientation analogous to conventional histological sectioning.

An unsupervised machine learning method for delineating stratum corneum in reflectance confocal microscopy stacks of human skin in vivo

Alican Bozkurt, Kivanc Kose, Christi A. Fox, et al.

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Study of the stratum corneum (SC) in human skin is important for research in barrier structure and function, drug delivery, and water permeability of skin. The optical sectioning and high resolution of reflectance confocal microscopy (RCM) allows visual examination of SC non-invasively. Here, we present an unsupervised segmentation algorithm that can automatically delineate thickness of the SC in RCM images of human skin in-vivo. We mimic clinicians visual process by applying complex wavelet transform over non-overlapping local regions of size 16 x 16 μm called tiles, and analyze the textural changes in between consecutive tiles in axial (depth) direction. We use dual-tree complex wavelet transform to represent textural structures in each tile. This transform is almost shift-invariant, and directionally selective, which makes it highly efficient in texture representation. Using DT-CWT, we decompose each tile into 6 directional sub-bands with orientations in ±15, 45, and 75 degrees and a low-pass band, which is the decimated version of the input. We apply 3 scales of decomposition by recursively transforming the low-pass bands and obtain 18 bands of different directionality at different scales. We then calculate mean and variance of each band resulting in a feature vector of 36 entries. Feature vectors obtained for each stack of tiles in axial direction are then clustered using spectral clustering in order to detect the textural changes in depth direction. Testing on a set of 15 RCM stacks produced a mean error of 5.45±1.32 μm, compared to the ”ground truth” segmentation provided by a clinical expert reader.

Cutaneous porphyrins exhibit anti-stokes fluorescence that is detectable in sebum (Conference Presentation)

Giselle Tian, Haishan Zeng, Jianhua Zhao, et al.

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Porphyrins produced by Propionibacterium acnes represent the principal fluorophore associated with acne, and appear as orange-red luminescence under the Wood’s lamp. Assessment of acne based on Wood’s lamp (UV) or visible light illumination is limited by photon penetration depth and has limited sensitivity for earlier stage lesions. Inducing fluorescence with near infrared (NIR) excitation may provide an alternative way to assess porphyrin-related skin disorders. We discovered that under 785 nm CW laser excitation PpIX powder exhibits fluorescence emission in the shorter wavelength range of 600-715 nm with an intensity that is linearly dependent on the excitation power. We attribute this shorter wavelength emission to anti-Stokes fluorescence. Similar anti-Stokes fluorescence was also detected focally in all skin-derived samples containing porphyrins. Regular (Stokes) fluorescence was present under UV and visible light excitation on ex vivo nasal skin and sebum from uninflamed acne, but not on nose surface smears or sebum from inflamed acne. Co-registered CW laser-excited anti-Stokes fluorescence and fs laser-excited multi-photon fluorescence images of PpIX powder showed similar features. In the skin samples because of the anti-Stokes effect, the NIR-induced fluorescence was presumably specific for porphyrins since there appeared to be no anti-Stokes emission signals from other typical skin fluorophores such as lipids, keratins and collagen. Anti-Stokes fluorescence under NIR CW excitation is more sensitive and specific for porphyrin detection than UV- or visible light-excited regular fluorescence and fs laser-excited multi-photon fluorescence. This approach also has higher image contrast compared to NIR fs laser-based multi-photon fluorescence imaging. The anti-Stokes fluorescence of porphyrins within sebum could potentially be applied to detecting and targeting acne lesions for treatment via fluorescence image guidance.

Fluorescence excitation-emission matrix spectroscopy of vitiligo skin in vivo (Conference Presentation)

Jianhua Zhao, Vincent Richer, Mohammed Al Jasser, et al.

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Fluorescence signals depend on the intensity of the exciting light, the absorption properties of the constituent molecules, and the efficiency with which the absorbed photons are converted to fluorescence emission. The optical features and appearance of vitiligo have been explained primarily on the basis of reduced epidermal pigmentation, which results in abnormal white patches on the skin. The objective of this study is to explore the fluorescence properties of vitiligo and its adjacent normal skin using fluorescence excitation-emission matrix (EEM) spectroscopy. Thirty five (35) volunteers with vitiligo were acquired using a double-grating spectrofluorometer with excitation and emission wavelengths of 260-450 nm and 300-700 nm respectively. As expected, the most pronounced difference between the spectra obtained from vitiligo lesions compared to normally pigmented skin was that the overall fluorescence was much higher in vitiligo; these differences increased at shorter wavelengths, thus matching the characteristic spectral absorption of epidermal melanin. When comparing the fluorescence spectra from vitiligo to normal skin we detected three distinct spectral bands centered at 280nm, 310nm, and 335nm. The 280nm band may possibly be related to inflammation, whereas the 335 nm band may arise from collagen or keratin cross links. The source of the 310 nm band is uncertain; it is interesting to note its proximity to the 311 nm UV lamps used for vitiligo phototherapy. These differences are accounted for not only by changes in epidermal pigment content, but also by other optically active cutaneous biomolecules.

Measurement of diffusion of fluorescent compounds and autofluorescence in skin in vivo using a confocal instrument

K. K. Buttenschoen, E. E. Sutton, D. Daly, et al.

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Using compact and affordable instrumentation based upon fluorescent confocal imaging we have tracked the movement of autofluorescent compounds through skin in near real time with high temporal and spatial resolution and sensitivity. The ability to measure the diffusion of compounds through skin with such resolution plays an important role for applications such as monitoring the penetration of pharmaceuticals applied to skin and assessing the integrity of the skin barrier. Several measurement methods exist, but they suffer from a number of problems such as being slow, expensive, non-portable and lacking sensitivity. To address these issues, we adapted a technique that we previously developed for tracking fluorescent compounds in the eye to measure the autofluorescence and the diffusion of externally applied fluorescent compounds in skin in vivo. Results are presented that show the change in autofluorescence of the volar forearm over the course of a week. We furthermore demonstrate the ability of the instrument to measure the diffusion speed and depth of externally applied fluorescent compounds both in healthy skin and after the skin barrier function has been perturbed. The instrument is currently being developed further for increased sensitivity and multi-wavelength excitation. We believe that the presented instrument is suitable for a large number of applications in fields such as assessment of damage to the skin barrier, development of topical and systemic medication and tracking the diffusion of fluorescent compounds through skin constructs as well as monitoring effects of skin products and general consumer products which may come into contact with the skin.

Metal-clad waveguide characterization for contact-based light transmission into tissue

Jeffrey Chininis, Paul Whiteside, Heather K. Hunt

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As contemporary laser dermatology procedures, like tattoo removal and skin resurfacing, become more popular, the complications of their operation are also becoming more prevalent. Frequent incidences of over-exposure, ocular injury, and excessive thermal damage represent mounting concerns for those seeking such procedures; moreover, each of these problems is a direct consequence of the standard, free-space method of laser transmission predominantly used in clinical settings. Therefore, an alternative method of light transmission is needed to minimize these problems. Here, we demonstrate and characterize an alternative method that uses planar waveguides to deliver light into sample tissue via direct contact. To do this, slab substrates made from glass were clad in layers of titanium and silver, constraining the light within the waveguide along the waveguide’s length. By creating active areas on the waveguide surface, the propagating light could then optically tunnel into the tissue sample, when the waveguide was brought into contact with the tissue. SEM and EDS were used to characterize the metal film thickness and deposition rates onto the glass substrates. Laser light from a Q-switched Nd:YAG source operating at 532nm was coupled into the waveguide and transmitted into samples of pig skin. The amount of light transmitted was measured using photoacoustics techniques, in conjunction with a photodiode and integrating sphere. Transmitting light into tissue in this manner effectively resolves or circumvents the complications caused by free-space propagation methods as it reduces the operating distance to 0, which prevents hazardous back-reflections and allows for the ready incorporation of contact cooling technologies.

Remote optical configuration of pigmented lesion detection and diagnosis of bone fractures

Nisan Ozana, Yael Bishitz, Yevgeny Beiderman, et al.

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In this paper we present a novel approach of realizing a safe, simple, and inexpensive sensor applicable to bone fractures and pigmented lesions detection. The approach is based on temporal tracking of back-reflected secondary speckle pattern generated while illuminating the affected area with a laser and applying periodic pressure to the surface via a controlled vibration. The use of such a concept was already demonstrated for non-contact monitoring of various bio-medical parameters such as heart rate, blood pulse pressure, concentration of alcohol and glucose in the blood stream and intraocular pressure. The presented technique is a safe and effective method of detecting bone fractures in populations at risk. When applied to pigmented lesions, the technique is superior to visual examination in avoiding many false positives and resultant unnecessary biopsies. Applying a series of different vibration frequencies at the examined tissue and analyzing the 2-D speckle pattern trajectory in response to the applied periodic pressure creates a unique signature for each and different pigmented lesion. Analyzing these signatures is the first step toward detection of malignant melanoma. In this paper we present preliminary experiments that show the validity of the developed sensor for both applications: the detection of damaged bones as well as the classification of pigmented lesions.

UV photostability of insect repellents evaluated through Raman spectroscopy

Viviane Gadret Bório, Adjaci Uchôa Fernandes, Landulfo Silveira Jr.

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The use of insect repellents either indoors or at places with incidence of solar radiation has been common due to dengue epidemics in Brazil. The lack of studies on the photostability of these substances has motivated this study, where the main goal was to verify the photostability and photodegradation of some of the commercially insect repellents available under the simulated ultraviolet (UV) radiation, by evaluating the molecular changes using dispersive Raman spectroscopy (830 nm excitation). A laboratory-made chamber was used for irradiating the repellents, where UV-A + UV-B radiations (UV-A: 5.5 mW/cm² and UV-B 1.5 mW/cm²) can be obtained. The chamber internal temperature did not exceed 31 °C during experiments. The compounds n,n-diethyl-m-toluamide (DEET), IR-3535, andiroba and citronella oils, used as active ingredients in insect repellents, and commercial formula containing DEET (14.5% in ethanol and isopropyl myristate) and IR-3535 (16% in carbopol) were continuously irradiated for 8 h. The Raman spectrum of each sample was obtained before and after UV exposure. The compounds and the commercial formula containing IR-3535 showed photo-stability when irradiated, since no changes in the peaks were found. The commercial formula containing DEET showed spectral decrease at 524, 690, 1003 and 1606 cm^-1, assigned to the DEET, and increase at 884 cm^-1, assigned to the ethanol. These results indicate that the excipient could influence the photostability of the active ingredient. The Raman spectroscopy can be suitable to monitor the photodegradation under UV irradiation rapidly and reliably.

Fluorescence spectroscopy incorporating a ratiometric approach for the diagnosis and classification of urothelial carcinoma

Suresh Anand, Riccardo Cicchi, Alfonso Crisci, et al.

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The current most popular clinical method for the screening of urothelial carcinoma is white light cystoscopy. This method has inherent disadvantages making a strong genesis towards developing more powerful diagnostic techniques. Laser induced intrinsic fluorescence spectroscopy has been studied as an adjunct to current methods for the detection of tumors. This technique allows real time results based on the changes in spectral profile between normal and tumor tissues. We conducted a pilot study based on fluorescence spectroscopy at two wavelengths 378 and 445 nm excitation for the differentiation of urothelial carcinoma. At both the excitation wavelengths, the measured fluorescence signal showed an increased intensity at wavelengths greater than 520 nm. In addition, the emission profile showed modulation at 580 nm which is due to the reabsorption of emitted fluo- rescence due to hemoglobin. Additionally, we developed a tissue characterizing algorithm, based on fluorescence intensity ratios, F510/F600 and F520/F580 at 378 and 445 nm excitation wavelengths respectively. Further, the results were correlated with the pathologists assessment of urothelial carcinoma. This ratiometric classification algorithm yielded 81% sensitivity and 83% specificity at 378 nm and while at 445 nm excitation we achieved a sensitivity and specificity of 85% and 86% for classifying normal and tumor bladder tissues. In this study we have demonstrated the potential of a simple ratiometric algorithm based on fluorescence spectroscopy could be an alternative tool to tissue biopsy. Furthermore, this technique based fiber-based fluorescence spectroscopy could be integrated into an endoscopy system for use in the operating room.

Cavitation bubble dynamics during thulium fiber laser lithotripsy

Luke A. Hardy, Joshua D. Kennedy, Christopher R. Wilson, et al.

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The Thulium fiber laser (TFL) is being explored for lithotripsy. TFL parameters differ from standard Holmium:YAG laser in several ways, including smaller fiber delivery, more strongly absorbed wavelength, low pulse energy/high pulse rate operation, and more uniform temporal pulse structure. High speed imaging of cavitation bubbles was performed at 105,000 fps and 10 μm spatial resolution to determine influence of these laser parameters on bubble formation. TFL was operated at 1908 nm with pulse energies of 5-75 mJ, and pulse durations of 200-1000 μs, delivered through 100-μm-core fiber. Cavitation bubble dynamics using Holmium laser at 2100 nm with pulse energies of 200-1000 mJ and pulse duration of 350 μs was studied, for comparison. A single, 500 μs TFL pulse produced a bubble stream extending 1090 ± 110 μm from fiber tip, and maximum bubble diameters averaged 590 ± 20 μm (n=4). These observations are consistent with previous studies which reported TFL ablation stallout at working distances < 1.0 mm. TFL bubble dimensions were five times smaller than for Holmium laser due to lower pulse energy, higher water absorption coefficient, and smaller fiber diameter used.

Multimodal, 3D pathology-mimicking bladder phantom for evaluation of cystoscopic technologies (Conference Presentation)

Gennifer T. Smith, Kristen L. Lurie, Dimitar V. Zlatev, et al.

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Optical coherence tomography (OCT) and blue light cystoscopy (BLC) have shown significant potential as complementary technologies to traditional white light cystoscopy (WLC) for early bladder cancer detection. Three-dimensional (3D) organ-mimicking phantoms provide realistic imaging environments for testing new technology designs, the diagnostic potential of systems, and novel image processing algorithms prior to validation in real tissue. Importantly, the phantom should mimic features of healthy and diseased tissue as they appear under WLC, BLC, and OCT, which are sensitive to tissue color and structure, fluorescent contrast, and optical scattering of subsurface layers, respectively. We present a phantom posing the hollow shape of the bladder and fabricated using a combination of 3D-printing and spray-coating with Dragon Skin (DS) (Smooth-On Inc.), a highly elastic polymer to mimic the layered structure of the bladder. Optical scattering of DS was tuned by addition of titanium dioxide, resulting in scattering coefficients sufficient to cover the human bladder range (0.49 to 2.0 mm^-1). Mucosal vasculature and tissue coloration were mimicked with elastic cord and red dye, respectively. Urethral access was provided through a small hole excised from the base of the phantom. Inserted features of bladder pathology included altered tissue color (WLC), fluorescence emission (BLC), and variations in layered structure (OCT). The phantom surface and underlying material were assessed on the basis of elasticity, optical scattering, layer thicknesses, and qualitative image appearance. WLC, BLC, and OCT images of normal and cancerous features in the phantom qualitatively matched corresponding images from human bladders.

Study of cavitation bubble dynamics during Ho:YAG laser lithotripsy by high-speed camera

Jian J. Zhang, Jason R. Xuan, Honggang Yu, et al.

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Although laser lithotripsy is now the preferred treatment option for urolithiasis, the mechanism of laser pulse induced calculus damage is still not fully understood. This is because the process of laser pulse induced calculus damage involves quite a few physical and chemical processes and their time-scales are very short (down to sub micro second level). For laser lithotripsy, the laser pulse induced impact by energy flow can be summarized as: Photon energy in the laser pulse → photon absorption generated heat in the water liquid and vapor (super heat water or plasma effect) → shock wave (Bow shock, acoustic wave) → cavitation bubble dynamics (oscillation, and center of bubble movement , super heat water at collapse, sonoluminscence) → calculus damage and motion (calculus heat up, spallation/melt of stone, breaking of mechanical/chemical bond, debris ejection, and retropulsion of remaining calculus body). Cavitation bubble dynamics is the center piece of the physical processes that links the whole energy flow chain from laser pulse to calculus damage. In this study, cavitation bubble dynamics was investigated by a high-speed camera and a needle hydrophone. A commercialized, pulsed Ho:YAG laser at 2.1 mu;m, StoneLight^TM 30, with pulse energy from 0.5J up to 3.0 J, and pulse width from 150 mu;s up to 800 μs, was used as laser pulse source. The fiber used in the investigation is SureFlex^TM fiber, Model S-LLF365, a 365 um core diameter fiber. A high-speed camera with frame rate up to 1 million fps was used in this study. The results revealed the cavitation bubble dynamics (oscillation and center of bubble movement) by laser pulse at different energy level and pulse width. More detailed investigation on bubble dynamics by different type of laser, the relationship between cavitation bubble dynamics and calculus damage (fragmentation/dusting) will be conducted as a future study.

Feasibility of laser-integrated high intensity focused ultrasound (HIFU) treatment for bladder tumors: in vitro study (Conference Presentation)

Van Phuc Nguyen, Suhyun Park, Junghwan Oh, et al.

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Previous studies have shown that photothemal therapy combined with high intensity focused ultrasound (HIFU) can provide a promising method to achieve rapid thermal coagulation during surgical procedures. The current study investigated the feasibility of the laser-integrated high intensity focused ultrasound (HIFU) application to treat bladder tumors by enhancing thermal effects and therapeutic depth in vitro. To generate thermal coagulation, a single element HIFU transducer with a central frequency of 2.0 MHz was used to transmit acoustic energy to 15 fresh porcine bladders injected with an artificial tumor (100 µl gelatin and hemoglobin solution) in vitro. Simultaneously, an 80-W 532-nm laser system was also implemented to induce thermal necrosis in the targeted tissue. The intensity of 570 W/cm2 at the focus of HIFU and laser energy of 0.9 W were applied to all the samples for 40 s. The temperature rise increased up to about 1.6 or 3 folds (i.e., ΔT=32±3.8 K for laser-integrated HIFU, ΔT=20±6.5 K for HIFU only, and ΔT=11±5.6 K for laser only). The estimated lesion depth also increased by 1.3 and 2 folds during the dual-thermal treatment, in comparison with the treatment by either HIFU or laser. The results indicated that the laser-integrated HIFU treatment can be an efficient hyperthermic method for tumor coagulation.

Thulium fiber laser lithotripsy using small spherical distal fiber tips

Christopher R. Wilson, Luke A. Hardy, Joshua D. Kennedy, et al.

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This study tests a 100-μm-core fiber with 300-μm-diameter ball tip during Thulium fiber laser (TFL) lithotripsy. The TFL was operated at 1908 nm wavelength with 35-mJ pulse energy, 500-μs pulse duration, and 300-Hz pulse rate. Calcium oxalate/phosphate stone samples were weighed, laser procedure times measured, and ablation rates calculated for ball tip fibers, with comparison to bare tip fibers. Photographs of ball tips were taken before and after each procedure to observe ball tip degradation and determine number of procedures completed before need to replace fiber. Saline irrigation rates and ureteroscope deflection were measured with and without TFL fiber present. There was no statistical difference (P > 0.05) between stone ablation rates for single-use ball tip fiber (1.3 ± 0.4 mg/s) (n=10), multiple-use ball tip fiber (1.3 ± 0.5 mg/s) (n=44), and conventional single-use bare tip fibers (1.3 ± 0.2 mg/s) (n=10). Ball tip durability varied widely, but fibers averaged > 4 stone procedures before decline in stone ablation rates due to mechanical damage at front surface of ball tip. The small fiber diameter did not impact ureteroscope deflection or saline flow rates. The miniature ball tip fiber may provide a cost-effective design for safe fiber insertion through the ureteroscope working channel and the ureter without risk of scope damage or tissue perforation, and without compromising stone ablation efficiency during TFL ablation of kidney stones.

Application of novel optical diffuser for urethral stricture treatment (Conference Presentation)

Trung Hau Nguyen, Yun-Hee Rhee, Jin-Chul Ahn, et al.

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Optical fibers have frequently been used for photothermal laser therapy due to its efficiency to deliver laser energy directly to tissue. The aim of the current study was to develop a diffusing optical fiber to achieve radially uniform light irradiation for endoscopically treating urethral stricture. The optical diffuser was fabricated by micro-machining helical patterns on the fiber surface using CO2 laser light at 5 W. Visible light emission (632 nm) and spatial emissions (including polar, azimuthal, and longitudinal emissions) of the fiber tip were evaluated to validate the performance of the fabricated diffuser. Prior to tissue tests, numerical simulation on heat distribution was developed to estimate the degree of tissue coagulation depth during interstitial coagulation. Due to a high absorption coefficient by tissue water, 1470 nm laser was used for photothermal therapy treatment of urethral stricture to obtain a more precise depth profile. For in vitro tissue tests, porcine liver tissue was irradiated with three different power levels (3, 6, and 9 W) at various irradiation times. Porcine urethral tissue was also tested with the diffuser for 10 sec at 6 W to validate the feasibility of circumferential photothermal treatment. The treated tissue was stained with hematoxylin and eosin (H and E) and then imaged with an optical transmission microscope. The spatial emission characteristics of the diffusing optical fiber presented an almost uniform power distribution along the diffuser tip (less than 10% deviation) and around its circumference (less than 5% deviation). The peak temperature in simulation model at the tissue interface between the glass-cap and the tissue was 373 K that was higher than that at the distal end. The tissue tests showed that higher power levels resulted in lower coagulation thresholds (e.g., 1 sec at 9 W vs 8 sec at 3 W). Furthermore, the coagulation depth was approximately 20% thinner than the simulation results (p<0.001). The extent of coagulation thickness in urethral tissue was measured to be 1.3±0.2 mm, which was slightly thicker (18%) than the liver testing (1.1±0.1 mm) under the same conditions (p < 0.001). The proposed optical diffuser may be a feasible tool to treat the urethral stricture in a uniform manner.

Miniaturized rapid scanning, forward-viewing catheterscope for optical coherence tomography (Conference Presentation)

Kristen L. Lurie, Robin Guay Lord, Caroline Boudoux, et al.

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Patients afflicted with bladder cancer undergo annual surveillance in the clinic with flexible white light cystoscopy (WLC). However, WLC lacks the sensitivity to detect all bladder tumors and provides no stage information. Optical coherence tomography (OCT) can overcome these limitations of WLC due to its ability to visualize subsurface details of the bladder wall, to stage cancers and to detect tumors otherwise invisible to WLC. A major challenge, however, to realizing OCT imaging during clinical cystoscopies is developing a forward-viewing OCT catheterscope capable of passing through the 2.4-mm working channel of a standard flexible cystoscope. Additionally, to aid in identifying new tumors, the OCT system must be fast enough to collect data over the surface of the bladder without significantly increasing the procedure time. We have developed the first rapid-scanning forward-viewing OCT catheterscope that uses scanning fiber technology and is suitable for integration into flexible cystoscopes. The scanning fiber scope has a resonance frequency exceeding 2 kHz, which enables rapid volumetric data collection at a rate of 12.5 Hz. We expand on our previous design of such a scope by miniaturizing the scope package to a diameter of 1.29 mm and a rigid length of 19 mm, making this the smallest such package for forward-viewing, scanning OCT scopes. We validate the imaging quality of our prototype scope using phantom and ex vivo pig bladder samples. The miniaturized, rapid-scanning OCT scope is a promising tool to enable early detection and staging of bladder cancer during flexible WLC.

High efficiency for prostate biopsy qualification with full-field OCT after training

C. Yang, R. Ricco, A. Sisk, et al.

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Full-field optical coherence tomography (FFOCT) offers a fast and non-destructive method of obtaining images of biological tissues at ultrahigh resolution, approaching traditional histological sections. In the context of prostate cancer diagnosis involving multiple biopsies, FFOCT could be used to validate the cores just after they are obtained in order to guide the number of biopsies to be performed. The aim of the study was to define and test a training protocol for efficient FFOCT prostate biopsy assessment. Three readers (a pathologist with previous experience with FFOCT, a pathologist new to FFOCT, and a urologist new to FFOCT) were trained to read FFOCT images of prostate biopsies on a set of 20 commented zooms (1 mm field of view) and 25 complete images. They were later tested on a set of 115 anonymized and randomized images of prostate biopsies. The results showed that an extra 30 images were necessary for more complete training as compared to prior studies. After training, pathologists obtained 100% sensitivity on high-grade cancer detection and 96% overall specificity; the urologist obtained 88% sensitivity on high-grade cancer and 89% overall specificity. Overall, the readers obtained a mean of 93% accuracy of qualifying malignancy on prostate biopsies. Moreover, the two pathologists showed a steeper learning curve than the urologist. This study demonstrates that a training protocol for such a new imaging modality may be implemented and yield very high efficiency for the pre-histologic detection of malignancy on prostate biopsies.

Virtual 3D bladder reconstruction for augmented medical records from white light cystoscopy (Conference Presentation)

Kristen L. Lurie, Dimitar V. Zlatev, Roland Angst, et al.

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Bladder cancer has a high recurrence rate that necessitates lifelong surveillance to detect mucosal lesions. Examination with white light cystoscopy (WLC), the standard of care, is inherently subjective and data storage limited to clinical notes, diagrams, and still images. A visual history of the bladder wall can enhance clinical and surgical management. To address this clinical need, we developed a tool to transform in vivo WLC videos into virtual 3-dimensional (3D) bladder models using advanced computer vision techniques. WLC videos from rigid cystoscopies (1280 x 720 pixels) were recorded at 30 Hz followed by immediate camera calibration to control for image distortions. Video data were fed into an automated structure-from-motion algorithm that generated a 3D point cloud followed by a 3D mesh to approximate the bladder surface. The highest quality cystoscopic images were projected onto the approximated bladder surface to generate a virtual 3D bladder reconstruction. In intraoperative WLC videos from 36 patients undergoing transurethral resection of suspected bladder tumors, optimal reconstruction was achieved from frames depicting well-focused vasculature, when the bladder was maintained at constant volume with minimal debris, and when regions of the bladder wall were imaged multiple times. A significant innovation of this work is the ability to perform the reconstruction using video from a clinical procedure collected with standard equipment, thereby facilitating rapid clinical translation, application to other forms of endoscopy and new opportunities for longitudinal studies of cancer recurrence.

Partial wave spectroscopic microscopy can predict prostate cancer progression and mitigate over-treatment (Conference Presentation)

Di Zhang, Taylor Graff, Susan Crawford, et al.

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Prostate Cancer (PC) is the second leading cause of cancer deaths in American men. While prostate specific antigen (PSA) test has been widely used for screening PC, >60% of the PSA detected cancers are indolent, leading to unnecessary clinical interventions. An alternative approach, active surveillance (AS), also suffer from high expense, discomfort and complications associated with repeat biopsies (every 1-3 years), limiting its acceptance. Hence, a technique that can differentiate indolent from aggressive PC would attenuate the harms from over-treatment. Combining microscopy with spectroscopy, our group has developed partial wave spectroscopic (PWS) microscopy, which can quantify intracellular nanoscale organizations (e.g. chromatin structures) that are not accessible by conventional microscopy. PWS microscopy has previously been shown to predict the risk of cancer in seven different organs (N ~ 800 patients). Herein we use PWS measurement of label-free histologically-normal prostatic epithelium to distinguish indolent from aggressive PC and predict PC risk. Our results from 38 men with low-grade PC indicated that there is a significant increase in progressors compared to non-progressors (p=0.002, effect size=110%, AUC=0.80, sensitivity=88% and specificity=72%), while the baseline clinical characteristics were not significantly different. We further improved the diagnostic power by performing nuclei-specific measurements using an automated system that separates in real-time the cell nuclei from the remaining prostate epithelium. In the long term, we envision that the PWS based prognostication can be coupled with AS without any change to the current procedure to mitigate the harms caused by over-treatment.

Using optical coherence tomography (OCT) to evaluate the status of human donor kidneys (Conference Presentation)

Peter M. Andrews, Brandon Konkel, Erik Anderson M.D., et al.

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The main cause of delayed renal function following the transplant of donor kidneys is ischemic induced acute tubular necrosis (ATN). The ability to determine the degree of ATN suffered by donor kidneys prior to their transplant would enable transplant surgeons to use kidneys that might otherwise be discarded and better predict post-transplant renal function. Currently, there are no reliable tests to determine the extent of ATN of donor kidneys prior to their transplant. In ongoing clinical trials, we have been using optical coherence tomography (OCT) to non-invasively image the superficial proximal tubules of human donor kidneys prior to and following transplant, and correlate these observations with post-transplant renal function. Thus far we have studied over 40 living donor kidneys and 10 cadaver donor kidneys, and demonstrated that this imaging can be performed in a sterile and expeditious fashion in the operating room (OR). Because of many variables associated with a diverse population of donors/recipients and transplant operation parameters, more transplant data must be collected prior to drawing definite conclusions. Nevertheless, our observations have thus far mirrored our previously published laboratory results indicating that damage to the kidney proximal tubules as indicated by tubule swelling is a good measure of post-transplant ATN and delayed graft function. We conclude that OCT is a useful procedure for analyzing human donor kidneys.

A method for tuning the excitation wavelength of an LED light source during fluorescence-based cystoscopy (Conference Presentation)

Lars R. Lindvold, Gregers G. Hermannn M.D.

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In clinical applications of fluorescence-guided endoscopy of the bladder (cystoscopy) it can be observed that the contrast in light from autofluorescence and from photodynamic diagnosis (PDD) varies from patient to patient. To compensate for this effect, a new method is presented for tuning the wavelength of a LED-based light source during fluorescence guided endoscopy of the bladder i.e. photodynamic diagnosis of bladder tumours. In the present embodiment, the wavelength of the LED source, developed in our laboratory, can be tuned to vary the excitation wavelength of both the sensitised fluorescence in the tumours (PDD) as well as the native fluorescence of the bladder mucosa and blood vessels. The contrast of the image observed through the CCD-camera attached to the cystoscope is thereby increased. In this way, patient to patient variations in autofluorescence and in sensitised fluorescence of tumours can be compensated for during fluorescence-guided cystoscopy in the clinic.

Proximal fiber tip damage during Holmium:YAG and thulium fiber laser ablation of kidney stones

Christopher R. Wilson, Luke A. Hardy, Pierce B. Irby M.D., et al.

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The Thulium fiber laser (TFL) is being studied as an alternative to Holmium:YAG laser for lithotripsy. TFL beam originates within an 18-μm-core thulium doped silica fiber, and its near single mode, Gaussian beam profile enables transmission of higher laser power through smaller fibers than possible during Holmium laser lithotripsy. This study examines whether TFL beam profile also reduces proximal fiber tip damage compared to Holmium laser multimodal beam. TFL beam at wavelength of 1908 nm was coupled into 105-μm-core silica fibers, with 35-mJ energy, 500-μs pulse duration, and pulse rates of 50-500 Hz. For each pulse rate, 500,000 pulses were delivered. Magnified images of proximal fiber surfaces were taken before and after each trial. For comparison, 20 single-use, 270-μm-core fibers were collected after clinical Holmium laser lithotripsy procedures using standard settings (600 mJ, 350 μs, 6 Hz). Total laser energy, number of laser pulses, and laser irradiation time were recorded, and fibers were rated for damage. For TFL studies, output power was stable, and no proximal fiber damage was observed after delivery of 500,000 pulses at settings up to 35 mJ, 500 Hz, and 17.5 W average power. In contrast, confocal microscopy images of fiber tips after Holmium lithotripsy showed proximal fiber tip degradation in all 20 fibers. The proximal fiber tip of a 105-μm-core fiber transmitted 17.5 W of TFL power without degradation, compared to degradation of 270-μm-core fibers after transmission of 3.6 W of Holmium laser power. The smaller and more uniform TFL beam profile may improve fiber lifetime, and potentially reduce costs for the surgical disposables as well.

Laser treatment of female stress urinary incontinence: optical, thermal, and tissue damage simulations

Luke A. Hardy, Chun-Hung Chang, Erinn M. Myers M.D., et al.

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Treatment of female stress urinary incontinence (SUI) by laser thermal remodeling of subsurface tissues is studied. Light transport, heat transfer, and thermal damage simulations were performed for transvaginal and transurethral methods. Monte Carlo (MC) provided absorbed photon distributions in tissue layers (vaginal wall, endopelvic fascia, urethral wall). Optical properties (n,μa,μs,g) were assigned to each tissue at λ=1064 nm. A 5-mm-diameter laser beam and power of 5 W for 15 s was used, based on previous experiments. MC output was converted into absorbed energy, serving as input for ANSYS finite element heat transfer simulations of tissue temperatures over time. Convective heat transfer was simulated with contact cooling probe set at 0 °C. Thermal properties (κ,c,ρ) were assigned to each tissue layer. MATLAB code was used for Arrhenius integral thermal damage calculations. A temperature matrix was constructed from ANSYS output, and finite sum was incorporated to approximate Arrhenius integral calculations. Tissue damage properties (Ea,A) were used to compute Arrhenius sums. For the transvaginal approach, 37% of energy was absorbed in endopelvic fascia layer with 0.8% deposited beyond it. Peak temperature was 71°C, treatment zone was 0.8-mm-diameter, and almost all of 2.7-mm-thick vaginal wall was preserved. For transurethral approach, 18% energy was absorbed in endopelvic fascia with 0.3% deposited beyond it. Peak temperature was 80°C, treatment zone was 2.0-mm-diameter, and only 0.6 mm of 2.4-mm-thick urethral wall was preserved. A transvaginal approach is more feasible than transurethral approach for laser treatment of SUI.

Diffusing, side-firing, and radial delivery laser balloon catheters for creating subsurface thermal lesions in tissue

Chun-Hung Chang, Nathaniel M. Fried

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Infrared lasers have been used in combination with applied cooling methods to preserve superficial skin layers during cosmetic surgery. Similarly, combined laser irradiation and tissue cooling may also allow development of minimally invasive laser therapies beyond dermatology. This study compares diffusing, side-firing, and radial delivery laser balloon catheter designs for creation of subsurface lesions in tissue, ex vivo, using a near-IR laser and applied contact cooling. An Ytterbium fiber laser with 1075 nm wavelength delivered energy through custom built 18 Fr (6-mm-OD) balloon catheters incorporating either 10-mm-long diffusing fiber tip, 90 degree side-firing fiber, or radial delivery cone mirror, through a central lumen. A chilled solution was flowed through a separate lumen into 9-mm-diameter balloon to keep probe cooled at 7°C. Porcine liver tissue samples were used as preliminary tissue model for immediate observation of thermal lesion creation. The diffusing fiber produced subsurface thermal lesions measuring 49.3 ± 10.0 mm2 and preserved 0.8 ± 0.1 mm of surface tissue. The side-firing fiber produced subsurface thermal lesions of 2.4 ± 0.9 mm2 diameter and preserved 0.5 ± 0.1 mm of surface tissue. The radial delivery probe assembly failed to produce subsurface thermal lesions, presumably due to the small effective spot diameter at the tissue surface, which limited optical penetration depth. Optimal laser power and irradiation time measured 15 W and 100 s for diffusing fiber and 1.4 W and 20 s, for side-firing fiber, respectively. Diffusing and side-firing laser balloon catheter designs provided subsurface thermal lesions in tissue. However, the divergent laser beam in both designs limited the ability to preserve a thicker layer of tissue surface. Further optimization of laser and cooling parameters may be necessary to preserve thicker surface tissue layers.

Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps (Conference Presentation)

Chong Huang, Jeffrey P. Radabaugh, Rony K. Aouad, et al.

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Head and neck cancer accounts for 3 to 5% of all cancers in the United States. Primary or salvage surgeries are extensive and often lead to major head and neck defects that require complex reconstructions with local, regional, or free tissue transfer flaps. Knowledge of tissue blood flow (BF) changes after free tissue transfer may enable surgeons to predict the failure of flap thrombosis at an early stage. This study used our recently developed noncontact diffuse correlation spectroscopy to monitor dynamic BF changes in free flaps without getting in contact with the targeted tissue. Eight free flaps were elevated in patients with head and neck cancer; one of the flaps failed. Multiple BF measurements probing the transferred tissue were performed during and post the surgical operation. Postoperative BF values were normalized to the intraoperative baselines (assigning '1') for the calculation of relative BF change (rBF). The rBF changes over the seven successful flaps were 1.89 ± 0.15, 2.26 ± 0.13, and 2.43 ± 0.13 (mean ± standard error) respectively on postoperative days 2, 4, and 7. These postoperative values were significantly higher than the intraoperative baseline values (p < 0.001), indicating a gradual recovery of flap vascularity after the tissue transfer. By contrast, rBF changes observed from the unsuccessful flap were 1.14 and 1.34 respectively on postoperative days 2 and 4, indicating a less flow recovery. Measurement of BF recovery after flap anastomosis holds the potential to act early to salvage ischemic flaps.

Monitoring longitudinal changes in irradiated head and neck cancer xenografts using diffuse reflectance spectroscopy

Karthik Vishwanath, Shudong Jiang, Jason R. Gunn, et al.

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Radiation therapy is often used as the preferred clinical treatment for control of localized head and neck cancer. However, during the course of treatment (6-8 weeks), feedback about functional and/or physiological changes within impacted tissue are not obtained, given the onerous financial and/or logistical burdens of scheduling MRI, PET or CT scans. Diffuse optical sensing is well suited to address this problem since the instrumentation can be made low-cost and portable while still being able to non-invasively provide information about vascular oxygenation in vivo. Here we report results from studies that employed an optical fiber-based portable diffuse reflectance spectroscopy (DRS) system to longitudinally monitor changes in tumor vasculature within two head and neck cancer cell lines (SCC-15 and FaDu) xenografted in the flanks of nude mice, in two separate experiments. Once the tumor volumes were 100mm³, 67% of animals received localized (electron beam) radiation therapy in five fractions (8Gy/day, for 5 days) while 33% of the animals served as controls. DRS measurements were obtained from each animal on each day of treatment and then for two weeks post-treatment. Reflectance spectra were parametrized to extract total hemoglobin concentration and blood oxygen-saturation and the resulting time-trends of optical parameters appear to be dissimilar for the two cell-lines. These findings are also compared to previous animal experiments (using the FaDu line) that were irradiated using a photon beam radiotherapy protocol. These results and implications for the use of fiber-based DRS measurements made at local (irradiated) tumor site as a basis for identifying early radiotherapy-response are presented and discussed.

Progress in reflectance confocal microscopy for imaging oral tissues in vivo

Gary Peterson, Daniella Karassawa Zanoni, Jocelyn Migliacci, et al.

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We report progress in development and feasibility testing of reflectance confocal microscopy (RCM) for imaging in the oral cavity of humans. We adapted a small rigid relay telescope (120mm long x 14mm diameter) and a small water immersion objective lens (12mm diameter, NA 0.7) to a commercial handheld RCM scanner (Vivascope 3000, Caliber ID, Rochester NY). This scanner is designed for imaging skin but we adapted the front end (the objective lens and the stepper motor that axially translates) for intra-oral use. This adaption required a new approach to address the loss of the automated stepper motor for acquisition of images in depth. A helical spring-like cap (with a coverslip to contact tissue) was designed for approximately 150 um of travel. Additionally other methods for focusing optics were designed and evaluated. The relay telescope optics is being tested in a clinical setting. With the capture of video and “video-mosaicing”, extended areas can be imaged. The feasibility of imaging oral tissues was initially investigated in volunteers. RCM imaging in buccal mucosa in vivo shows nuclear and cellular detail in the epithelium and epithelial junction, and connective tissue and blood flow in the underlying lamina propria. Similar detail, including filiform and fungiform papillae, can be seen on the tongue in vivo. Clinical testing during head and neck surgery is now in progress and patients are being imaged for both normal tissue and cancerous margins in lip and tongue mucosa.

Intraoperative detection and elimination of microscopic tumors in head and neck (Conference Presentation)

Ekaterina Y. Lukianova-Hleb, Yoo-Shin Kim, Ihar Belatsarkouski, et al.

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Failure of cancer surgery to intraoperatively detect and eliminate microscopic residual disease (MRD) causes lethal recurrence and metastases, whereas removal of important normal tissues causes excessive morbidity. We report plasmonic nanobubble (PNB) surgical technology to intraoperatively detect and eliminate MRD in surgical bed. PNBs were generated in vivo in head and neck cancer cells by systemically targeting tumor with gold colloids and locally-applied near-infrared low energy short laser pulse, and were simultaneously detected with acoustic probe. In mouse models of head and neck squamous cell carcinoma, single cancer cells and MRD (undetectable with standard histological methods) were instantaneously non-invasively detected in solid tissue in surgical bed. In resectable MRD, PNB-guided surgery prevented local recurrence and delivered 100% tumor-free survival. In unresectable MRD, PNB nano-surgery improved survival by two-fold compared to standard surgery. PNB metrics correlated with the tumor recurrence rate. PNB surgical technology precisely detects and immediately eliminates MRD at macro- and micro-scale in a simple and safe intraoperative procedure.

1300 nm and 890 nm OCT images of oral cancer tissue engineered models and biopsy samples offer complimentary performance (Conference Presentation)

Joseph Boadi, Robert A. Byers, Jon Fernandes, et al.

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OCT has demonstrated great potential to non-invasively detect oral epithelial cancers, potentially guiding biopsy and surgical resection. On non-ophthalmic tissues the preferred illumination wavelength is 1300 nm. Previous studies on skin have shown that useful image data can also be obtained at shorter wavelengths, with systems at 1060 nm and 820 nm offering reduced depth penetration but higher contrast. Here we apply a similar comparison to tissue engineered models of oral cancer and also to human biopsy samples, generally finding a similar trend. 1300 nm multi-beam OCT (Michelson Diagnostics EX1301) visualises stromal structures and surface keratin more clearly, providing useful image contrast down to around 1 mm. This system was compared with an ultra-high resolution home-built system operating at 890 nm (2.5 micron resolution vs 7.5 micron axial resolution for the EX1301). The UHR system reveals epithelial features more clearly, especially in the DOK pre-invasive cell line model and the biopsy samples. The relative effects of center wavelength vs axial resolution in generating the differential, wavelength-dependent contrast are assessed and the OCT biopsy images are compared with contemporary histology.

Development of a high-speed VCSEL OCT system for real-time imaging of conscious patients larynx using a hand-held probe (Conference Presentation)

Swathi Rangarajan, Li-Dek Chou, Carolyn Coughlan, et al.

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Fourier domain optical coherence tomography (FD-OCT) is a noninvasive imaging modality that has previously been used to image the human larynx. However, differences in anatomical geometry and short imaging range of conventional OCT limits its application in a clinical setting. In order to address this issue, we have developed a gradient-index (GRIN) lens rod-based hand-held probe in conjunction with a long imaging range 200 kHz Vertical-Cavity Surface Emitting Lasers (VCSEL) swept-source optical coherence tomography (SS-OCT) system for high speed real-time imaging of the human larynx in an office setting. This hand-held probe is designed to have a long and dynamically tunable working distance to accommodate the differences in anatomical geometry of human test subjects. A nominal working distance (~6 cm) of the probe is selected to have a lateral resolution <100 um within a depth of focus of 6.4 mm, which covers more than half of the 12 mm imaging range of the VCSEL laser. The maximum lateral scanning range of the probe at 6 cm working distance is approximately 8.4 mm, and imaging an area of 8.5 mm by 8.5 mm is accomplished within a second. Using the above system, we will demonstrate real-time cross-sectional OCT imaging of larynx during phonation in vivo in human and ex-vivo in pig vocal folds.

Swept-source anatomic optical coherence elastography of porcine trachea

Ruofei Bu, Hillel Price, Sorin Mitran, et al.

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Quantitative endoscopic imaging is at the vanguard of novel techniques in the assessment upper airway obstruction. Anatomic optical coherence tomography (aOCT) has the potential to provide the geometry of the airway lumen with high-resolution and in 4 dimensions. By coupling aOCT with measurements of pressure, optical coherence elastography (OCE) can be performed to characterize airway wall stiffness. This can aid in identifying regions of dynamic collapse as well as informing computational fluid dynamics modeling to aid in surgical decision-making. Toward this end, here we report on an anatomic optical coherence tomography (aOCT) system powered by a wavelength-swept laser source. The system employs a fiber-optic catheter with outer diameter of 0.82 mm deployed via the bore of a commercial, flexible bronchoscope. Helical scans are performed to measure the airway geometry and to quantify the cross-sectional-area (CSA) of the airway. We report on a preliminary validation of aOCT for elastography, in which aOCT-derived CSA was obtained as a function of pressure to estimate airway wall compliance. Experiments performed on a Latex rubber tube resulted in a compliance measurement of 0.68±0.02 mm²/cmH₂O, with R2=0.98 over the pressure range from 10 to 40 cmH2O. Next, ex vivo porcine trachea was studied, resulting in a measured compliance from 1.06±0.12 to 3.34±0.44 mm²/cmH₂O, (R²>0.81). The linearity of the data confirms the elastic nature of the airway. The compliance values are within the same order-of-magnitude as previous measurements of human upper airways, suggesting that this system is capable of assessing airway wall compliance in future human studies.

Intraoperative handheld probe for 3D imaging of pediatric benign vocal fold lesions using optical coherence tomography (Conference Presentation)

Fouzi Benboujja, Jordan Garcia, Kathy Beaudette, et al.

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Excessive and repetitive force applied on vocal fold tissue can induce benign vocal fold lesions. Children affected suffer from chronic hoarseness. In this instance, the vibratory ability of the folds, a complex layered microanatomy, becomes impaired. Histological findings have shown that lesions produce a remodeling of sup-epithelial vocal fold layers. However, our understanding of lesion features and development is still limited. Indeed, conventional imaging techniques do not allow a non-invasive assessment of sub-epithelial integrity of the vocal fold. Furthermore, it remains challenging to differentiate these sub-epithelial lesions (such as bilateral nodules, polyps and cysts) from a clinical perspective, as their outer surfaces are relatively similar. As treatment strategy differs for each lesion type, it is critical to efficiently differentiate sub-epithelial alterations involved in benign lesions. In this study, we developed an optical coherence tomography (OCT) based handheld probe suitable for pediatric laryngological imaging. The probe allows for rapid three-dimensional imaging of vocal fold lesions. The system is adapted to allow for high-resolution intra-operative imaging. We imaged 20 patients undergoing direct laryngoscopy during which we looked at different benign pediatric pathologies such as bilateral nodules, cysts and laryngeal papillomatosis and compared them to healthy tissue. We qualitatively and quantitatively characterized laryngeal pathologies and demonstrated the added advantage of using 3D OCT imaging for lesion discrimination and margin assessment. OCT evaluation of the integrity of the vocal cord could yield to a better pediatric management of laryngeal diseases.

Measurement of ciliary beat frequency using ultra-high resolution optical coherence tomography

Jason J. Chen, Joseph C. Jing, Erica Su, et al.

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Ciliated epithelial cells populate up to 80% of the surface area of the human airway and are responsible for mucociliary transport, which is the key protective mechanism that provides the first line of defense in the respiratory tract. Cilia beat in a rhythmic pattern and may be easily affected by allergens, pollutants, and pathogens, altering ciliary beat frequency (CBF) subsequently. Diseases including cystic fibrosis, chronic obstructive pulmonary disease, and primary ciliary dyskinesia may also decrease CBF. CBF is therefore a critical component of respiratory health. The current clinical method of measuring CBF is phase-contrast microscopy, which involves a tissue biopsy obtained via brushing of the nasal cavity. While this method is minimally invasive, the tissue sample must be oriented to display its profile view, making the visualization of a single layer of cilia challenging. In addition, the conventional method requires subjective analysis of CBF, e.g., manually counting by visual inspection. On the contrary, optical coherence tomography (OCT) has been used to study the retina in ophthalmology as well as vasculature in cardiology, and offers higher resolution than conventional computed tomography and magnetic resonance imaging. Based on this technology, our lab specifically developed an ultra-high resolution OCT system to image the microstructure of the ciliated epithelial cells. Doppler analysis was also performed to determine CBF. Lastly, we also developed a program that utilizes fast Fourier transform to determine CBF under phase-contrast microscopy, providing a more objective method compared to the current method.

Simultaneous multi-scale microscopy as a potential dedicated tool for intra-operative parathyroid identification during thyroid surgery (Conference Presentation)

Étienne De Montigny, Nadir Goulamhoussen, Wendy-Julie Madore, et al.

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While thyroidectomy is considered a safe surgery, dedicated tools facilitating tissue identification during surgery could improve its outcome. The most common complication following surgery is hypocalcaemia, which results from iatrogenic removal or damage to parathyroid glands. This research project aims at developing and validating an instrument based on optical microscopy modalities to identify tissues in real time during surgery. Our approach is based on a combination of reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) to obtain multi-scale morphological contrast images. The orthogonal field of views provide information to navigate through the sample. To allow simultaneous, synchronized video-rate imaging in both modalities, we designed and built a dual-band wavelength-swept laser which scans a 30 nm band centered at 780 nm and a 90 nm band centered at 1310 nm. We built an imaging setup integrating a custom-made objective lens and a double-clad fibre coupler optimized for confocal microscopy. It features high resolutions in RCM (2µm lateral and 20 µm axial) in a 500 µm x 500 µm field-of-view and a larger field-of-view of 2 mm (lateral) x 5 mm (axial) with 20 µm lateral and axial resolutions in OCT. Imaging of ex vivo animal samples is demonstrated on a bench-top system. Tissues that are visually difficult to distinguish from each other intra-operatively such as parathyroid gland, lymph nodes and adipose tissue are imaged to show the potential of this approach in differentiating neck tissues. We will also provide an update on our ongoing clinical pilot study on patients undergoing thyroidectomy.

Biochemical and molecular characterization of thyroid tissue by micro-Raman spectroscopy and gene expression analysis

Lázaro P. M. Neto, Aírton A. Martin, Claudio A. T. Soto, et al.

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Thyroid carcinomas represent the main endocrine malignancy and their diagnosis may produce inconclusive results. Raman spectroscopy and gene expression analysis have shown excellent results on the differentiation of carcinomas. This study aimed to improve the discrimination between different thyroid pathologies combining of both analyses. A total of 35 thyroid tissues samples including normal tissue (n=10), goiter (n=10), papillary (n=10) and follicular carcinomas (n=5) were analyzed. Confocal Raman spectra was obtain by using a Rivers Diagnostic System, 785 nm laser excitation and CCD detector. The data was processed by the software Labspec5 and Origin 8.5 and analyzed by Minitab® program. The gene expression analysis was performed by qRT-PCR technique for TG, TPO, PDGFB, SERPINA1, LGALS3 and TFF3 genes and statistically analyzed by Mann-Whitney test. The confocal Raman spectroscopy allowed a maximum discrimination of 91.1% between normal and tumor tissues, 84.8% between benign and malignant pathologies and 84.6% among carcinomas analyzed. Significant differences was observed for TG, LGALS3, SERPINA1 and TFF3 genes between benign lesions and carcinomas, and SERPINA1 and TFF3 genes between papillary and follicular carcinomas. Principal component analysis was performed using PC1 and PC2 in the papillary carcinoma samples that showed over gene expression when compared with normal sample, where 90% of discrimination was observed at the Amide 1 (1655 cm^-1), and at the tyrosine spectra region (856 cm^-1). The discrimination of tissues thyroid carried out by confocal Raman spectroscopy and gene expression analysis indicate that these techniques are promising tools to be used in the diagnosis of thyroid lesions.

Simultaneous fingerprint and high-wavenumber fiber-optic Raman endoscopy for in vivo diagnosis of laryngeal cancer

Kan Lin, Wei Zheng, Jianfeng Wang, et al.

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We report a unique simultaneous fingerprint (FP) and high-wavenumber (HW) fiber-optic confocal Raman spectroscopy for in vivo diagnosis of laryngeal cancer in the head and neck under wide-field endoscopic imaging. The simultaneous FP and HW Raman endoscopy technique was performed on 21 patients and differentiated laryngeal carcinoma from normal tissues with both sensitivity and specificity of ~85%. This study shows the great potential of the FP/HW Raman endoscopic technique developed for in vivo diagnosis of laryngeal carcinoma during routine endoscopic examination.

A novel mosaicking algorithm for in vivo full-field thickness mapping of the human tympanic membrane using low coherence interferometry (Conference Presentation)

Paritosh Pande, Ryan L. Shelton, Guillermo L. Monroy, et al.

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Tympanic membrane (TM) thickness can provide crucial information for diagnosing several middle ear pathologies. An imaging system integrating low coherence interferometry (LCI) with the standard video otoscope has been shown as a promising tool for quantitative assessment of in-vivo TM thickness. The small field-of-view (FOV) of TM surface images acquired by the combined LCI-otoscope system, however, makes the spatial registration of the LCI imaging sites and their location on the TM difficult to achieve. It is therefore desirable to have a tool that can map the imaged points on to an anatomically accurate full-field surface image of the TM. To this end, we propose a novel automated mosaicking algorithm for generating a full-field surface image of the TM with co-registered LCI imaging sites from a sequence of multiple small FOV images and corresponding LCI data. Traditional image mosaicking techniques reported in the biomedical literature, mostly for retinal imaging, are not directly applicable to TM image mosaicking because unlike retinal images, which have several distinctive features, TM images contain large homogeneous areas lacking in sharp features. The proposed algorithm overcomes these challenges of TM image mosaicking by following a two-step approach. In the first step, a coarse registration based on the correlation of gross image features is performed. Subsequently, in the second step, the coarsely registered images are used to perform a finer intensity-based co-registration. The proposed algorithm is used to generate, for the first time, full-field thickness distribution maps of in-vivo human TMs.

Effect of low level laser therapy (LLLT) on ouabain induced auditory neuropathy in gerbils (Conference Presentation)

Chung-Ku Rhee M.D., Sung Huyn Bae, So-Young Chang, et al.

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Aim: to investigate effectiveness of Low level laser therapy (LLLT) in rescueing ouabain induced spiral ganglion cell damage using Mongolian gerbils. Methods: Animals were divided into 3 groups; Control, Ouabain, Ouabain + LLLT group. Auditory neuropathy was induced by topical application of ouabain (1 mmol/L, 3uL) on the round window membrane in gerbils. Transmeatal LLLT was irradiated into the right ear for 1h (200mW, 720 J) daily for 7d in Ouabain + LLLT group. Before and 7 days after ouabain application, hearing was evaluated using both ABR and distortion product otoacoustic emissions (DPOAE). Seven days after ouabain application, animals were sacrificed to evaluate the morphological changes of cochlea using cochlear section image and whole mount Immunofluorescent staining. Results: DPOAE tests were normal in all animals after ouabain topical treatment indicating intact outer hair cells. Ouabain group showed ABR threshold increase compared with control group. Ouabain+LLLT group showed significant improvement of ABR threshold compared to ouabain only group. H and E stains of mid-modiolar section of cochlear showed spiral ganglion cells, neurofilaments, and post synaptic receptor counts were decreased while inner and outer hair cells were preserved in ouabain group. Ouabain +LLLT group showed higher numbers of spiral ganglion cells, density of neurofilaments and post synaptic receptor counts compared to ouabain group. Conclusions: The results demonstrated that LLLT was effective to rescue ouabain-induced spiral ganglion neuropathy.

Differentiation of bacterial versus viral otitis media using a combined Raman scattering spectroscopy and low coherence interferometry probe (Conference Presentation)

Youbo Zhao, Ryan L. Shelton, Haohua Tu, et al.

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Otitis media (OM) is a highly prevalent disease that can be caused by either a bacterial or viral infection. Because antibiotics are only effective against bacterial infections, blind use of antibiotics without definitive knowledge of the infectious agent, though commonly practiced, can lead to the problems of potential harmful side effects, wasteful misuse of medical resources, and the development of antimicrobial resistance. In this work, we investigate the feasibility of using a combined Raman scattering spectroscopy and low coherence interferometry (LCI) device to differentiate OM infections caused by viruses and bacteria and improve our diagnostic ability of OM. Raman spectroscopy, an established tool for molecular analysis of biological tissue, has been shown capable of identifying different bacterial species, although mostly based on fixed or dried sample cultures. LCI has been demonstrated recently as a promising tool for determining tympanic membrane (TM) thickness and the presence and thickness of middle-ear biofilm located behind the TM. We have developed a fiber-based ear insert that incorporates spatially-aligned Raman and LCI probes for point-of-care diagnosis of OM. As shown in human studies, the Raman probe provides molecular signatures of bacterial- and viral-infected OM and normal middle-ear cavities, and LCI helps to identify depth-resolved structural information as well as guide and monitor positioning of the Raman spectroscopy beam for relatively longer signal acquisition time. Differentiation of OM infections is determined by correlating in vivo Raman data collected from human subjects with the Raman features of different bacterial and viral species obtained from cultured samples.

A short-wave infrared otoscope for middle ear disease diagnostics (Conference Presentation)

Jessica A. Carr, Tulio Valdez, Oliver Bruns, et al.

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Otitis media, a range of inflammatory conditions of the middle ear, is the second most common illness diagnosed in children. However, the diagnosis can be challenging, particularly in pediatric patients. Otitis media is commonly over-diagnosed and over-treated and has been identified as one of the primary factors in increased antibiotic resistance. We describe the development of a short-wave infrared (SWIR) otoscope for objective middle ear effusion diagnosis. The SWIR otoscope can unambiguously detect the presence of middle ear fluid based on its strong light absorption in the SWIR. This absorption causes a stark, visual contrast between the presence and absence of fluid behind the tympanic membrane. Additionally, when there is no middle ear fluid, the deeper tissue penetration of SWIR light allows the SWIR otoscope to better visualize middle ear anatomy through the tympanic membrane than is possible with visible light. We demonstrate that in healthy, adult human ears, SWIR otoscopy can image a range of middle ear anatomy, including landmarks of the entire ossicular chain, the promontory, the round window niche, and the chorda tympani. We suggest that SWIR otoscopy can provide valuable diagnostic information complementary to that provided by visible pneumotoscopy in the diagnosis of middle ear effusions, otitis media, and other maladies of the middle ear.

Signal and response properties indicate an optoacoustic effect underlying the intra-cochlear laser-optical stimulation

Nicole Kallweit, Peter Baumhoff, Alexander Krueger, et al.

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Optical cochlea stimulation is under investigation as a potential alternative to conventional electric cochlea implants in treatment of sensorineural hearing loss. If direct optical stimulation of spiral ganglion neurons (SGNs) would be feasible, a smaller stimulation volume and, therefore, an improved frequency resolution could be achieved. However, it is unclear whether the mechanism of optical stimulation is based on direct neuronal stimulation or on optoacoustics. Animal studies on hearing vs. deafened guinea pigs already identified the optoacoustic effect as potential mechanism for intra-cochlear optical stimulation. In order to characterize the optoacoustic stimulus more thoroughly the acoustic signal along the beam path of a pulsed laser in water was quantified and compared to the neuronal response properties of hearing guinea pigs stimulated with the same laser parameters. Two pulsed laser systems were used for analyzing the influence of variable pulse duration, pulse energy, pulse peak power and absorption coefficient. Preliminary results of the experiments in water and in vivo suggesta similar dependency of response signals on the applied laser parameters: Both datasets show an onset and offset signal at the beginning and the end of the laser pulse. Further, the resulting signal amplitude depends on the pulse peak power as well as the temporal development of the applied laser pulse. The data indicates the maximum of the first derivative of power as the decisive factor. In conclusion our findings strengthen the hypothesis of optoacoustics as the underlying mechanism for optical stimulation of the cochlea.

Three-dimensional imaging of intracochlear tissue by scanning laser optical tomography (SLOT)

N. Tinne, L. Nolte, G. C. Antonopoulos, et al.

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The presented study focuses on the application of scanning laser optical tomography (SLOT) for non-destructive visualization of anatomical structures inside the human cochlea ex vivo. SLOT is a laser-based highly efficient microscopy technique, which allows for tomographic imaging of the internal structure of transparent large-scale specimens (up to 1 cm³). Thus, in the field of otology this technique is best convenient for an ex vivo study of the inner ear anatomy. For this purpose, the preparation before imaging comprises mechanically assisted decalcification, dehydration as well as optical clearing of the cochlea samples. Here, we demonstrate results of SLOT visualizing hard and soft tissue structures of the human cochlea with an optical resolution in the micrometer range using absorption and autofluorescence as contrast mechanisms. Furthermore, we compare our results with the method of X-ray micro tomography (micro-CT, μCT) as clinical gold standard which is based only on absorption. In general, SLOT can provide the advantage of covering all contrast mechanisms known from other light microscopy techniques, such as fluorescence or scattering. For this reason, a protocol for antibody staining has been developed, which additionally enables selective mapping of cellular structures within the cochlea. Thus, we present results of SLOT imaging rodent cochleae showing specific anatomical structures such as hair cells and neurofilament via fluorescence. In conclusion, the presented study has shown that SLOT is an ideally suited tool in the field of otology for in toto visualization of the inner ear microstructure.

Combination therapy using antioxidants and low level laser therapy (LLLT) on noise induced hearing loss (NIHL)

So-Young Chang, Sung Kyu Lim, Min young Lee, et al.

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One of the most common factors that cause hearing disorders is noise trauma. Noise is an increasing hazard and it is pervasive, which makes it difficult to take precautions and prevent noise-induced hearing loss (NIHL). The prevalence of hearing loss among factory workers to be 42 %[1]. Ocupational noise induced hearing loss (ONIHL) continues to be a significant occupational hazard. ONIHL is permanent and may cause significant disability, for which there currently exists no cure, but is largely preventable. More than 30 million Americans are potentially exposed to hazardous noise levels in occupations such as transportation, construction, and coal mining, as well as recreationally. In the mainstream setting, exposure avoidance strategies aimed to reduce the incidence of ONIHL remain the focus of public health and occupational medicine approaches[2]. In military conditions this is most often caused by such things as explosions, blasts, or loud noises from vehicles ranging from 100 to 140 dB[3] and military weapons generating approximately 140–185 dB peak sound pressure levels[4].

Comparison of advanced optical imaging techniques with current otolaryngology diagnostics for improved middle ear assessment (Conference Presentation)

Ryan M. Nolan, Ryan L. Shelton, Guillermo L. Monroy, et al.

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Otolaryngologists utilize a variety of diagnostic techniques to assess middle ear health. Tympanometry, audiometry, and otoacoustic emissions examine the mobility of the tympanic membrane (eardrum) and ossicles using ear canal pressure and auditory tone delivery and detection. Laser Doppler vibrometry provides non-contact vibrational measurement, and acoustic reflectometry is used to assess middle ear effusion using sonar. These technologies and techniques have advanced the field beyond the use of the standard otoscope, a simple tissue magnifier, yet the need for direct visualization of middle ear disease for superior detection, assessment, and management remains. In this study, we evaluated the use of portable optical coherence tomography (OCT) and pneumatic low-coherence interferometry (LCI) systems with handheld probe delivery to standard tympanometry, audiometry, otoacoustic emissions, laser Doppler vibrometry, and acoustic reflectometry. Comparison of these advanced optical imaging techniques and current diagnostics was conducted with a case study subject with a history of unilateral eardrum trauma. OCT and pneumatic LCI provide novel dynamic spatiotemporal structural data of the middle ear, such as the thickness of the eardrum and quantitative detection of underlying disease pathology, which could allow for more accurate diagnosis and more appropriate management than currently possible.

Primary investigations on the potential of a novel diode pumped Er:YAG laser system for middle ear surgery

Karl Stock, Holger Wurm, Florian Hausladen

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Flashlamp pumped Er:YAG lasers are successfully used clinically for both precise soft and hard tissue ablation. Since several years a novel diode pumped Er:YAG laser system (Pantec Engineering AG) is available, with mean laser power up to 40 W and pulse repetition rate up to 1 kHz. The aim of the study was to investigate the suitability of the laser system specifically for stapedotomy. Firstly an experimental setup was realized with a beam focusing unit and a computer controlled translation stage to move the samples (slices of porcine bone) with a defined velocity while irradiation with various laser parameters. A microphone was positioned in a defined distance to the ablation point and the resulting acoustic signal of the ablation process was recorded. For comparison, measurements were also performed with a flash lamp pumped Er:YAG laser system. After irradiation the resulting ablation quality and efficacy were determined using light microscopy. Using a high speed camera and “Töpler-Schlierentechnik” the cavitation bubble in water after perforation of a bone slice was investigated. The results show efficient bone ablation using the diode pumped Er:YAG laser system. Also a decrease of the sound level and of the cavitation bubble volume was observed with decreasing pulse duration. Higher repetition rates lead to a slightly increase of thermal side effects but have no influence on the ablation efficiency. In conclusion, these first experiments demonstrate the high potential of the diode pumped Er:YAG laser system for use in middle ear surgery.

Heartbeat OCT: a new tool for interventional imaging (Conference Presentation)

Tianshi Wang, Tom Pfeiffer, Wolfgang Wieser, et al.

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We have developed a super fast intravascular optical coherence tomography (OCT) system called Heartbeat OCT. Heartbeat OCT relies on a Fourier Domain Mode Locked (FDML) laser and a micro-motor based catheter. The system enables acquisition of a uniformly sampled data set within one cardiac cycle, triggered by the ECG, to restore 3D OCT image fidelity. Here, we present a robust and easy to operate preclinical prototype system for interventional imaging which greatly facilitates data acquisition. The new system is using a fully automatic 1.6 MHz turnkey FDML laser with increased stability. The entire system was mounted into a 1.6 x 0.8 x 0.7 m cart. It is coupled to a guidewire compatible rapid-exchange catheter that can be used for routine imaging. The system is robust, compact, and moveable. We present the design, demonstrate ex-vivo imaging results and discuss in-vivo applications, as well as considerations for clinical translation of the technology. The ex-vivo imaging experiments were conducted with metal stents and bioresorbable vascular scaffold. The images provide clear and comprehensive visualization of the stents structure not only in cross-section but also in longitudinal rendering and 3D construction.

First clinical pilot study with intravascular polarization sensitive optical coherence tomography (Conference Presentation)

Martin Villiger, Antonios Karanasos, Jian Ren, et al.

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Polarization sensitive (PS) OCT measures the polarization states of the light backscattered by tissue and provides measures of tissue birefringence and depolarization in addition to the structural OCT signal. Ex vivo studies have demonstrated that birefringence is increased in tissue rich in collagen and with elevated smooth muscle cell content. Preliminary data further suggests that depolarization can identify regions of macrophage infiltration, lipid, and irregularly arranged collagen fibers. These are important aspects of the mechanical integrity and vulnerability of atherosclerotic plaques. To evaluate the potential of PS-OCT in the clinical setting, we combined our custom PS-OCT system with commercially available OCT catheters (Fastview, Terumo Corporation) and performed a pilot study in 30 patients, scheduled to undergo percutaneous coronary intervention (PCI) on the grounds of stable or unstable angina. A total of 82 pullbacks in 39 vessels were performed, either in the native coronary arteries or post procedure. Comparing consecutive pullbacks of the same coronary artery, we found excellent agreement between the polarization features in the repeat pullbacks, validating the repeatability and robustness of PS-OCT in the clinical in vivo setting. In addition we observed that the birefringence and depolarization features vary significantly across lesions with identical structural OCT appearance, suggesting morphological subtypes. This first human pilot study proved the feasibility and robustness of intravascular PS-OCT. PS-OCT achieves improved tissue characterization and may help in identifying high-risk plaques, with the potential to ultimately improve risk stratification and help guiding PCI.

Mechanical modeling of cholesterol crystallization in atherosclerotic plaques base on Micro-OCT images (Conference Presentation)

Yuemei Luo M.D., Xinyu Liu Sr., Si Chen M.D., et al.

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Plaque rupture is the critical cause of cardiovascular thrombosis but this process is still under discussion. Recent studies show that, during crystallization, cholesterol crystals in atheromatous plaques accumulate rapidly in a limited space and may result in plaque rupture. However, the actual role of cholesterol crystals on plaque rupture remains unclear due to the lack of detailed morphological information of cholesterol crystals. In this study, we used a Micro-optical coherence tomography (µOCT) setup with 1-2 µm spatial resolution to extract the geometry of cholesterol crystals from human atherosclerotic artery ex vivo firstly. With measured dimensions of cholesterol crystals by this µOCT system (the average length and thickness of 269.1±80.16 µm and 3.0±0.33 µm), we developed a two-dimensional mechanical model in which rectangular shaped cholesterol crystals distribute at different locations spatially. We predicted the stress on the thin cap induced by the expansion of cholesterol crystals by use of finite-element method. Since a large portion of plaques (58%) rupture at points of peak circumferential stress (PCS), we used PCS as the primary indicator of plaque stability with blood pressure of 14.6 kPa on the lumen. The results demonstrate that loading of the concentrated crystals especially at the cap shoulder destabilize the plaque by proportionally increasing the PCS, while evenly distributed crystals loading along the cap might impose less PCS to the plaque than the concentrated case.

Blood coagulation profiling in patients using optical thromboelastography (OTEG) (Conference Presentation)

Markandey M Tripathi, Diane M. Tshikudi, Zeinab Hajjarian, et al.

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Impaired blood coagulation is often associated with increased postoperative mortality and morbidity in cardiovascular patients. The capability for blood coagulation profiling rapidly at the bedside will enable the timely detection of coagulation defects and open the opportunity for tailoring therapy to correct specific coagulation deficits Optical Thromboelastography (OTEG), is an optical approach to quantify blood coagulation status within minutes using a few drops of whole blood. The goal of the current study is to evaluate the diagnostic accuracy of OTEG for rapid coagulation profiling in patients. In OTEG, temporal laser speckle intensity fluctuations from a drop of clotting blood are measured using a CMOS camera. To quantify coagulation status, the speckle intensity autocorrelation function is measured, the mean square displacement of scattering particles is extracted, and viscoelastic modulus (G), during coagulation is measured via the generalized Stokes-Einstein relation. By quantifying time-resolved changes in G, the coagulation parameters, reaction time (R), clot progression time (K), clot progression rate (Angle), and maximum clot strength (MA) are derived. In this study, the above coagulation parameters were measured using OTEG in 269 patients and compared with standard mechanical Thromboelastography (TEG). Our results showed a strong correlation between OTEG and TEG measurements for all parameters: R-time (R=0.80, p<0.001), clotting time (R=0.78, p<0.001), Angle (R=0.58, p<0.001), and MA (R=0.60, p<0.001). These results demonstrate the unique capability of OTEG for rapid quantification of blood coagulation status to potentially improve clinical capability for identifying impaired coagulation in cardiovascular patients at the point of care.

Optical profiling of anticoagulation status (Conference Presentation)

Diane M. Tshikudi, Markandey M. Tripathi, Zeinab Hajjarian, et al.

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Defective blood coagulation resulting from excessive procoagulant activity often leads to thrombotic disorders such as stroke and myocardial infarction. A variety of oral and injectable anticoagulant drugs are prescribed to prevent or treat life-threatening thrombosis. However, due to bleeding complications often associated with anticoagulant treatment, routine monitoring and accurate dosing of anticoagulant therapy is imperative. We have developed Optical thromboelastography (OTEG), a non-contact approach that utilizes a drop of whole blood to measure blood coagulation status in patients. Here, we demonstrate the capability of OTEG for rapidly monitoring anticoagulation in whole blood samples. OTEG monitors coagulation status by assessing changes in blood viscosity from temporal intensity fluctuations of laser speckle patterns during clotting. In OTEG a blood drop is illuminated with coherent light and the blood viscosity is measured from the speckle intensity autocorrelation curve, g2 (t). The metrics, clotting time (R+k), clot progression (angle) and maximum clot stiffness (MA) are then extracted. The aim of the current study was to evaluate the accuracy of OTEG in assessing anticoagulation status of common anticoagulants including heparin, argatroban and rivaroxaban status. A dose-dependent prolongation of R+k was observed in anticoagulated blood, which closely corresponded with standard-reference Thromboelastography (TEG) (r 0.87-0.99, P>0.01 for all cases). OTEG angle was unaltered by anticoagulation whereas TEG angle presented a dose-dependent diminution probably linked to clot rupture. In both OTEG and TEG, MA was unaffected by heparin, argatroban or rivaroxaban. We conclude that OTEG can accurately monitor anticoagulation status following treatment, potentially providing a powerful tool for routine monitoring of patients in the doctor’s office or in the home setting.

Brillouin spectroscopy of clotting dynamics in a model system

Sandra C. Bustamante-Lopez, Andrew J. Traverso, Vladislav V. Yakovlev, et al.

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Keys to successful treatment of disease include early diagnosis and timely treatment. It is hypothesized that early clotting events may contribute to a pro-thrombotic state that exacerbates atherothrombotic vascular disease. Brillouin spectroscopy involves inelastic coupling of light with phonons and enables viscoelastic characterization of samples at the microscale. In this work, we apply Brillouin spectroscopy to a model fibrinogen-thrombin clotting system with the goal of measuring clotting dynamics at the microscale and providing characterization that is not possible with standard rheometric techniques. Here, the clotting dynamics of the model clotting system are measured at various fibrinogen and thrombin concentrations.

In-vivo continuous monitoring of mixed venous oxygen saturation by photoacoustic transesophageal echocardiography (Conference Presentation)

Li Li, Balachundhar Subramaniam, Aaron D. Aguirre, et al.

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Mixed venous oxygen saturation (SvO2), measured from pulmonary arteries, is a gold-standard measure of the dynamic balance between the oxygen supply and demand in the body. In critical care, continuous monitoring of SvO2 plays a vital role in early detection of circulatory shock and guiding goal-oriented resuscitation. In current clinical practice, SvO2 is measured by invasive pulmonary artery catheters (PAC), which are associated with a 10% risk of severe complications. To address the unmet clinical need for a non-invasive SvO2 monitor, we are developing a new technology termed photoacoustic transesophageal echocardiography (PA-TEE). PA-TEE integrates transesophageal echocardiography with photoacoustic oximetry, and enables continuous assessment of SvO2 through an esophageal probe that can be inserted into the body in a minimally invasive manner. We have constructed a clinically translatable PA-TEE prototype, which features a mobile OPO laser, a modified ultrasonography console and a dual-modality esophageal probe. Comprised of a rotatable acoustic array detector, a flexible optical fiber bundle and a light-integrating acoustic lens, the oximetric probe has an outer diameter smaller than 15 mm and will be tolerable for most patients. Through custom-made C++/Qt software, our device acquires and displays ultrasonic and photoacoustic images in real time to guide the deployment of the probe. SvO2 is calculated on-line and updated every second. PA-TEE has now been used to evaluate SvO2 in living swine. Our findings show that changing the fraction of oxygen in the inspired gas modulates SvO2 measured by PA-TEE. Statistic comparison between SvO2 measurements from PA-TEE in vivo the gold-standard laboratorial analysis on blood samples drawn from PACs will be presented.

Evaluation of combined near-IR spectroscopic (NIRS)-IVUS imaging as a means to detect lipid-rich plaque burden in human coronary autopsy specimens

Jimmy L. Su, Stephanie J. Grainger, Cherry A. Greiner, et al.

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Intracoronary near-infrared spectroscopy (NIRS) can identify lipid in the coronary arteries, but lacks depth resolution. A novel catheter is currently in clinical use that combines NIRS with intravascular ultrasound (IVUS), which provides depth-resolved structural information via the IVUS modality. A measure designated as lipid-rich plaque burden (LRPB) has been proposed as a means to interpret the combined acoustic and optical information of NIRS-IVUS. LRPB is defined as the area created by the intersection of the NIRS lipid-rich arc with the corresponding IVUS-measured plaque burden. We determined the correlation in human coronary autopsy specimens between LRPB, a measure of lipid presence and extent available via intravascular imaging in patients, and the area of lipid-rich plaque as determined by the gold-standard of histology. Fifteen artery segments from 8 human autopsy hearts were imaged with the NIRS-IVUS system (TVC Imaging System, Infraredx Inc., Burlington, MA). Arteries were imaged in a specialty fixture that assured accurate co-registration between imaging and histology. The arteries were then fixed and divided into 2 mm blocks for histological staining. Pathological contouring of lipid-rich areas was performed on the stained thin sections for 54 lipid-rich blocks. Computation of LRPB was performed on transverse NIRS-IVUS frames corresponding to the histologic sections. The quantified LRPB was frequently higher than the lipid-rich plaque area determined by histology, because the region denoted by the EEL and lumen within the NIRS lipid-rich arc is not entirely comprised of lipid. Overall, a moderate to strong correlation (R = 0.73) was found between LRPB determined by NIRS-IVUS imaging and the lipid-rich plaque area determined by histology. LRPB, which can be measured in patients with NIRS-IVUS imaging, corresponds to the amount of lipid-rich plaque in a coronary artery. LRPB should be evaluated in prospective clinical trials for its ability to identify vulnerable plaques.

Compensation of spectral artifacts in dual-modality intravascular optical coherence tomography and near-infrared spectroscopy (Conference Presentation)

Ali M. Fard, Joseph A. Gardecki, Giovanni J. Ughi, et al.

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Intravascular optical coherence tomography (OCT) is a high-resolution catheter-based imaging method that provides three-dimensional microscopic images of coronary artery in vivo, facilitating coronary artery disease treatment decisions based on detailed morphology. Near-infrared spectroscopy (NIRS) has proven to be a powerful tool for identification of lipid-rich plaques inside the coronary walls. We have recently demonstrated a dual-modality intravascular imaging technology that integrates OCT and NIRS into one imaging catheter using a two-fiber arrangement and a custom-made dual-channel fiber rotary junction. It therefore enables simultaneous acquisition of microstructural and composition information at 100 frames/second for improved diagnosis of coronary lesions. The dual-modality OCT-NIRS system employs a single wavelength-swept light source for both OCT and NIRS modalities. It subsequently uses a high-speed photoreceiver to detect the NIRS spectrum in the time domain. Although use of one light source greatly simplifies the system configuration, such light source exhibits pulse-to-pulse wavelength and intensity variation due to mechanical scanning of the wavelength. This can be in particular problematic for NIRS modality and sacrifices the reliability of the acquired spectra. In order to address this challenge, here we developed a robust data acquisition and processing method that compensates for the spectral variations of the wavelength-swept light source. The proposed method extracts the properties of the light source, i.e., variation period and amplitude from a reference spectrum and subsequently calibrates the NIRS datasets. We have applied this method on datasets obtained from cadaver human coronary arteries using a polygon-scanning (1230-1350nm) OCT system, operating at 100,000 sweeps per second. The results suggest that our algorithm accurately and robustly compensates the spectral variations and visualizes the dual-modality OCT-NIRS images. These findings are therefore crucial for the practical application and clinical translation of dual-modality intravascular OCT-NIRS imaging when the same swept sources are used for both OCT and spectroscopy.

High speed intravascular photoacoustic imaging of atherosclerotic arteries (Conference Presentation)

Zhonglie Piao, Teng Ma, Yueqiao Qu, et al.

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Cardiovascular disease is the leading cause of death in the industrialized nations. Accurate quantification of both the morphology and composition of lipid-rich vulnerable atherosclerotic plaque are essential for early detection and optimal treatment in clinics. In previous works, intravascular photoacoustic (IVPA) imaging for detection of lipid-rich plaque within coronary artery walls has been demonstrated in ex vivo, but the imaging speed is still limited. In order to increase the imaging speed, a high repetition rate laser is needed. In this work, we present a high speed integrated IVPA/US imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A miniature catheter with 1.0 mm outer diameter was designed with a 200 μm multimode fiber and an ultrasound transducer with 45 MHz center frequency. The fiber was polished at 38 degree and enclosed in a glass capillary for total internal reflection. An optical/electrical rotary junction and pull-back mechanism was applied for rotating and linearly scanning the catheter to obtain three-dimensional imaging. Atherosclerotic rabbit abdominal aorta was imaged as two frame/second at 1725 nm. Furthermore, by wide tuning range of the laser wavelength from 1680 nm to 1770 nm, spectroscopic photoacoustic analysis of lipid-mimicking phantom and an human atherosclerotic artery was performed ex vivo. The results demonstrated that the developed IVPA/US imaging system is capable for high speed intravascular imaging for plaque detection.

Lipid detection by intravascular photoacoustic imaging with flexible catheter at 20 fps (Conference Presentation)

Min Wu, Verya Daeichin, Geert Springeling, et al.

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Intravascular Photoacoustic (IVPA) imaging is a promising new technology to assess lipid content of coronary atherosclerotic plaque, an important determinant of the risk associated with the plaque triggering a heart attack. Clinical translation of IVPA imaging requires real-time image acquisition, which has been a technological challenge. In this work, we demonstrate a high-speed, dual-wavelength IVPA imaging system at 1.7 µm wavelength, operating with a flexible catheter of 1.2 mm outer diameter (including outer sheath). The catheter was custom designed and fabricated, and used a 40 MHz transducer for intravascular ultrasound (IVUS) and IVPA imaging. The optical excitation is provided by a dual OPO system, pumped by CW diode-pumped Q-switched Nd:YAG lasers, with a repetition rate of 5 kHz. Each OPO can be tuned to a custom wavelength between 1690 and 1750 nm; two wavelengths only are needed to discriminate between plaque lipids and adipose tissue. The pulse energy is about 80 µJ. We tested the imaging performance of the presented system in a polyvinyl-alcohol (PVA) vessel mimicking phantom and human coronary arteries ex vivo. IVPA identified lipid deposits inside atherosclerotic plaque, while IVUS showed tissue structure. We demonstrated IVPA imaging at a speed of 20 frames per second, with 250 A-scans per frame. This is significantly faster than previous IVPA imaging systems, and will enable the translation of IVPA imaging into clinical practice.

Design and validation of the ball lens-based intravascular catheter for fluorescence lifetime imaging microscopy of atherosclerosis (Conference Presentation)

Xi Chen, Wihan Kim, Michael J. Serafino, et al.

Localization Analysis of Lipid Core Plaques Detected by a Near Infrared Spectroscopy System as Compared to Histological Findings (Conference Presentation)

Zhihua He, Stephen T. Sum

Support vector machine based classification and mapping of atherosclerotic plaques using fluorescence lifetime imaging (Conference Presentation)

Hussain Fatakdawala, Dimitris S. Gorpas, Julien Bec, et al.

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The progression of atherosclerosis in coronary vessels involves distinct pathological changes in the vessel wall. These changes manifest in the formation of a variety of plaque sub-types. The ability to detect and distinguish these plaques, especially thin-cap fibroatheromas (TCFA) may be relevant for guiding percutaneous coronary intervention as well as investigating new therapeutics. In this work we demonstrate the ability of fluorescence lifetime imaging (FLIm) derived parameters (lifetime values from sub-bands 390/40 nm, 452/45 nm and 542/50 nm respectively) for generating classification maps for identifying eight different atherosclerotic plaque sub-types in ex vivo human coronary vessels. The classification was performed using a support vector machine based classifier that was built from data gathered from sixteen coronary vessels in a previous study. This classifier was validated in the current study using an independent set of FLIm data acquired from four additional coronary vessels with a new rotational FLIm system. Classification maps were compared to co-registered histological data. Results show that the classification maps allow identification of the eight different plaque sub-types despite the fact that new data was gathered with a different FLIm system. Regions with diffuse intimal thickening (n=10), fibrotic tissue (n=2) and thick-cap fibroatheroma (n=1) were correctly identified on the classification map. The ability to identify different plaque types using FLIm data alone may serve as a powerful clinical and research tool for studying atherosclerosis in animal models as well as in humans.

OptoDyCE: Automated system for high-throughput all-optical dynamic cardiac electrophysiology

Aleksandra Klimas, Jinzhu Yu, Christina M. Ambrosi, et al.

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In the last two decades, <30% of drugs withdrawals from the market were due to cardiac toxicity, where unintended interactions with ion channels disrupt the heart’s normal electrical function. Consequently, all new drugs must undergo preclinical testing for cardiac liability, adding to an already expensive and lengthy process. Recognition that proarrhythmic effects often result from drug action on multiple ion channels demonstrates a need for integrative and comprehensive measurements. Additionally, patient-specific therapies relying on emerging technologies employing stem-cell derived cardiomyocytes (e.g. induced pluripotent stem-cell-derived cardiomyocytes, iPSC-CMs) require better screening methods to become practical. However, a high-throughput, cost-effective approach for cellular cardiac electrophysiology has not been feasible. Optical techniques for manipulation and recording provide a contactless means of dynamic, high-throughput testing of cells and tissues. Here, we consider the requirements for all-optical electrophysiology for drug testing, and we implement and validate OptoDyCE, a fully automated system for all-optical cardiac electrophysiology. We demonstrate the high-throughput capabilities using multicellular samples in 96-well format by combining optogenetic actuation with simultaneous fast high-resolution optical sensing of voltage or intracellular calcium. The system can also be implemented using iPSC-CMs and other cell-types by delivery of optogenetic drivers, or through the modular use of dedicated light-sensitive somatic cells in conjunction with non-modified cells. OptoDyCE provides a truly modular and dynamic screening system, capable of fully-automated acquisition of high-content information integral for improved discovery and development of new drugs and biologics, as well as providing a means of better understanding of electrical disturbances in the heart.

Ultrahigh phase-stable swept-source optical coherence tomography as a cardiac imaging platform (Conference Presentation)

Yuye Ling, Christine P. Hendon

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Functional extensions to optical coherence tomography (OCT) provide useful imaging contrasts that are complementary to conventional OCT. Our goal is to characterize tissue types within the myocardial due to remodeling and therapy. High-speed imaging is necessary to extract mechanical properties and dynamics of fiber orientation changes in a beating heart. Functional extensions of OCT such as polarization sensitive and optical coherence elastography (OCE) require high phase stability of the system, which is a drawback of current mechanically tuned swept source OCT systems. Here we present a high-speed functional imaging platform, which includes an ultrahigh-phase-stable swept source equipped with KTN deflector from NTT-AT. The swept source does not require mechanical movements during the wavelength sweeping; it is electrically tuned. The inter-sweep phase variance of the system was measured to be less than 300 ps at a path length difference of ~2 mm. The axial resolution of the system is 20 µm and the -10 dB fall-off depth is about 3.2 mm. The sample arm has an 8 mmx8 mm field of view with a lateral resolution of approximately 18 µm. The sample arm uses a two-axis MEMS mirror, which is programmable and capable of scanning arbitrary patterns at a sampling rate of 50 kHz. Preliminary imaging results showed differences in polarization properties and image penetration in ablated and normal myocardium. In the future, we will conduct dynamic stretching experiments with strips of human myocardial tissue to characterize mechanical properties using OCE. With high speed imaging of 200 kHz and an all-fiber design, we will work towards catheter-based functional imaging.

Development of multifunctional optical coherence tomography and application to mouse myocardial infarction model in vivo (Conference Presentation)

Sun-Joo Jang, Taejin Park, Inho Shin, et al.

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Optical coherence tomography (OCT) is a useful imaging method for in vivo tissue imaging with deep penetration and high spatial resolution. However, imaging of the beating mouse heart is still challenging due to limited temporal resolution or penetration depth. Here, we demonstrate a multifunctional OCT system for a beating mouse heart, providing various types of visual information about heart pathophysiology with high spatiotemporal resolution and deep tissue imaging. Angiographic imaging and polarization-sensitive (PS) imaging were implemented with the electrocardiogram (ECG)-triggered beam scanning scheme on the high-speed OCT platform (A-line rate: 240 kHz). Depth-resolved local birefringence and the local orientation of the mouse myocardial fiber were visualized from the PS-OCT. ECG-triggered angiographic OCT (AOCT) with the custom-built motion stabilization imaging window provided myocardial vasculature of a beating mouse heart. Mice underwent coronary artery ligation to derive myocardial infarction (MI) and were imaged with the multifunctional OCT system at multiple time points. AOCT and PS-OCT visualize change of functionality of coronary vessels and myocardium respectively at different phases (acute and chronic) of MI in an ischemic mouse heart. Taken together, the integrated imaging of PS-OCT and AOCT would play an important role in study of MI providing multi-dimensional information of the ischemic mouse heart in vivo.

Real-time optical monitoring of permanent lesion progression in radiofrequency ablated cardiac tissue (Conference Presentation)

Rajinder P. Singh-Moon, Christine P. Hendon

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Despite considerable advances in guidance of radiofrequency ablation (RFA) therapies for atrial fibrillation, success rates have been hampered by an inability to intraoperatively characterize the extent of permanent injury. Insufficient lesions can elusively create transient conduction blockages that eventually reconduct. Prior studies suggest significantly greater met-myoglobin (Mmb) concentrations in the lesion core than those in the healthy myocardium and may serve as a marker for irreversible tissue damage. In this work, we present real-time monitoring of permanent injury through spectroscopic assessment of Mmb concentrations at the catheter tip. Atrial wedges (n=6) were excised from four fresh swine hearts and submerged under pulsatile flow of warm (37oC) phosphate buffered saline. A commercial RFA catheter inserted into a fiber optic sheath allowed for simultaneous measurement of tissue diffuse reflectance (DR) spectra (500-650nm) during application of RF energy. Optical measurements were continuously acquired before, during, and post-ablation, in addition to healthy neighboring tissue. Met-myoglobin, oxy-myoglobin, and deoxy-myoglobin concentrations were extracted from each spectrum using an inverse Monte Carlo method. Tissue injury was validated with Masson’s trichrome and hematoxylin and eosin staining. Time courses revealed a rapid increase in tissue Mmb concentrations at the onset of RFA treatment and a gradual plateauing thereafter. Extracted Mmb concentrations were significantly greater post-ablation (p<0.0001) as compared to healthy tissue and correlated well with histological assessment of severe thermal tissue destruction. On going studies are aimed at integrating these findings with prior work on near infrared spectroscopic lesion depth assessment. These results support the use of spectroscopy-facilitated guidance of RFA therapies for real-time permanent injury estimation.

OCT imaging of myocardium extending to pulmonary vein

Zhifang Li, Timm Dickfeld, Qinggong Tang, et al.

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In this study, we propose to use optical coherence tomography to enable a direct visualization of myocardium extending into the pulmonary vein (PV). The results showed that there are obvious differences in the morphology of myocardium and fibrous tissue in the transition region of myocardial sleeve, which is in agreement with the histological analysis. In addition, the myocardial area in transition point has three layers in the depth of 1 mm, and the depth-resolved myocardial fiber show different orientation in the different layers. This characteristic was applied for segmentation of the structures of myocardium extending into PV.

Influence of distance and incident angle on light intensities in intravascular optical coherence tomography pullback runs

Shengnan Liu, Jeroen Eggermont, Ron Wolterbeek, et al.

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Intravascular optical coherence tomography (IVOCT) is an intravascular imaging modality which enables the visualization arterial structures at the micro-structural level. The interpretations of these structures is mainly on the basis of relative image intensities. However, even for homogeneous tissue light intensities can differ. In this study the incident light intensity is modeled to be related to the catheter position. Two factors, the distance between catheter and inner lumen wall as well as the incident angle of the light upon the lumen wall, are considered. A three-level hierarchical model is constructed to statistically validate this model to include the potential effect of different pullbacks and/or frame numbers. The model is solved using 169 images out of 9 pull-backs recorded with a St.Jude Medical IVOCT system. F-tests results indicate that both the distance and the incident angle contribute to the model statistically significantly with p < 0.001. Based on the results from the statistical analysis, a potential compensation method is introduced to normalize the IVOCT intensities for the catheter position effects and small shadows.

Common path ball lens probe for optical coherence tomography (Conference Presentation)

Kanwarpal Singh, Daisuke Yamada, Guillermo J. Tearney M.D.

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Background: Common path probes are highly desirable for optical coherence tomography (OCT) as they reduce system complexity and cost. In this work we report an all-fiber common path side viewing monolithic probe for coronary artery imaging. Methods: Our common path probe was designed for spectrometer based Fourier domain OCT at 1310 nm wavelength. Light from the fiber expands in the coreless fiber region and then focussed by the ball lens. Reflection from ball lens-air interface served as reference signal. The monolithic ball lens probe was assembled within a 560 µmouter diameter drive shaft which was attached to a rotary junction. The drive shaft was placed inside an outer, transparent sheath of 800 µm diameter. Results: With a source input power of 25 mW, we could achieve sensitivity of 100.5 dB. The axial resolution of the system was found to be 15.6 µm in air and the lateral resolution (full width half maximum) was approximately 49 µm. As proof of principal, images of skin acquired using this probe demonstrated clear visualization of the stratum corneum, epidermis, and papillary dermis, along with sweat ducts. Conclusion: In this work we have demonstrated a monolithic, ball lens common, path probe for OCT imaging. The designed ball lens probe is easy to fabricate using a laser splicer. Based on the features and capability of common path probes to provide a simpler solution for OCT, we believe that this development will be an important enhancement for certain types of catheters.

Light intensity matching between different intravascular optical coherence tomography systems

Shengnan Liu, Jeroen Eggermont, Shimpei Nakatani M.D., et al.

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Currently two commercial intravascular optical coherence tomography (IVOCT) systems are available: Illumien Optis from St. Jude Medical (SJM) and Lunawave from Terumo. Both systems store the light intensity data in a raw vendor specific polar format. However, whereas SJM uses 16-bits per pixel Terumo uses 8-bits meaning the intensity values are in different ranges. This complicates quantitative light intensity based analysis when comparing results based on data from both systems. Therefore, this work aims to find an intensity transformation function from Terumo’s 8-bit OFDI data to SJM’s 16-bit range. The data consists of 8 pullbacks, 4 acquired with each system in the same arteries of 2 different patents pre- and post-stenting implantation. A total of 133 matching sections without stent struts from the two sets of pullbacks were identified based on landmarks such as side-branches and calcified regions. Since the main region of interest in the image is the tissue region only the pixels within 2mm behind the lumen border are used. In order to match the SJM data range, the Terumo data was rescaled and cumulative distribution functions (CDF) were calculated based on the histogram distributions. Comparing these CDFs, the transformation function can be determined. Application of this transformation function not only improves the visual similarity of matching slices it can also be used for further quantitative analysis.

Characterization of atherosclerotic plaques by cross-polarization optical coherence tomography

Ekaterina V. Gubarkova, Varvara V. Dudenkova, Felix I. Feldchtein, et al.

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We combined cross-polarization optical coherence tomography (CP OCT) and non-linear microscopy based on second harmonic generation (SHG) and two-photon-excited fluorescence (2PEF) to assess collagen and elastin fibers in the development of the atherosclerotic plaque (AP). The study shows potential of CP OCT for the assessment of collagen and elastin fibers condition in atherosclerotic arteries. Specifically, the additional information afforded by CP OCT, related to birefringence and cross-scattering properties of arterial tissues, may improve the robustness and accuracy of assessment about the microstructure and composition of the plaque for different stages of atherosclerosis.

Aortic endothelium detection using spectral estimation optical coherence tomography (Conference Presentation)

Xinyu Liu Sr., Si Chen M.D., Yuemei Luo, et al.

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The evaluation of the endothelium coverage on the vessel wall is most wanted by cardiologists. Arterial endothelial cells play a crucial role in keeping low-density lipoprotein and leukocytes from entering into the intima. The damage of endothelial cells is considered as the first step of atherosclerosis development and the presence of endothelial cells is an indicator of arterial healing after stent implantation. Intravascular OCT (IVOCT) is the highest-resolution coronary imaging modality, but it is still limited by an axial resolution of 10-15 µm. This limitation in axial resolution hinders our ability to visualize cellular level details associated with coronary atherosclerosis. Spectral estimation optical coherence tomography (SE-OCT) uses modern spectral estimation techniques and may help reveal the microstructures underlying the resolution limit. In this presentation, we conduct an ex vivo study using SE-OCT to image the endothelium cells on the fresh swine aorta. We find that in OCT images with an axial resolution of 10 µm, we may gain the visibility of individual endothelium cells by applying the autoregressive spectral estimation techniques to enhance the axial resolution. We believe the SE-OCT can provide a potential to evaluate the coverage of endothelium cells using current IVOCT with a 10-µm axial resolution.

A pilot study using laser-based technique for non-invasive diagnostics of hypertensive conditions in mice

Karina S. Litvinova, Shakil Ahmad, Keqing Wang, et al.

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Endothelial dysfunction is directly linked to preeclampsia, a maternal hypertensive condition that is life threating for both the mother and the baby. Epidemiological studies show that women with a history of pre-eclampsia have an elevated risk for cardiovascular disease. Here we report a new non-invasive diagnostic test for preeclampsia in mice that allows us to non-invasively assess the condition of the animals during the experiment and treatment in established models of preeclampsia. A laser-based multifunctional diagnostics system (LAKK-M) was chosen to carry out non-invasive analysis of multiple parameters. The device was used to simultaneously record the microcirculatory blood flow and oxygen saturation, as well as fluorescence levels of endogenous fluorophores. Preliminary experiments were conducted on adenoviral (Ad-)- mediated overexpression of sFlt-1 (Ad-sFlt-1) to mimic preeclampsialike symptoms in mice. The recorded data displayed the ability of the LAKK-M diagnostics device to detect significant differences in perfusion measurements between the control and Ad-sFlt-1 treatment. Preliminary results provide a potential avenue to employ these diagnostics technology to monitor and aid in maintaining control of live animal conditions throughout the experiment and treatment.

All-optical pulse-echo ultrasound probe for intravascular imaging (Conference Presentation)

Richard J. Colchester, Sacha Noimark, Charles A. Mosse, et al.

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High frequency ultrasound probes such as intravascular ultrasound (IVUS) and intracardiac echocardiography (ICE) catheters can be invaluable for guiding minimally invasive medical procedures in cardiology such as coronary stent placement and ablation. With current-generation ultrasound probes, ultrasound is generated and received electrically. The complexities involved with fabricating these electrical probes can result in high costs that limit their clinical applicability. Additionally, it can be challenging to achieve wide transmission bandwidths and adequate wideband reception sensitivity with small piezoelectric elements. Optical methods for transmitting and receiving ultrasound are emerging as alternatives to their electrical counterparts. They offer several distinguishing advantages, including the potential to generate and detect the broadband ultrasound fields (tens of MHz) required for high resolution imaging. In this study, we developed a miniature, side-looking, pulse-echo ultrasound probe for intravascular imaging, with fibre-optic transmission and reception. The axial resolution was better than 70 microns, and the imaging depth in tissue was greater than 1 cm. Ultrasound transmission was performed by photoacoustic excitation of a carbon nanotube/polydimethylsiloxane composite material; ultrasound reception, with a fibre-optic Fabry-Perot cavity. Ex vivo tissue studies, which included healthy swine tissue and diseased human tissue, demonstrated the strong potential of this technique. To our knowledge, this is the first study to achieve an all-optical pulse-echo ultrasound probe for intravascular imaging. The potential for performing all-optical B-mode imaging (2D and 3D) with virtual arrays of transmit/receive elements, and hybrid imaging with pulse-echo ultrasound and photoacoustic sensing are discussed.

Non-contact measurement of carotid arterial stiffness by two-point heart-pulse laser detection

M. Benedetti, V. Favalli, A. Mariano, et al.

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Arterial stiffness (AS) is a recognized predictor of cardiovascular risk and mortality, and a potential marker for monitoring the beneficial effects of medical treatments for arterial diseases. AS is typically evaluated indirectly, by assessing the so called pulse wave velocity (PWV), i.e. the speed at which the pressure wave created by the heart contraction travels along the aorta and other arteries. PWV is generally measured using piezoelectric transducers, or via a complex ultrasound technique, but in both cases it requires a direct contact with the patient, which could also modify the measured parameters. In the EU project "NISTAS" (Non-invasive screening of the status of the vascular system) [1], we develop a contactless system allowing to measure the PWV thanks to a technology derived from laser triangulation devices. The measurement principle consists in the detection of the small (around 100μm) displacement of the neck skin, induced by the transit of the pressure wave in the carotid. By simultaneously measuring the displacement caused by the pulse wave in two distinct points along the carotid, the time required by the pressure wave to travel a certain distance can be measured, and the PWV can then be easily calculated. The chosen technique for the skin displacement measurement is laser triangulation in its 2D variant (i.e. “laser profilometry”), which is robust to slight movements of the target, it does not suffer from speckle-pattern signal fading, and it can be conveniently implemented using low-cost optical components. Two light lines, emitted by two blue LEDs are projected on the target (the patient's neck skin), and the skin displacement versus time is measured using a high-frame-rate CMOS camera. In this manuscript we present the results obtained by measuring the PWV of 10 volunteers. It is foreseen that this technique can become a simple and widespread point-of-care method for large-scale cardiovascular system screening over large populations.

Intravascular laser speckle imaging for the mechanical analysis of coronary plaques (Conference Presentation)

Masaki Hosoda, Jing Wang, Diane Tsikudi, et al.

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Acute myocardial infarction is frequently caused by the rupture of coronary plaques with severely compromised viscoelastic properties. We have developed a new optical technology termed intravascular laser speckle imaging (ILSI) that evaluates plaque viscoelastic properties, by measuring the time scale (time constant, τ) of temporally evolving laser speckle fluctuations. To enable coronary evaluation in vivo, an optical ILSI catheter has been developed that accomplishes omni-directional illumination and viewing of the entire coronary circumference without the need for mechanical rotation. Here, we describe the capability of ILSI for evaluating human coronary atherosclerosis in cadaveric hearts. ILSI was conducted in conjunction with optical coherence tomography (OCT) imaging in five human cadaveric hearts. The left coronary artery (LCA), left anterior descending (LAD), left circumflex artery (LCx), and right coronary artery (RCA) segments were resected and secured on custom-developed coronary holders to enable accurate co-registration between ILSI, OCT, and histopathology. Speckle time constants, τ, calculated from each ILSI section were compared with lipid and collagen content measured from quantitative Histopathological analysis of the corresponding Oil Red O and Picrosirius Red stained sections. Because the presence of low viscosity lipid elicits rapid speckle fluctuations, we observed an inverse correlation between τ measured by ILSI and lipid content (R= -0.64, p< 0.05). In contrast, the higher viscoelastic modulus of fibrous regions resulted in a positive correlation between τ and collagen content (R= 0.54, p< 0.05). These results demonstrate the feasibility of conducting ILSI evaluation of arterial mechanical properties using a miniaturized omni-directional catheter.

Assessment of atherosclerotic plaque collagen content and architecture using polarization-sensitive optical coherence tomography (Conference Presentation)

Pallavi Doradla, Martin Villiger, Diane M. Tshikudi, et al.

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Acute myocardial infarction, caused by the rupture of vulnerable coronary plaques, is the leading cause of death worldwide. Collagen is the primary extracellular matrix macromolecule that imparts the mechanical stability to a plaque and its reduction causes plaque instability. Intracoronary polarization sensitive optical coherence tomography (PS-OCT) measures the polarization states of the backscattered light from the tissue to evaluate plaque birefringence, a material property that is elevated in proteins such as collagen with an ordered structure. Here we investigate the dependence of the PS-OCT parameters on the quantity of the plaque collagen and fiber architecture. In this study, coronary arterial segments from human cadaveric hearts were evaluated with intracoronary PS-OCT and compared with Histopathological assessment of collagen content and architecture from picrosirius-red (PSR) stained sections. PSR sections were visualized with circularly-polarized light microscopy to quantify collagen birefringence, and the additional assessment of color hue indicated fibril thickness. Due to the ordered architecture of thick collagen fibers, a positive correlation between PS-OCT retardation and quantity of thick collagen fibers (r=0.54, p=0.04), and similarly with the total collagen content (r=0.51, p=0.03) was observed. In contrast, there was no perceivable relationship between PS-OCT retardation and the presence of thin collagen fibers (r=0.08, p=0.07), suggesting that thin and disorganized collagen fiber architecture did not significantly contribute to the PS-OCT retardation. Further analysis will be performed to assess the relationship between PS-OCT retardation and collagen architecture based on immunohistochemical analysis of collagen type. These results suggest that intracoronary PS-OCT may open the opportunity to assess collagen architecture in addition total collagen content, potentially enabling an improved understanding of coronary plaque rupture.

Three-photon imaging of ovarian cancer

Jennifer Kehlet Barton, Babak Amirsolaimani, Photini Rice, et al.

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Optical imaging methods have the potential to detect ovarian cancer at an early, curable stage. Optical imaging has the disadvantage that high resolution techniques require access to the tissue of interest, but miniature endoscopes that traverse the natural orifice of the reproductive tract, or access the ovaries and fallopian tubes through a small incision in the vagina wall, can provide a minimally-invasive solution. We have imaged both rodent and human ovaries and fallopian tubes with a variety of endoscope-compatible modalities. The recent development of fiber-coupled femtosecond lasers will enable endoscopic multiphoton microscopy (MPM). We demonstrated two- and three-photon excited fluorescence (2PEF, 3PEF), and second- and third-harmonic generation microscopy (SHG, THG) in human ovarian and fallopian tube tissue. A study was undertaken to understand the mechanisms of contrast in these images. Six patients (normal, cystadenoma, and ovarian adenocarcinoma) provided ovarian and fallopian tube biopsies. The tissue was imaged with three-dimensional optical coherence tomography, multiphoton microscopy, and frozen for histological sectioning. Tissue sections were stained with hematoxylin and eosin, Masson’s trichrome, and Sudan black. Approximately 1 μm resolution images were obtained with an excitation source at 1550 nm. 2PEF signal was absent. SHG signal was mainly from collagen. 3PEF and THG signal came from a variety of sources, including a strong signal from fatty connective tissue and red blood cells. Adenocarcinoma was characterized by loss of SHG signal, whereas cystic abnormalities showed strong SHG. There was limited overlap of two- and three- photon signals, suggesting that three-photon imaging can provide additional information for early diagnosis of ovarian cancer.

Improved selection of cortical ovarian strips for autotransplantation of ovarian tissue using full-field optical coherence tomography (FFOCT)

Paulien L. Stegehuis, Inge T. A. Peters, Jeroen Eggermont, et al.

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Premature ovarian failure is a major concern in women of reproductive age who undergo gonadotoxic cancer treatment. Autotransplantation of frozen-thawed cortical ovarian tissue allows the immediate start of cancer treatment, but risks reintroduction of cancer. Current tumor detection methods compromise the ovarian tissue’s viability and can therefore only be used to exclude the presence of metastases in the cortical ovarian strips that are not transplanted. A non-invasive method is needed that can be used to exclude metastases in the actual ovarian autografts without affecting the tissue’s viability. In this study we applied FFOCT – a non-fixative technique that uses white light interferometry to make highresolution images (1μm isotropic) of fresh tissue – to study healthy and malignant ovarian tissue. We created an image atlas of healthy ovarian tissues from premenopausal patients and ovarian tissues with breast cancer metastases. To get the best possible match between hematoxylin-and-eosin stained slides and FFOCT images formalinfixed paraffin-embedded tissue samples were deparaffinized and FFOCT images were acquired within a few minutes. FFOCT images were compared with histology images. All normal structures such as follicles in all phases, inclusion cysts, blood vessels, corpora lutea, and corpora albicantia were clearly recognizable. Ovarian metastases could be well distinguished from normal ovarian tissue. FFOCT is a promising technique in the field of fertility preservation: metastases can be detected and additionally cortical ovarian strips can be selected on the basis of high follicle density.

Functional optical coherence tomography for high-resolution mapping of cilia beat frequency in the mouse oviduct in vivo

Shang Wang, Jason C. Burton, Richard R. Behringer, et al.

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Since mouse is a superior model for genetic analysis of human disorders, reproductive studies in mice have significant implications on further understanding of fertility and infertility in humans. Fertilized oocytes are transported through the reproductive tract by motile cilia lining the lumen of the oviduct as well as by oviduct contractions. While the role of cilia is well recognized, ciliary dynamics in the oviduct is not well understood, largely owing to the lack of live imaging approaches. Here, we report in vivo micro-scale mapping of cilia and cilia beat frequency (CBF) in the mouse oviduct using optical coherence tomography (OCT). This functional imaging method is based on spectral analysis of the OCT speckle variations produced by the beat of cilia in the oviduct, which does not require exogenous contrast agents. Animal procedures similar to the ones used for production of transgenic mice are utilized to expose the reproductive organs for imaging in anesthetized females. In this paper, we first present in vivo structural imaging of the mouse oviduct capturing the oocyte and the preimplantation embryo and then show the result of depth-resolved high-resolution CBF mapping in the ampulla of the live mouse. These data indicate that this structural and functional OCT imaging approach can be a useful tool for a variety of live investigations of mammalian reproduction and infertility.

Dispersion analysis of collagen fiber networks in cervical tissue using optical coherence tomography (Conference Presentation)

Yu Gan, Wang Yao, Kristin M. Myers, et al.

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Understanding the human cervical collagen fiber network is critical to delineating the physiology of cervical remodeling during pregnancy. Previously, we presented our methodology to study the ultrastructure of collagen fibers over an entire field of transverse slices of human cervix tissue using optical coherence tomography. Here, we present a pixel-wise fiber orientation method to enable dispersion analysis on entire slices of human cervical tissues. We obtained en face images that were parallel to the surface. In each en face image, we masked the collagen fiber region based on signal noise ratio. Then, we extracted fiber orientations in each pixel using a weighted summation scheme and generated a pixel-wise directionality map within the entire region. The weight was determined by intensity variations between a pixel of interest and its neighboring pixels and their corresponding distances. We divided the directionality map into regions of 400 μm × 400 μm along radial direction in all four quadrants. In each region, we fit von-Mises distribution to fiber orientations of pixels with mode θ and dispersion b. We compared dispersions among regions and samples. Using IRB approved protocols, we obtained whole transverse slices of cervical tissue from pregnant (n = 2) and non-pregnant (n = 13) women. We observed higher dispersion in pregnant samples compared to non-pregnant samples and higher dispersions in patient’s right/left zones than posterior/anterior zones within an axial slice. Future studies will analyze how collagen fiber dispersion patterns change from the internal to the external os.

Visualization of tumor vascular reactivity in response to respiratory challenges by optical coherence tomography (Conference Presentation)

Hoon Sup Kim, Songhyun Lee, Kiri Lee, et al.

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We previously reported the potential of using vascular reactivity during respiratory challenges as a marker to predict the response of breast tumor to chemotherapy in a rat model by using a continuous wave near-infrared spectroscopy. However, it cannot visualize how the vascular reactivity from tumor vessel can predict the tumor response to its treatment. In this study, we utilized a spectral domain optical coherence tomography (SD-OCT) system to visualize vascular reactivity of both tumor and normal vasculature during respiratory challenges in a mouse model. We adapted intensity based Doppler variance algorithm to draw angiogram from the ear of mouse (8-week-old Balb/c nu/nu). Animals were anesthetized using 1.5% isoflurane, and the body temperature was maintained by a heating pad. Inhalational gas was switched from air (10min) to 100% oxygen (10min), and a pulse oximeter was used to monitor arterial oxygen saturation and heart rate. OCT angiograms were acquired 5 min after the onset of each gas. The vasoconstriction effect of hyperoxic gas on vasculature was shown by subtracting an en-face image acquired during 100% oxygen from the image acquired during air inhalation. The quantitative change in the vessel diameter was measured from the en-face OCT images of the individual blood vessels. The percentage of blood vessel diameter reduction varied from 1% to 12% depending on arterial, capillary, or venous blood vessel. The vascular reactivity change during breast tumor progression and post chemotherapy will be monitored by OCT angiography.

Redox subpopulations and the risk of cancer progression: a new method for characterizing redox heterogeneity

He N. Xu, Lin Z. Li

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It has been shown that a malignant tumor is akin to a complex organ comprising of various cell populations including tumor cells that are genetically, metabolically and functionally different. Our redox imaging data have demonstrated intra-tumor redox heterogeneity in all mouse xenografts derived from human melanomas, breast, prostate, and colon cancers. Based on the signals of NADH and oxidized flavoproteins (Fp, including flavin adenine dinucleotide (FAD)) and their ratio, i.e., the redox ratio, which is an indicator of mitochondrial metabolic status, we have discovered several distinct redox subpopulations in xenografts of breast tumors potentially recapitulating functional/metabolic heterogeneity within the tumor. Furthermore, xenografts of breast tumors with higher metastatic potential tend to have a redox subpopulation whose redox ratio is significantly different from that of tumors with lower metastatic potential and usually have a bi-modal distribution of the redox ratio. The redox subpopulations from human breast cancer samples can also be very complex with multiple subpopulations as determined by fitting the redox ratio histograms with multi- Gaussian functions. In this report, we present a new method for identifying the redox subpopulations within individual breast tumor xenografts and human breast tissues, which may be used to differentiate between breast cancer and normal tissue and among breast cancer with different risks of progression.

High-throughput autofluorescence flow cytometry of breast cancer metabolism (Conference Presentation)

Amy T. Shah, Taylor M. Cannon, Jim N. Higginbotham, et al.

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Tumor heterogeneity poses challenges for devising optimal treatment regimens for cancer patients. In particular, subpopulations of cells can escape treatment and cause relapse. There is a need for methods to characterize tumor heterogeneity of treatment response. Cell metabolism is altered in cancer (Warburg effect), and cells use the autofluorescent cofactor NADH in numerous metabolic reactions. Previous studies have shown that microscopy measurements of NADH autofluorescence are sensitive to treatment response in breast cancer, and these techniques typically assess hundreds of cells per group. An alternative approach is flow cytometry, which measures fluorescence on a single-cell level and is attractive for characterizing tumor heterogeneity because it achieves high-throughput analysis and cell sorting in millions of cells per group. Current applications for flow cytometry rely on staining with fluorophores. This study characterizes flow cytometry measurements of NADH autofluorescence in breast cancer cells. Preliminary results indicate flow cytometry of NADH is sensitive to cyanide perturbation, which inhibits oxidative phosphorylation, in nonmalignant MCF10A cells. Additionally, flow cytometry is sensitive to higher NADH intensity for HER2-positive SKBr3 cells compared with triple-negative MDA-MB-231 cells. These results agree with previous microscopy studies. Finally, a mixture of SKBr3 and MDA-MB-231 cells were sorted into each cell type using NADH intensity. Sorted cells were cultured, and microscopy validation showed the expected morphology for each cell type. Ultimately, flow cytometry could be applied to characterize tumor heterogeneity based on treatment response and sort cell subpopulations based on metabolic profile. These achievements could enable individualized treatment strategies and improved patient outcomes.

Using a reflectance-based correction on Cherenkov images to strengthen correlation with radiation surface dose in an anthropomorphic breast phantom

Jacqueline M. Andreozzi, Rongxiao Zhang, Adam K. Glaser, et al.

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Cherenkov imaging during radiotherapy is a method by which an optical analog for the high-energy radiation beam can be observed directly on the surface of the patient. While simple geometries and volumes demonstrate a strong correlation between Cherenkov emission intensity and surface dose, in vivo data collected from 14 whole-breast patients has not exhibited the same correlation. The purpose of this anthropomorphic phantom study was to investigate a new method for improving the in vivo correlation based on a pixel-by-pixel correction from a reference reflectance image. The pixel intensities in Cherenkov images of a phantom were correlated with the surface dose measured from thermoluminescent dosimeters (TLDs) placed on the phantom’s surface. Because the phantom had homogeneous optical properties, results show a no appreciable change in correlation between Cherenkov intensity and surface dose when using the correction method on images of an anthropomorphic solid silicone phantom, nor a change in the dose fall-off at the edges of the phantom. The method may improve correlation with in vivo data.

Diffuse optical tomography with structured-light patterns to quantify breast density

Jessica Kwong, Farouk Nouizi, Jaedu Cho, et al.

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Breast density is an independent risk factor for breast cancer, where women with denser breasts are more likely to develop cancer. By identifying women at higher risk, healthcare providers can suggest screening at a younger age to effectively diagnose and treat breast cancer in its earlier stages. Clinical risk assessment models currently do not incorporate breast density, despite its strong correlation with breast cancer. Current methods to measure breast density rely on mammography and MRI, both of which may be difficult to use as a routine risk assessment tool. We propose to use diffuse optical tomography with structured-light to measure the dense, fibroglandular (FGT) tissue volume, which has a different chromophore signature than the surrounding adipose tissue. To test the ability of this technique, we performed simulations by creating numerical breast phantoms from segmented breast MR images. We looked at two different cases, one with a centralized FGT distribution and one with a dispersed distribution. As expected, the water and lipid volumes segmented at half-maximum were overestimated for the dispersed case. However, it was noticed that the recovered water and lipid concentrations were lower and higher, respectively, than the centralized case. This information may provide insight into the morphological distribution of the FGT and can be a correction in estimating the breast density.

Photoacoustic spectroscopy based investigatory approach to discriminate breast cancer from normal: a pilot study

Mallika Priya, Bola Sadashiva Satish Rao, Subhash Chandra, et al.

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In spite of many efforts for early detection of breast cancer, there is still lack of technology for immediate implementation. In the present study, the potential photoacoustic spectroscopy was evaluated in discriminating breast cancer from normal, involving blood serum samples seeking early detection. Three photoacoustic spectra in time domain were recorded from each of 20 normal and 20 malignant samples at 281nm pulsed laser excitations and a total of 120 spectra were generated. The time domain spectra were then Fast Fourier Transformed into frequency domain and 116.5625 - 206.875 kHz region was selected for further analysis using a combinational approach of wavelet, PCA and logistic regression. Initially, wavelet analysis was performed on the FFT data and seven features (mean, median, area under the curve, variance, standard deviation, skewness and kurtosis) from each were extracted. PCA was then performed on the feature matrix (7x120) for discriminating malignant samples from the normal by plotting a decision boundary using logistic regression analysis. The unsupervised mode of classification used in the present study yielded specificity and sensitivity values of 100% in each respectively with a ROC - AUC value of 1. The results obtained have clearly demonstrated the capability of photoacoustic spectroscopy in discriminating cancer from the normal, suggesting its possible clinical implications.

Design of an everting balloon to deploy a microendoscope to the fallopian tubes

Molly Keenan, Caitlin Howard, Tyler Tate, et al.

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The 5-year survival rate for ovarian cancer is only 45% largely due to lack of effective screening methods. Current methods include palpation, transvaginal ultrasound, and the CA-125 blood test. Finding disease reliably and at an early stage increase survival to 92%. We have designed and built a 0.7 mm endoscope for the early detection of ovarian cancer. Inserted transvaginally through the working channel of a hysteroscope, the falloposcope creates a minimally invasive procedure for the screening of high risk women. To improve the ease-of-use and safety of falloposcope deployment, we are working to create an everting balloon. Currently, the falloposcope would require a skilled user to operate due to the challenging anatomy of the fallopian tubes – a small opening from the uterus (< 1 mm), tortuous path, and delicate lumenal features. A balloon delivery system would gently open the fallopian tube and guide the falloposcope down the center of lumen. We show balloon design and discuss integration with the falloposcope prototype. We test possible mechanical damage to the tissue due to scraping, puncture, or overstretching. Successful introduction of the everting balloon to simplify falloposcope delivery could expand screening beyond specialized centers to smaller clinical locations.

Wide-field lifetime-based FRET imaging for the assessment of early functional distribution of transferrin-based delivery in breast tumor-bearing small animals

Nattawut Sinsuebphon, Alena Rudkouskaya, Margarida Barroso, et al.

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Targeted drug delivery is a critical aspect of successful cancer therapy. Assessment of dynamic distribution of the drug provides relative concentration and bioavailability at the target tissue. The most common approach of the assessment is intensity-based imaging, which only provides information about anatomical distribution. Observation of biomolecular interactions can be performed using Förster resonance energy transfer (FRET). Thus, FRET-based imaging can assess functional distribution and provide potential therapeutic outcomes. In this study, we used wide-field lifetime-based FRET imaging for the study of early functional distribution of transferrin delivery in breast cancer tumor models in small animals. Transferrin is a carrier for cancer drug delivery. Its interaction with its receptor is within a few nanometers, which is suitable for FRET. Alexa Fluor® 700 and Alexa Fluor® 750 were conjugated to holo-transferrin which were then administered via tail vein injection to the mice implanted with T47D breast cancer xenografts. Images were continuously acquired for 60 minutes post-injection. The results showed that transferrin was primarily distributed to the liver, the urinary bladder, and the tumor. The cellular uptake of transferrin, which was indicated by the level of FRET, was high in the liver but very low in the urinary bladder. The results also suggested that the fluorescence intensity and FRET signals were independent. The liver showed increasing intensity and increasing FRET during the observation period, while the urinary bladder showed increasing intensity but minimal FRET. Tumors gave varied results corresponding to their FRET progression. These results were relevant to the biomolecular events that occurred in the animals.

Large area 3-D optical coherence tomography imaging of lumpectomy specimens for radiation treatment planning

Cuihuan Wang, Leonard Kim, Nicola Barnard, et al.

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Our long term goal is to develop a high-resolution imaging method for comprehensive assessment of tissue removed during lumpectomy procedures. By identifying regions of high-grade disease within the excised specimen, we aim to develop patient-specific post-operative radiation treatment regimens. We have assembled a benchtop spectral-domain optical coherence tomography (SD-OCT) system with 1320 nm center wavelength. Automated beam scanning enables “sub-volumes” spanning 5 mm x 5 mm x 2 mm (500 A-lines x 500 B-scans x 2 mm in depth) to be collected in under 15 seconds. A motorized sample positioning stage enables multiple sub-volumes to be acquired across an entire tissue specimen. Sub-volumes are rendered from individual B-scans in 3D Slicer software and en face (XY) images are extracted at specific depths. These images are then tiled together using MosaicJ software to produce a large area en face view (up to 40 mm x 25 mm). After OCT imaging, specimens were sectioned and stained with HE, allowing comparison between OCT image features and disease markers on histopathology. This manuscript describes the technical aspects of image acquisition and reconstruction, and reports initial qualitative comparison between large area en face OCT images and HE stained tissue sections. Future goals include developing image reconstruction algorithms for mapping an entire sample, and registering OCT image volumes with clinical CT and MRI images for post-operative treatment planning.

Cervical collagen imaging for determining preterm labor risks using a colposcope with full Mueller matrix capability

Susan Stoff, Joseph Chue-Sang, Nola A. Holness, et al.

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Preterm birth is a worldwide health issue, as the number one cause of infant mortality and neurological disorders. Although affecting nearly 10% of all births, an accurate, reliable diagnostic method for preterm birth has, yet, to be developed. The primary constituent of the cervix, collagen, provides the structural support and mechanical strength to maintain cervical closure, through specific organization, during fetal gestation. As pregnancy progresses, the disorganization of the cervical collagen occurs to allow eventual cervical pliability so the baby can be birthed through the cervical opening. This disorganization of collagen affects the mechanical properties of the cervix and, if the changes occur prematurely, may be a significant factor leading to preterm birth. The organization of collagen can be analyzed through the use of Mueller Matrix Polarimetric imaging of the characteristic birefringence of collagen. In this research, we have built a full Mueller Matrix Polarimetry attachment to a standard colposcope to enable imaging of human cervixes during standard prenatal exams at various stages of fetal gestation. Analysis of the polarimetric images provides information of quantity and organization of cervical collagen at specific gestational stages of pregnancy. This quantitative information may provide an indication of risk of preterm birth.

Photodynamic therapy of Cervical Intraepithelial Neoplasia (CIN) high grade

Fernanda M. Carbinatto, Natalia Mayumi Inada, Welington Lombardi, et al.

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Cervical intraepithelial neoplasia (CIN) is the precursor of invasive cervical cancer and associated with human papillomavirus (HPV) infection. Photodynamic therapy (PDT) is a technique that has been used for the treatment of tumors. PDT is based on the accumulation of a photosensitizer in target cells that will generate cytotoxic reactive oxygen species upon illumination, inducing the death of abnormal tissue and PDT with less damaging to normal tissues than surgery, radiation, or chemotherapy and seems to be a promising alternative procedure for CIN treatment. The CIN high grades (II and III) presents potential indications for PDT due the success of PDT for CIN low grade treatment. The patients with CIN high grade that were treated with new clinic protocol shows lesion regression to CIN low grade 60 days after the treatment. The new clinical protocol using for treatment of CIN high grade shows great potential to become a public health technique.

GNR@mSiO2-TDM1 conjugates as multimodal platform for breast cancer therapy as well as enhanced photoacoustic agent

Fei Cao, Qian Yao, Xiuhong Wang

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The development of combination of two or more therapies to fight against cancer together has been important research in oncology. Here we rationally designed a novel nanodrug which can incorporate active targeting, antibody therapy, drug therapy and photothermal therapy within one single platform to fight against Her2-positive breast cancer. To this end, a layer of mesoporous SiO2 was encapsulated onto the gold nanorods followed by covalent association of breast cancer drug TDM1 to the silica shell. TDM1 is an antibody drug conjugate consisting of engineered antibody trastuzumab and anti-miotic agent emtansine. Drug therapy followed by photothermal therapy using NIR laser (793nm) specifically ablated Her2-positive breast cancer cells with enhanced efficiency. In addition, the engineered nanodrug has amplified photoacoustic performance allowing sensitive detection of Her2-positive cancer cells.

Morphologic 3D scanning of fallopian tubes to assist ovarian cancer diagnosis

Wendy-Julie Madore, Etienne De Montigny, Andréanne Deschênes, et al.

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Pathological evaluation of the fallopian tubes is an important diagnostic result but tumors can be missed using routine approaches. As the majority of high-grade serous ovarian cancers are now believed to originate in the fallopian tubes, pathological examination should include in a thorough examination of the excised ovaries and fallopian tubes. We present an dedicated imaging system for diagnostic exploration of human fallopian tubes. This system is based on optical coherence tomography (OCT), a laser imaging modality giving access to sub- epithelial tissue architecture. This system produces cross-sectional images up to 3 mm in depth, with a lateral resolution of ≈15μm and an axial resolution of ≈12μm. An endoscopic single fiber probe was developed to fit in a human fallopian tube. This 1.2 mm probe produces 3D volume data of the entire inner tube within a few minutes. To demonstrate the clinical potential of OCT for lesion identification, we studied 5 different ovarian lesions and healthy fallopian tubes. We imaged 52 paraffin-embedded human surgical specimens with a benchtop system and compared these images with histology slides. We also imaged and compared healthy oviducts from 3 animal models to find one resembling the human anatomy and to develop a functional ex vivo imaging procedure with the endoscopic probe. We also present an update on an ongoing clinical pilot study on women undergoing prophylactic or diagnostic surgery in which we image ex vivo fallopian tubes with the endoscopic probe.

Spectroscopic imaging system for high-throughput viability assessment of ovarian spheroids or microdissected tumor tissues (MDTs) in a microfluidic chip

A. St-Georges-Robillard, M. Masse, J. Kendall-Dupont, et al.

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There is a growing effort in the biomicrosystems community to develop a personalized treatment response assay for cancer patients using primary cells, patient-derived spheroids, or live tissues on-chip. Recently, our group has developed a technique to cut tumors in 350 μm diameter microtissues and keep them alive on-chip, enabling multiplexed in vitro drug assays on primary tumor tissue. Two-photon microscopy, confocal microscopy and flow cytometry are the current standard to assay tissue chemosensitivity on-chip. While these techniques provide microscopic and molecular information, they are not adapted for high-throughput analysis of microtissues. We present a spectroscopic imaging system that allows rapid quantitative measurements of multiple fluorescent viability markers simultaneously by using a liquid crystal tunable filter to record fluorescence and transmittance spectra. As a proof of concept, 24 spheroids composed of ovarian cancer cell line OV90 were formed in a microfluidic chip, stained with two live cell markers (CellTracker^TM Green and Orange), and imaged. Fluorescence images acquired were normalized to the acquisition time and gain of the camera, dark noise was removed, spectral calibration was applied, and spatial uniformity was corrected. Spectral un-mixing was applied to separate each fluorophore's contribution. We have demonstrated that rapid and simultaneous viability measurements on multiple spheroids can be achieved, which will have a significant impact on the prediction of a tumor’s response to multiple treatment options. This technique may be applied as well in drug discovery to assess the potential of a drug candidate directly on human primary tissue.

Study of photoacoustic measurement of bone health based on clinically relevant models

Ting Feng, Ken Kozloff, Meng Cao, et al.

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Photoacoustic (PA) technique involving both ultrasound and light has been explored for potential application in the assessment of bone health. The optical and ultrasound penetration in bone have been studied. The feasibility of conducting 3D PA imaging of bone, and performing quantitative evaluation of bone microstructures by using photoacoustic spectrum analysis (PASA) has also been investigated. The findings from the experiments demonstrate that PA measurement could offer information of bone mineral density and bone microstructure, both relevant to bone health.

Determining early markers of disease using Raman spectroscopy in a rat combat-trauma model of heterotopic ossification

Katherine E. Cilwa, Ammar T. Qureshi, Jonathan A. Forsberg, et al.

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Traumatic heterotopic ossification (HO) is the pathological formation of bone in soft tissue and is a debilitating sequela following acute trauma involving blast-related extremity musculoskeletal injuries, severe burns, spinal cord injury, and traumatic brain injury. Over 60% of combat related injuries and severe burns develop HO; often resulting in reduced mobility, chronic pain, ulceration, tissue entrapment, and reduced ambulation. Detection and prognosis is limited by current clinical imaging modalities (computed tomography, radiography, and ultrasound). This study identifies Raman spectral signatures corresponding to histological changes in a combat-trauma induced rat HO model at early time points prior to radiographic evidence of HO. HO was induced in Sprague-Dawley rats via blast over pressure injury, mid-femoral fracture, soft tissue crush injury, and limb amputation through the zone of injury. Rats were euthanized, and amputated limbs were formalin fixed and embedded in paraffin; 10 μm sections were placed on gold slides, and paraffin was chemically removed. Tissues from sham-treated animals served as controls. Tissue maps consisting of Raman spectra were generated using a Raman microprobe system with an 80-90 μm spot size and 785 nm excitation in regions exhibiting histological evidence of early HO development according to adjacent HE sections. Factors were extracted from mapping data using Band-Target Entropy Minimization algorithms. Areas of early HO were highlighted by a Raman factor indicative of the presence of collagen. Identification of collagen as an early marker of HO prior to radiographic detection in a clinically relevant animal model serves to inform future clinical work.

Photoacoustic imaging of inflammatory arthritis in human joints

Janggun Jo, Guan Xu, April Marquardt, et al.

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The ducal imaging with photoacoustic imaging (PAI) that is an emerging technology and clinical ultrasound imaging that is an established modality is developed for the imaging of early inflammatory arthritis. PAI is sensitive to blood volume, not limited by flow like ultrasound, holding great promise for the earliest detection of increase in blood volume and angiogenesis - a key early finding inflammation PAI has the capability of assessing inflammation in superficial human soft tissues, offering potential benefits in diagnosis, treatment and monitoring of inflammatory arthritis. PAI combined with ultrasonography (US), is a real time dual-modality system developed and tested to identify active synovitis in metacarpophalangeal (MCP) joints of 10 arthritis patients and 10 normal volunteers. Photoacoustic images of the joints were acquired at 580-nm laser wavelength, which provided the desired balance between the optical contrast of hemoglobin over bone cortex and the imaging depth. Confirmed by US Doppler imaging, the results from ten patients and ten normal volunteers demonstrated satisfactory sensitivity of PAI in assessing enhanced blood flow due to active synovitis. This preliminary study suggests that photoacoustic imaging, by identifying early increase in blood volume, related to increased vascularity, a hallmark of joint inflammation, could be a valuable supplement to musculoskeletal US.

Optical diagnostics of osteoblast cells and osteogenic drug screening

Elayaraja Kolanti, Sarath Chandra Veerla, Deepak Kumar Khajuria, et al.

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Microfluidic device based diagnostics involving optical fibre path, in situ imaging and spectroscopy are gaining importance due to recent advances in diagnostics instrumentation and methods, besides other factors such as low amount of reagent required for analysis, short investigation times, and potential possibilities to replace animal model based study in near future. It is possible to grow and monitor tissues in vitro in microfluidic lab-on-chip. It may become a transformative way of studying how cells interact with drugs, pathogens and biomaterials in physiologically relevant microenvironments. To a large extent, progress in developing clinically viable solutions has been constrained because of (i) contradiction between in vitro and in vivo results and (ii) animal model based and clinical studies which is very expensive. Our study here aims to evaluate the usefulness of microfluidic device based 3D tissue growth and monitoring approach to better emulate physiologically and clinically relevant microenvironments in comparison to conventional in vitro 2D culture. Moreover, the microfluidic methodology permits precise high-throughput investigations through real-time imaging while using very small amounts of reagents and cells. In the present study, we report on the details of an osteoblast cell based 3D microfluidic platform which we employ for osteogenic drug screening. The drug formulation is functionalized with fluorescence and other biomarkers for imaging and spectroscopy, respectively. Optical fibre coupled paths are used to obtain insight regarding the role of stress/flow pressure fluctuation and nanoparticle-drug concentration on the osteoblast growth and osteogenic properties of bone.

Fourth near-infrared optical window for assessment of bone and other tissues

Diana C. Sordillo, Laura A. Sordillo, Peter P. Sordillo M.D., et al.

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Recently, additional near-infrared (NIR) optical windows beyond the conventional first therapeutic window have been utilized for deep tissue imaging through scattering media. Biomedical applications using a second optical window (1100 to 1300 nm) and a third (1600 to 1870 nm) are emerging. A fourth window (2100 to 2300 nm) has been largely ignored due to high water absorption and a lack of high sensitivity imaging detectors and ultrafast laser sources. In this study, optical properties of bone in this fourth NIR optical window, were investigated. Results were compared to those seen at the first, second and third windows, and are consistent with our previous work on malignant and benign breast and prostate tissues. Bone and malignant tissues showed highest uptake in the third and fourth windows. As collagen is a major chromophore with prominent spectral peaks between 2100 and 2300 nm, it may be that the fourth optical window is particularly useful for studying tissues with a higher collagen content, such as bone or malignant tumors.

A portable cross-shape near-infrared spectroscopic detector for bone marrow lesions diagnosis

Yu Su, Ting Li

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Bone marrow lesions (BMLs) is an incidence-increasing disease which seriously hazard to human health and possibly contribute to paralysis. Delayed treatment often occurred to BMLs patients due to its characteristics such as complex and diverse clinical manifestations, non-specific, easy to misdiagnosis and etc. The conventional diagnosis methods of BMLs mainly rely on bone marrow biopsy/aspiration, which are invasive, painful, high health risk, and discontinuous which disabled monitoring and during-surgery guidance. Thus we proposed to develop a noninvasive, real-time, continuous measurement, easy-operated device aimed at detecting bone marrow diseases. This device is based on near-infrared spectroscopy and the probe is designed with a cross-shape to tightly and comfortably attach human spine. Space-resolved source-detector placement and measurement algorithm are employed. Four selected wavelength were utilized here to extract BMLs-related component contents of oxy-, deoxy-hemoglobin, fat, scattering index corresponding to fibrosis. We carried out an ink experiment and one clinical measurement to verify the feasibility of our device. The potential of NIRS in BMLs clinics is revealed.

Spatially offset raman spectroscopy for non-invasive assessment of fracture healing

Hao Ding, Guijin Lu, Christopher West, et al.

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Fracture non-unions and bone re-fracture are common challenges for post-fracture management. To achieve better prognosis and treatment evaluation, it is important to be able to assess the quality of callus over the time course of healing. This study evaluated the potential of spatially offset Raman spectroscopy for assessing the fracture healing process in situ. We investigated a rat model of fracture healing at two weeks and 4 weeks post fracture with a fractured femur and a contralateral control in each animal. Raman spectra were collected from the depilated thighs on both sides transcutaneously in situ with various source/detection offsets. Bone signals were recovered from SORS spectra, and then compared with those collected from bare bones. The relative intensity of mineral from fractured bone was markedly decreased compared to the control. The fractured bones demonstrated lower mineral and carbonate level and higher collagen content in the callus at the early time point. Compared to week 2, collagen mineralization and mineral carbonation increased at 4 weeks post fracture. Similarly, the material properties of callus determined by reference point indentation also increased in the 4-week group, indicating improved callus quality with time. The results from Raman analysis are in agreement with radiographic and material testing, indicating the potential of this technique in assessing fracture healing in vivo.

In-situ photopolymerized and monitored implants: successful application to an intervertebral disc replacement

Andreas M. Schmocker, Azadeh Khoushabi, Pierre-Etienne Bourban, et al.

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Photopolymerization is a common method to harden materials initially in a liquid state. A surgeon can directly trigger the solidification of a dental implant or a bone or tissue filler by using ultra-violet light. Traditionally, photopolymerization has been used mainly in dentistry. Over the last decade advances in material development including a wide range of biocompatible gel- and cement-systems open up a new avenue for in-situ photopolymerization. We designed a miniaturized light probe where a photoactive material can be 1) mixed, pressurized and injected 2) photopolymerized or photoactivated and 3) monitored during the chemical reaction. The device enables surgeries to be conducted through a hole smaller than 500 μm in diameter. Using a combination of Raman and fluorescence spectroscopy, the current state of the photopolymerization was inferred and monitored in real time within an in-vitro tissue model. It was also possible to determine roughly the position of the probe within the tissue cavity by analysing the fluorescence signal. Using the technique hydrogels were successfully implanted into a bovine intervertebral disc model. Mechanical tests could not obstruct the functionality of the implant. Finally, the device was also used for other application such as the implantation of a hydrogel into an aneurysm tissue cavity which will be presented at the conference.

Quantitative assessment of optical properties in healthy cartilage and repair tissue by optical coherence tomography and histology (Conference Presentation)

Sanne M. A. Jansen M.D., Paul Cernohorsky M.D., Daniel M. de Bruin, et al.

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Quantification of the OCT signal is an important step toward clinical implementation of a diagnostic tool in cartilage imaging. Discrimination of structural cartilage differences in patients with osteoarthritis is critical, yet challenging. This study assesses the variation in the optical attenuation coefficient (μOCT) between healthy cartilage, repair tissue, bone and layers within repair tissue in a controlled setting. OCT and histology was used to assess goat talus articular surfaces in which central osteochondral defects were created. Exact matches of OCT and histology were selected for research. μOCT measurements were taken from healthy cartilage, repair tissue and bone. Measured μOCT in healthy cartilage was higher compared to both repair tissue and bone tissue. Two possible mechanisms for the difference in attenuation were investigated. We studied morphological parameters in terms of nucleus count, nucleus size and inter-nucleus distance. Collagen content in healthy cartilage and repair tissue was assessed using polarization microscopy. Quantitative analysis of the nuclei did not demonstrate a difference in nucleus size and count between healthy cartilage and repair tissue. In healthy cartilage, cells were spaced farther apart and had a lower variation in local nuclear density compared to repair tissue. Polarization microscopy suggested higher collagen content in healthy cartilage compared to repair tissue. μOCT measurements can distinguish between healthy cartilage, repair tissue and bone. Results suggest that cartilage OCT attenuation measurements could be of great impact in clinical diagnostics of osteoarthritis.

Imaging and characterizing of bone tissue with photoacoustic and ultrasound modalities (Conference Presentation)

Bahman Lashkari, Lifeng Yang, Joel W. Y. Tan, et al.

Reliability analysis of instrument design of noninvasive bone marrow disease detector

Yu Su, Ting Li, Yunlong Sun

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Bone marrow is an important hematopoietic organ, and bone marrow lesions (BMLs) may cause a variety of complications with high death rate and short survival time. Early detection and follow up care are particularly important. But the current diagnosis methods rely on bone marrow biopsy/puncture, with significant limitations such as invasion, complex operation, high risk, and discontinuous. It is highly in need of a non-invasive, safe, easily operated, and continuous monitoring technology. So we proposed to design a device aimed for detecting bone marrow lesions, which was based on near infrared spectrum technology. Then we fully tested its reliabilities, including the sensitivity, specificity, signal-to-noise ratio (SNR), stability, and etc. Here, we reported this sequence of reliability test experiments, the experimental results, and the following data analysis. This instrument was shown to be very sensitive, with distinguishable concentration less than 0.002 and with good linearity, stability and high SNR. Finally, these reliability-test data supported the promising clinical diagnosis and surgery guidance of our novel instrument in detection of BMLs.

Imaging cellular heterogeneity in cancer (Conference Presentation)

Melissa C. Skala

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This Conference Presentation was recorded at SPIE Photonics West 2016 held in San Francisco, California, United States.

Photonic Therapeutics and Diagnostics XII

Volume Details

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Table of Contents