Pilot study of freshly excised breast tissue response in the 300-600 GHz range

Biomedical application of terahertz imaging technology: a narrative review

Background and Objective

Terahertz (THz) imaging has wide applications in biomedical research due to its properties, such as non-ionizing, non-invasive and distinctive spectral fingerprints. Over the past 6 years, the application of THz imaging in tumor tissue has made encouraging progress. However, due to the strong absorption of THz by water, the large size, high cost, and low sensitivity of THz devices, it is still difficult to be widely used in clinical practice. This paper provides ideas for researchers and promotes the development of THz imaging in clinical research.

Methods

The literature search was conducted in the Web of Science and PubMed databases using the keywords "Terahertz imaging", "Breast", "Brain", "Skin" and "Cancer". A total of 94 English language articles from 1 January, 2017 to 30 December, 2022 were reviewed.

Key Content and Findings

In this review, we briefly introduced the recent advances in THz near-field imaging, single-pixel imaging and real-time imaging, the applications of THz imaging for detecting breast, brain and skin tissues in the last 6 years were reviewed, and the advantages and existing challenges were identified. It is necessary to combine machine learning and metamaterials to develop real-time THz devices with small size, low cost and high sensitivity that can be widely used in clinical practice. More powerful THz detectors can be developed by combining graphene, designing structures and other methods to improve the sensitivity of the devices and obtain more accurate information. Establishing a THz database is one of the important methods to improve the repeatability and accuracy of imaging results.

Conclusions

THz technology is an effective method for tumor imaging. We believe that with the joint efforts of researchers and clinicians, accurate, real-time, and safe THz imaging will be widely applied in clinical practice in the future.

Advances in terahertz technology for cancer detection applications

Currently, there is an increasing demand for the diagnostic techniques that provide functional and morphological information with early cancer detection capability. Novel modern medical imaging systems driven by the recent advancements in technology such as terahertz (THz) and infrared radiation-based imaging technologies which are complementary to conventional modalities are being developed, investigated, and validated. The THz cancer imaging techniques offer novel opportunities for label free, non-ionizing, non-invasive and early cancer detection. The observed image contrast in THz cancer imaging studies has been mostly attributed to higher refractive index, absorption coefficient and dielectric properties in cancer tissue than that in the normal tissue due the local increase of the water molecule content in tissue and increased blood supply to the cancer affected tissue. Additional image contrast parameters and cancer biomarkers that have been reported to contribute to THz image contrast include cell structural changes, molecular density, interactions between agents (e.g., contrast agents and embedding agents) and biological tissue as well as tissue substances like proteins, fiber and fat etc. In this paper, we have presented a systematic and comprehensive review of the advancements in the technological development of THz technology for cancer imaging applications. Initially, the fundamentals principles and techniques for THz radiation generation and detection, imaging and spectroscopy are introduced. Further, the application of THz imaging for detection of various cancers tissues are presented, with more focus on the in vivo imaging of skin cancer. The data processing techniques for THz data are briefly discussed. Also, we identify the advantages and existing challenges in THz based cancer detection and report the performance improvement techniques. The recent advancements towards THz systems which are optimized and miniaturized are also reported. Finally, the integration of THz systems with artificial intelligent (AI), internet of things (IoT), cloud computing, big data analytics, robotics etc. for more sophisticated systems is proposed. This will facilitate the large-scale clinical applications of THz for smart and connected next generation healthcare systems and provide a roadmap for future research.

Measurement and Modeling of the Optical Properties of Adipose Tissue in the Terahertz Range: Aspects of Disease Diagnosis

In this paper, the measurement and modeling of optical properties in the terahertz (THz) range of adipose tissue and its components with temperature changes were performed. Spectral measurements were made in the frequency range 0.25–1 THz. The structural models of main triglycerides of fatty acids are constructed using the B3LYP/6-31G(d) method and the Gaussian03, Revision B.03 program. The optical density (OD) of adipose tissue samples decreases as temperature increases, which can be associated mostly with the dehydration of the sample. Some inclusion of THz wave scattering suppression into the OD decrease can also be expected due to refractive index matching provided by free fatty acids released from adipocytes at thermally induced cell lipolysis. It was shown that the difference between the THz absorption spectra of water and fat makes it possible to estimate the water content in adipose tissue. The proposed model was verified on the basis of molecular modeling and a comparison with experimental data for terahertz spectra of adipose tissue during its heating. Knowing the exact percentage of free and bound water in adipose tissue can help diagnose and monitor diseases, such as diabetes, obesity, and cancer.

Complex refractive index of freshly excised human breast tissue as a marker of disease

We report differences in the refractive index of healthy and tumorous freshly excised human breast tissue as determined from reflectance profile measurements at five wavelengths (432 nm, 532 nm, 633 nm, 964 nm, 1551 nm) in the visible and near-infrared using a standard prism-coupling refractometer. These refractive index differences, particularly in the near-infrared, can be used to distinguish fibroadenomas and cancerous growths not only from normal breast tissue but also from each other.

THz medical imaging: from in vitro to in vivo

Terahertz (THz) radiation has attracted considerable attention in medical imaging owing to its nonionizing and spectral fingerprinting characteristics. To date, most studies have focused on in vitro and ex vivo objects with water-removing pretreatment because the water in vivo excessively absorbs the THz waves, which causes deterioration of the image quality. In this review, we discuss how THz medical imaging can be used for a living body. The development of imaging contrast agents has been particularly useful to this end. In addition, we also introduce progress in novel THz imaging methods that could be more suitable for in vivo applications. Based on our discussions, we chart a developmental roadmap to take THz medical imaging from in vitro to in vivo.

Terahertz Imaging for Breast Cancer Detection

Terahertz (THz) imaging has the potential to detect breast tumors during breast-conserving surgery accurately. Over the past decade, many research groups have extensively studied THz imaging and spectroscopy techniques for identifying breast tumors. This manuscript presents the recent development of THz imaging techniques for breast cancer detection. The dielectric properties of breast tissues in the THz range, THz imaging and spectroscopy systems, THz radiation sources, and THz breast imaging studies are discussed. In addition, numerous chemometrics methods applied to improve THz image resolution and data collection processing are summarized. Finally, challenges and future research directions of THz breast imaging are presented.

Terahertz scattering microscopy for dermatology diagnostics

We explore the possibility of detecting anomalous structures buried under the skin surface by studying the deviations from the ideal Airy pattern of the point-spread function (PSF) of a terahertz microscope that includes the skin as one of the reflecting surfaces of the optical system. Using a custom terahertz microscope with a monochromatic point source emitting at 0.611 THz, we record the PSF images with a microbolometer camera. Skin simulants based on collagen gel, with and without artificial buried structures, have been analyzed. The geometrical features characterizing the PSF deformations have been extracted automatically from the PSF images. A machine learning algorithm applied to these geometrical features produces a reliable classification of targets with or without buried structures with error below 5%. It can even classify targets with anisotropic buried structures according to their different orientation.

Label-Free Observation of Micrometric Inhomogeneity of Human Breast Cancer Cell Density Using Terahertz Near-Field Microscopy

Terahertz-light imaging is attracting great attention as a new approach in non-invasive/non-staining biopsy of cancerous tissues. Positively, terahertz light has been shown to be sensitive to the cell density, the hydration content, and the chemical composition of biological samples. However, the spatial resolution of terahertz imaging is typically limited to several millimeters, making it difficult to apply the technology to image biological tissues which have sub-terahertz-wavelength-scale inhomogeneity. For overcoming the resolution, we have recently developed a terahertz near-field microscope with a spatial resolution of 10 µm, named scanning point terahertz source (SPoTS) microscope. In contrast to conventional far-field terahertz techniques, this microscope features the near-field interactions between samples and point terahertz sources on a sub-terahertz-wavelength scale. Herein, to evaluate the usefulness of terahertz imaging in cancer tissue biopsy in greater detail, we performed terahertz near-field imaging of a paraffin-embedded human-breast-cancer section having sub-terahertz-wavelength-scale inhomogeneity of the cancer cell density using the SPoTS microscope. The observed terahertz images successfully visualized local (~250 µm) inhomogeneities of the cell density in breast invasive ductal carcinoma. These results may bypass the terahertz limitation in terms of spatial resolution and may further motivate the application of terahertz light to cancer tissue biopsy.

Terahertz refractive index-based morphological dilation for breast carcinoma delineation

This paper reports investigations led on the combination of the refractive index and morphological dilation to enhance performances towards breast tumour margin delineation during conserving surgeries. The refractive index map of invasive ductal and lobular carcinomas were constructed from an inverse electromagnetic problem. Morphological dilation combined with refractive index thresholding was conducted to classify the tissue regions as malignant or benign. A histology routine was conducted to evaluate the performances of various dilation geometries associated with different thresholds. It was found that the combination of a wide structuring element and high refractive index was improving the correctness of tissue classification in comparison to other configurations or without dilation. The method reports a sensitivity of around 80% and a specificity of 82% for the best case. These results indicate that combining the fundamental optical properties of tissues denoted by their refractive index with morphological dilation may open routes to define supporting procedures during breast-conserving surgeries.

Continuous-Wave THz Imaging for Biomedical Samples

In the past few decades, the applications of terahertz (THz) spectroscopy and imaging technology have seen significant developments in the fields of biology, medical diagnosis, food safety, and nondestructive testing. Label-free diagnosis of malignant tumours has been obtained and also achieved significant development in THz biomedical imaging. This review mainly presents the research status and prospects of several common continuous-wave (CW) THz medical imaging systems and applications of THz medical imaging in biological tissues. Here, we first introduce the properties of THz waves and how these properties play a role in biomedical imaging. Then, we analyse both the advantages and disadvantages of the CW THz imaging methods and the progress of these methods in THz biomedical imaging in recent ten years. Finally, we summarise the obstacles in the way of the application of THz bio-imaging application technology in clinical detection, which need to be investigated and overcome in the future.

The potential of terahertz sensing for cancer diagnosis

The terahertz (THz) region lies between the microwave and infrared regions of the electromagnetic (EM) spectrum such that it is strongly attenuated by water and very sensitive to water content. Here, we numerically present what is to our knowledge the detecting system based on THz reflectance spectral responses data in the diagnosis of in vivo and ex vivo of some cancer's samples such as skin, breast and colon cancer tissue samples. The numerical analysis on the use of semiconductor metamaterial design/device as a complex refractive index (CRI) biosensor have been carried out. We demonstrate the application of terahertz pulse detecting (TPD) in reflection geometry for the study of normal and cancerous biological tissues. THz radiation has very low photon energy and thus it does not pose any ionization hazard for biological tissues. The sensitivity of THz radiation to polar molecules, such as water, makes TPD suitable to study the diseases in human body. By studying the THz pulse shape in the time domain, we have been able to differentiate between diseased and normal tissue for the study of basal cell carcinoma (BCC), breast and colon cancers. These results demonstrate the potential of TPD for the study of skin tissue and its related disorders, both in vivo and ex vivo. Findings of this study demonstrate the potential of TPD to depict breast and colon cancers and both in vivo and ex vivo of skin cancer and encourage further studies to determine the sensitivity and specificity of the technique.

Terahertz Imaging and Spectroscopy in Cancer Diagnostics: A Technical Review

Terahertz (THz) waves are electromagnetic waves with frequency in the range from 0.1 to 10 THz. THz waves have great potential in the biomedical field, especially in cancer diagnosis, because they exhibit low ionization energy and can be used to discern most biomolecules based on their spectral fingerprints. In this paper, we review the recent progress in two applications of THz waves in cancer diagnosis: imaging and spectroscopy. THz imaging is expected to help researchers and doctors attain a direct intuitive understanding of a cancerous area. THz spectroscopy is an efficient tool for component analysis of tissue samples to identify cancer biomarkers. Additionally, the advantages and disadvantages of the developed technologies for cancer diagnosis are discussed. Furthermore, auxiliary techniques that have been used to enhance the spectral signal-to-noise ratio (SNR) are also reviewed.

A Versatile Illumination System for Real-Time Terahertz Imaging

Terahertz technologies are attracting strong interest from high-end industrial fields, and particularly for non-destructive-testing purposes. Currently lacking compactness, integrability as well as adaptability for those implementations, the development and commercialisation of more efficient sources and detectors progressively ensure the transition toward applicative implementations, especially for real-time full-field imaging. In this work, a flexible illumination system, based on fast beam steering has been developed and characterized. Its primary goal is to suppress interferences induced by the coherence length of certain terahertz sources, spoiling terahertz images. The second goal is to ensure an enhanced signal-to-noise ratio on the detector side by the full use and optimized distribution of the available power. This system provides a homogeneous and adjustable illumination through a simplified setup to guarantee optimum real-time imaging capabilities, tailored to the sample under inspection. Working toward industrial implementations, different illumination process are conveniently assessed as a result of the versatility of this method.

Co-registered combined OCT and THz imaging to extract depth and refractive index of a tissue-equivalent test object

Terahertz (THz) imaging and optical coherence tomography (OCT) provide complementary information with similar length scales. In addition to OCT's extensive use in ophthalmology, both methods have shown some promise for other medical applications and non-destructive testing. In this paper, we present an iterative algorithm that combines the information from OCT and THz imaging at two different measurement locations within an object to determine both the depth of the reflecting layers at the two locations and the unknown refractive index of the medium for both the OCT wavelengths and THz frequencies. We validate this algorithm using a silicone test object with embedded layers and show that the depths and refractive index values obtained from the algorithm agreed with the measured values to within 3.3%. We further demonstrate for the first time that OCT and THz images can be co-registered and aligned using unsupervised image registration. Hence we show that a combined OCT/THz system can provide unique information beyond the capability of the separate modalities alone, with possible applications in the medical, industrial and pharmaceutical sectors.

Automatic recognition of breast invasive ductal carcinoma based on terahertz spectroscopy with wavelet packet transform and machine learning

We demonstrate an automatic recognition strategy for terahertz (THz) pulsed signals of breast invasive ductal carcinoma (IDC) based on a wavelet entropy feature extraction and a machine learning classifier. The wavelet packet transform was implemented into the complexity analysis of the transmission THz signal from a breast tissue sample. A novel index of energy to Shannon entropy ratio (ESER) was proposed to distinguish different tissues. Furthermore, the principal component analysis (PCA) method and machine learning classifier were further adopted and optimized for automatic classification of the THz signal from breast IDC sample. The areas under the receiver operating characteristic curves are all larger than 0.89 for the three adopted classifiers. The best breast IDC recognition performance is with the precision, sensitivity and specificity of 92.85%, 89.66% and 96.67%, respectively. The results demonstrate the effectiveness of the ESER index together with the machine learning classifier for automatically identifying different breast tissues.

Analysis and inspection techniques for mouse liver injury based on terahertz spectroscopy

At present, researchers are exploring biological tissue detection method using terahertz techniques. In this paper, techniques to inspect mouse liver injury by using terahertz spectroscopy were studied. The boxplots were applied to remove abnormal data, and the maximal information coefficient was employed to select crucial features from the absorption coefficient and refractive index spectra. Random Forests and AdaBoost were applied to recognize different levels of liver injury. We found that AdaBoost had better performance on low-level injury classification. This work suggests that terahertz techniques have the potential to detect liver injury at an early stage and evaluate liver treatment strategies.

Terahertz tomographic imaging of freshly excised human breast tissues

Terahertz imaging and spectroscopy characterization of freshly excised breast cancer tumors are presented in the range 0.15 to 3.5 THz. Cancerous breast tissues were obtained from partial or full removal of malignant tumors while healthy breast tissues were obtained from breast reduction surgeries. The reflection spectroscopy to obtain the refractive index and absorption coefficient is performed on experimental data at each pixel of the tissue, forming tomographic images. The transmission spectroscopy of the refractive index and absorption coefficient are retrieved from experimental data at few tissue points. The average refractive index and absorption coefficients for cancer, fat, and collagen tissue regions are compared between transmission and reflection modes. The reflection mode offers the advantage of retrieving the electrical properties across a significantly greater number of points without the need for sectioning or altering the freshly excised tissue as in the transmission mode. The terahertz spectral power images and the tomographic images demonstrated good qualitative comparison with pathology.