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Streeter SS, Xu X, Hebert KA, Werth PM, Hoopes PJ, Jarvis LA, Pogue BW, Paulsen KD, Samkoe KS, Henderson ER. Neoadjuvant Therapies Do Not Reduce Epidermal Growth Factor Receptor (EGFR) Expression or EGFR-Targeted Fluorescence in a Murine Model of Soft-Tissue Sarcomas. Mol Imaging Biol 2024; 26:272-283. [PMID: 38151580 DOI: 10.1007/s11307-023-01884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE ABY-029, an epidermal growth factor receptor (EGFR)-targeted, synthetic Affibody peptide labeled with a near-infrared fluorophore, is under investigation for fluorescence-guided surgery of sarcomas. To date, studies using ABY-029 have occurred in tumors naïve to chemotherapy (CTx) and radiation therapy (RTx), although these neoadjuvant therapies are frequently used for sarcoma treatment in humans. The goal of this study was to evaluate the impact of CTx and RTx on tumor EGFR expression and ABY-029 fluorescence of human soft-tissue sarcoma xenografts in a murine model. PROCEDURES Immunodeficient mice (n = 98) were divided into five sarcoma xenograft groups and three treatment groups - CTx only, RTx only, and CTx followed by RTx, plus controls. Four hours post-injection of ABY-029, animals were sacrificed followed by immediate fluorescence imaging of ex vivo adipose, muscle, nerve, and tumor tissues. Histological hematoxylin and eosin staining confirmed tumor type, and immunohistochemistry staining determined EGFR, cluster of differentiation 31 (CD31), and smooth muscle actin (SMA) expression levels. Correlation analysis (Pearson's correlation coefficients, r) and linear regression (unstandardized coefficient estimates, B) were used to determine statistical relationships in molecular expression and tissue fluorescence between xenografts and treatment groups. RESULTS Neoadjuvant therapies had no broad impact on EGFR expression (|B|≤ 7.0, p ≥ 0.4) or on mean tissue fluorescence (any tissue type, (|B|≤ 2329.0, p ≥ 0.1). Mean tumor fluorescence was significantly related to EGFR expression (r = 0.26, p = 0.01), as expected. CONCLUSION Results suggest that ABY-029 as an EGFR-targeted, fluorescent probe is not negatively impacted by neoadjuvant soft-tissue sarcoma therapies, although validation in humans is required.
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Affiliation(s)
- Samuel S Streeter
- Department of Orthopaedics, Dartmouth Health, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.
| | - Xiaochun Xu
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Kendra A Hebert
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Paul M Werth
- Department of Orthopaedics, Dartmouth Health, One Medical Center Drive, Lebanon, NH, 03756, USA
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - P Jack Hoopes
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Lesley A Jarvis
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Brian W Pogue
- Department of Medical Physics, University of Wisconsin, Madison, WI, 53705, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Eric R Henderson
- Department of Orthopaedics, Dartmouth Health, One Medical Center Drive, Lebanon, NH, 03756, USA
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
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Petusseau AF, Streeter SS, Ulku A, Feng Y, Samkoe KS, Bruschini C, Charbon E, Pogue BW, Bruza P. Subsurface fluorescence time-of-flight imaging using a large-format single-photon avalanche diode sensor for tumor depth assessment. J Biomed Opt 2024; 29:016004. [PMID: 38235320 PMCID: PMC10794045 DOI: 10.1117/1.jbo.29.1.016004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Significance Fluorescence guidance is used clinically by surgeons to visualize anatomical and/or physiological phenomena in the surgical field that are difficult or impossible to detect by the naked eye. Such phenomena include tissue perfusion or molecular phenotypic information about the disease being resected. Conventional fluorescence-guided surgery relies on long, microsecond scale laser pulses to excite fluorescent probes. However, this technique only provides two-dimensional information; crucial depth information, such as the location of malignancy below the tissue surface, is not provided. Aim We developed a depth sensing imaging technique using light detection and ranging (LiDAR) time-of-flight (TOF) technology to sense the depth of target tissue while overcoming the influence of tissue optical properties and fluorescent probe concentration. Approach The technology is based on a large-format (512 × 512 pixel ), binary, gated, single-photon avalanche diode (SPAD) sensor with an 18 ps time-gate step, synchronized with a picosecond pulsed laser. The fast response of the sensor was developed and tested for its ability to quantify fluorescent inclusions at depth and optical properties in tissue-like phantoms through analytical model fitting of the fast temporal remission data. Results After calibration and algorithmic extraction of the data, the SPAD LiDAR technique allowed for sub-mm resolution depth sensing of fluorescent inclusions embedded in tissue-like phantoms, up to a maximum of 5 mm in depth. The approach provides robust depth sensing even in the presence of variable tissue optical properties and separates the effects of fluorescence depth from absorption and scattering variations. Conclusions LiDAR TOF fluorescence imaging using an SPAD camera provides both fluorescence intensity images and the temporal profile of fluorescence, which can be used to determine the depth at which the signal is emitted over a wide field of view. The proposed tool enables fluorescence imaging at a higher depth in tissue and with higher spatial precision than standard, steady-state fluorescence imaging tools, such as intensity-based near-infrared fluorescence imaging, optical coherence tomography, Raman spectroscopy, or confocal microscopy. Integration of this technique into a standard surgical tool could enable rapid, more accurate estimation of resection boundaries, thereby improving the surgeon's efficacy and efficiency, and ultimately improving patient outcomes.
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Affiliation(s)
- Arthur F Petusseau
- Dartmouth College, Thayer School of Engineering and Dartmouth Cancer Center, Hanover, New Hampshire, United States
| | - Samuel S Streeter
- Geisel School of Medicine at Dartmouth, Department of Orthopaedics, Hanover, New Hampshire, United States
| | - Arin Ulku
- Ecole polytechnique fédérale de Lausanne, Advanced Quantum Architecture Laboratory, Neuchâtel, Switzerland
| | - Yichen Feng
- Geisel School of Medicine at Dartmouth, Department of Surgery, Hanover, New Hampshire, United States
| | - Kimberley S Samkoe
- Geisel School of Medicine at Dartmouth, Department of Surgery, Hanover, New Hampshire, United States
| | - Claudio Bruschini
- Ecole polytechnique fédérale de Lausanne, Advanced Quantum Architecture Laboratory, Neuchâtel, Switzerland
| | - Edoardo Charbon
- Ecole polytechnique fédérale de Lausanne, Advanced Quantum Architecture Laboratory, Neuchâtel, Switzerland
| | - Brian W Pogue
- Dartmouth College, Thayer School of Engineering and Dartmouth Cancer Center, Hanover, New Hampshire, United States
- University of Wisconsin-Madison, Department of Medical Physics, Madison, Wisconsin, United States
| | - Petr Bruza
- Dartmouth College, Thayer School of Engineering and Dartmouth Cancer Center, Hanover, New Hampshire, United States
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Bateman LM, Hebert KA, Nunziata JA, Streeter SS, Barth CW, Wang LG, Gibbs SL, Henderson ER. Preclinical evaluation of molecularly targeted fluorescent probes in perfused amputated human limbs. J Biomed Opt 2023; 28:082802. [PMID: 36619496 PMCID: PMC9813435 DOI: 10.1117/1.jbo.28.8.082802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
SIGNIFICANCE This first-in-kind, perfused, and amputated human limb model allows for the collection of human data in preclinical selection of lead fluorescent agents. The model facilitates more accurate selection and testing of fluorophores with human-specific physiology, such as differential uptake and signal in fat between animal and human models with zero risk to human patients. Preclinical testing using this approach may also allow for the determination of tissue toxicity, clearance time of fluorophores, and the production of harmful metabolites. AIM This study was conducted to determine the fluorescence intensity values and tissue specificity of a preclinical, nerve tissue targeted fluorophore, as well as the capacity of this first-in-kind model to be used for lead fluorescent agent selection in the future. APPROACH Freshly amputated human limbs were perfused for 30 min prior to in situ and ex vivo imaging of nerves with both open-field and closed-field commercial fluorescence imaging systems. RESULTS In situ, open-field imaging demonstrated a signal-to-background ratio (SBR) of 4.7 when comparing the nerve with adjacent muscle tissue. Closed-field imaging demonstrated an SBR of 3.8 when the nerve was compared with adipose tissue and 4.8 when the nerve was compared with muscle. CONCLUSIONS This model demonstrates an opportunity for preclinical testing, evaluation, and selection of fluorophores for use in clinical trials as well as an opportunity to study peripheral pathologies in a controlled environment.
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Affiliation(s)
- Logan M. Bateman
- Dartmouth Health, Department of Orthopaedics, Lebanon, New Hampshire, United States
| | - Kendra A. Hebert
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Jenna A. Nunziata
- Dartmouth Health, Heart and Vascular Center, Lebanon, New Hampshire, United States
| | - Samuel S. Streeter
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Connor W. Barth
- Oregon Health and Science University, Department of Biomedical Engineering, Portland, Oregon, United States
| | - Lei G. Wang
- Oregon Health and Science University, Department of Biomedical Engineering, Portland, Oregon, United States
| | - Summer L. Gibbs
- Oregon Health and Science University, Department of Biomedical Engineering, Portland, Oregon, United States
| | - Eric R. Henderson
- Dartmouth Health, Department of Orthopaedics, Lebanon, New Hampshire, United States
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Hanover, New Hampshire, United States
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Streeter SS, Zuurbier RA, diFlorio-Alexander RM, Hansberry MT, Maloney BW, Pogue BW, Wells WA, Paulsen KD, Barth RJ. ASO Visual Abstract: Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography-Challenges When Imaging Radiodense Resection Specimens. Ann Surg Oncol 2023; 30:4109-4110. [PMID: 37120488 DOI: 10.1245/s10434-023-13553-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, USA.
| | - Rebecca A Zuurbier
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Roberta M diFlorio-Alexander
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Mark T Hansberry
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Wendy A Wells
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Richard J Barth
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA.
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
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Streeter SS, Zuurbier RA, diFlorio-Alexander RM, Hansberry MT, Maloney BW, Pogue BW, Wells WA, Paulsen KD, Barth RJ. Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens. Ann Surg Oncol 2023; 30:4097-4108. [PMID: 37041429 PMCID: PMC10600965 DOI: 10.1245/s10434-023-13364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) is an integral component of early-stage breast cancer treatment, but costly reexcision procedures are common due to the high prevalence of cancer-positive margins on primary resections. A need exists to develop and evaluate improved methods of margin assessment to detect positive margins intraoperatively. METHODS A prospective trial was conducted through which micro-computed tomography (micro-CT) with radiological interpretation by three independent readers was evaluated for BCS margin assessment. Results were compared to standard-of-care intraoperative margin assessment (i.e., specimen palpation and radiography [abbreviated SIA]) for detecting cancer-positive margins. RESULTS Six hundred margins from 100 patients were analyzed. Twenty-one margins in 14 patients were pathologically positive. On analysis at the specimen-level, SIA yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 42.9%, 76.7%, 23.1%, and 89.2%, respectively. SIA correctly identified six of 14 margin-positive cases with a 23.5% false positive rate (FPR). Micro-CT readers achieved sensitivity, specificity, PPV, and NPV ranges of 35.7-50.0%, 55.8-68.6%, 15.6-15.8%, and 86.8-87.3%, respectively. Micro-CT readers correctly identified five to seven of 14 margin-positive cases with an FPR range of 31.4-44.2%. If micro-CT scanning had been combined with SIA, up to three additional margin-positive specimens would have been identified. DISCUSSION Micro-CT identified a similar proportion of margin-positive cases as standard specimen palpation and radiography, but due to difficulty distinguishing between radiodense fibroglandular tissue and cancer, resulted in a higher proportion of false positive margin assessments.
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Affiliation(s)
- Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, USA.
| | - Rebecca A Zuurbier
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Roberta M diFlorio-Alexander
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Mark T Hansberry
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Wendy A Wells
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA
| | - Richard J Barth
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, USA.
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
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Demidov VV, Clark MA, Streeter SS, Sottosanti JS, Gitajn IL, Elliott JT. High-energy open-fracture model with initial experience of fluorescence-guided bone perfusion assessment. J Orthop Res 2023; 41:1040-1048. [PMID: 36192829 PMCID: PMC10067537 DOI: 10.1002/jor.25443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
High-energy orthopedic injuries cause severe damage to soft tissues and are prone to infection and healing complications, making them a challenge to manage. Further research is facilitated by a clinically relevant animal model with commensurate fracture severity and soft-tissue damage, allowing evaluation of novel treatment options and techniques. Here we report a reproducible, robust, and clinically relevant animal model of high-energy trauma with extensive soft-tissue damage, based on compressed air-driven membrane rupture as the blast wave source. As proof-of-principle showing the reproducibility of the injury, we evaluate changes in tissue and bone perfusion for a range of different tibia fracture severities, using dynamic contrast-enhanced fluorescence imaging and microcomputed tomography. We demonstrate that fluorescence tracer temporal profiles for skin, femoral vein, fractured bone, and paw reflect the increasing impact of more powerful blasts causing a range of Gustilo grade I-III injuries. The maximum fluorescence intensity of distal tibial bone following 0.1 mg/kg intravenous indocyanine green injection decreased by 35% (p < 0.01), 75% (p < 0.001), and 87% (p < 0.001), following grade I, II, and III injuries, respectively, compared to uninjured bone. Other kinetic parameters of bone and soft tissue perfusion extracted from series of fluorescence images for each animal also showed an association with severity of trauma. In addition, the time-intensity profile of fluorescence showed marked differences in wash-in and wash-out patterns for different injury severities and anatomical locations. This reliable and realistic high-energy trauma model opens new research avenues to better understand infection and treatment strategies. Level of evidence: Level III; Case-control.
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Affiliation(s)
- Valentin V. Demidov
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Centre, Lebanon, NH
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Megan A. Clark
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | | | | | - I. Leah Gitajn
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Centre, Lebanon, NH
| | - Jonathan Thomas Elliott
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Centre, Lebanon, NH
- Geisel School of Medicine, Dartmouth College, Hanover, NH
- Thayer School of Engineering, Dartmouth College, Hanover, NH
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Hunt B, Gill GS, Alexander DA, Streeter SS, Gladstone DJ, Russo GA, Zaki BI, Pogue BW, Zhang R. Fast Deformable Image Registration for Real-Time Target Tracking During Radiation Therapy Using Cine MRI and Deep Learning. Int J Radiat Oncol Biol Phys 2023; 115:983-993. [PMID: 36309075 DOI: 10.1016/j.ijrobp.2022.09.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/10/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE We developed a deep learning (DL) model for fast deformable image registration using 2-dimensional sagittal cine magnetic resonance imaging (MRI) acquired during radiation therapy and evaluated its potential for real-time target tracking compared with conventional image registration methods. METHODS AND MATERIALS Our DL model uses a pair of cine MRI images as input and provides a motion vector field (MVF) as output. The MVF is then applied to align the input images. A retrospective study was conducted to train and evaluate our model using cine MRI data from patients undergoing treatment for abdominal and thoracic tumors. For each treatment fraction, MR-linear accelerator delivery log files, tracking videos, and cine image files were analyzed. Individual MRI frames were temporally sampled to construct a large set of image registration pairs used to evaluate multiple methods. The DL model was optimized using 5-fold cross validation, and model outputs (transformed images and MVFs) using test set images were saved for comparison with 3 conventional registration methods (affine, b-spline, and demons). Evaluation metrics were 3-fold: (1) registration error, (2) MVF stability (both spatial and temporal), and (3) average computation time. RESULTS We analyzed >21 hours of cine MRI (>629,000 frames) acquired during 86 treatment fractions from 21 patients. In a test set of 10,320 image registration pairs, DL registration outperformed conventional methods in both registration error (affine, b-spline, demons, DL; root mean square error: 0.067, 0.040, 0.036, 0.032; paired t test demons vs DL: t[20] = 4.2, P < .001) and computation time per frame (51, 1150, 4583, 8 ms). Among deformable methods, spatial stability of resulting MVFs was comparable; however, the DL model had significantly improved temporal consistency. CONCLUSIONS DL-based image registration can leverage large-scale MR cine data sets to outperform conventional registration methods and is a promising solution for real-time deformable motion estimation in radiation therapy.
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Affiliation(s)
- Brady Hunt
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Gobind S Gill
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Gregory A Russo
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bassem I Zaki
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brian W Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Henderson ER, Hebert KA, Werth PM, Streeter SS, Rosenthal EL, Paulsen KD, Pogue BW, Samkoe KS. Fluorescence guidance improves the accuracy of radiological imaging-guided surgical navigation. J Surg Oncol 2023; 127:490-500. [PMID: 36285723 PMCID: PMC10176708 DOI: 10.1002/jso.27128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Imaging-based navigation technologies require static referencing between the target anatomy and the optical sensors. Imaging-based navigation is therefore well suited to operations involving bony anatomy; however, these technologies have not translated to soft-tissue surgery. We sought to determine if fluorescence imaging complement conventional, radiological imaging-based navigation to guide the dissection of soft-tissue phantom tumors. METHODS Using a human tissue-simulating model, we created tumor phantoms with physiologically accurate optical density and contrast concentrations. Phantoms were dissected using all possible combinations of computed tomography (CT), magnetic resonance, and fluorescence imaging; controls were included. The data were margin accuracy, margin status, tumor spatial alignment, and dissection duration. RESULTS Margin accuracy was higher for combined navigation modalities compared to individual navigation modalities, and accuracy was highest with combined CT and fluorescence navigation (p = 0.045). Margin status improved with combined CT and fluorescence imaging. CONCLUSIONS At present, imaging-based navigation has limited application in guiding soft-tissue tumor operations due to its inability to compensate for positional changes during surgery. This study indicates that fluorescence guidance enhances the accuracy of imaging-based navigation and may be best viewed as a synergistic technology, rather than a competing one.
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Affiliation(s)
- Eric R. Henderson
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kendra A. Hebert
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul M. Werth
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Samuel S. Streeter
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Eben L. Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith D. Paulsen
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Brian W. Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kimberley S. Samkoe
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
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Wickramasinghe VA, Decker SM, Streeter SS, Sloop AM, Petusseau AF, Alexander DA, Bruza P, Gladstone DJ, Zhang R, Pogue BW. Color-resolved Cherenkov imaging allows for differential signal detection in blood and melanin content. J Biomed Opt 2023; 28:036005. [PMID: 36923987 PMCID: PMC10008915 DOI: 10.1117/1.jbo.28.3.036005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Significance High-energy x-ray delivery from a linear accelerator results in the production of spectrally continuous broadband Cherenkov light inside tissue. In the absence of attenuation, there is a linear relationship between Cherenkov emission and deposited dose; however, scattering and absorption result in the distortion of this linear relationship. As Cherenkov emission exits the absorption by tissue dominates the observed Cherenkov emission spectrum. Spectroscopic interpretation of this effects may help to better relate Cherenkov emission to ionizing radiation dose delivered during radiotherapy. Aim In this study, we examined how color Cherenkov imaging intensity variations are caused by absorption from both melanin and hemoglobin level variations, so that future Cherenkov emission imaging might be corrected for linearity to delivered dose. Approach A custom, time-gated, three-channel intensified camera was used to image the red, green, and blue wavelengths of Cherenkov emission from tissue phantoms with synthetic melanin layers and varying blood concentrations. Our hypothesis was that spectroscopic separation of Cherenkov emission would allow for the identification of attenuated signals that varied in response to changes in blood content versus melanin content, because of their different characteristic absorption spectra. Results Cherenkov emission scaled with dose linearly in all channels. Absorption in the blue and green channels increased with increasing oxy-hemoglobin in the blood to a greater extent than in the red channel. Melanin was found to absorb with only slight differences between all channels. These spectral differences can be used to derive dose from measured Cherenkov emission. Conclusions Color Cherenkov emission imaging may be used to improve the optical measurement and determination of dose delivered in tissues. Calibration for these factors to minimize the influence of the tissue types and skin tones may be possible using color camera system information based upon the linearity of the observed signals.
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Affiliation(s)
| | - Savannah M. Decker
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Samuel S. Streeter
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Austin M. Sloop
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Arthur F. Petusseau
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Daniel A. Alexander
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Petr Bruza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - David J. Gladstone
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, United States
| | - Rongxiao Zhang
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
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10
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Chen Y, Streeter SS, Hunt B, Sardar HS, Gunn JR, Tafe LJ, Paydarfar JA, Pogue BW, Paulsen KD, Samkoe KS. Fluorescence molecular optomic signatures improve identification of tumors in head and neck specimens. Front Med Technol 2023; 5:1009638. [PMID: 36875185 PMCID: PMC9975724 DOI: 10.3389/fmedt.2023.1009638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background Fluorescence molecular imaging using ABY-029, an epidermal growth factor receptor (EGFR)-targeted, synthetic Affibody peptide labeled with a near-infrared fluorophore, is under investigation for surgical guidance during head and neck squamous cell carcinoma (HNSCC) resection. However, tumor-to-normal tissue contrast is confounded by intrinsic physiological limitations of heterogeneous EGFR expression and non-specific agent uptake. Objective In this preliminary study, radiomic analysis was applied to optical ABY-029 fluorescence image data for HNSCC tissue classification through an approach termed "optomics." Optomics was employed to improve tumor identification by leveraging textural pattern differences in EGFR expression conveyed by fluorescence. The study objective was to compare the performance of conventional fluorescence intensity thresholding and optomics for binary classification of malignant vs. non-malignant HNSCC tissues. Materials and Methods Fluorescence image data collected through a Phase 0 clinical trial of ABY-029 involved a total of 20,073 sub-image patches (size of 1.8 × 1.8 mm2) extracted from 24 bread-loafed slices of HNSCC surgical resections originating from 12 patients who were stratified into three dose groups (30, 90, and 171 nanomoles). Each dose group was randomly partitioned on the specimen-level 75%/25% into training/testing sets, then all training and testing sets were aggregated. A total of 1,472 standardized radiomic features were extracted from each patch and evaluated by minimum redundancy maximum relevance feature selection, and 25 top-ranked features were used to train a support vector machine (SVM) classifier. Predictive performance of the SVM classifier was compared to fluorescence intensity thresholding for classifying testing set image patches with histologically confirmed malignancy status. Results Optomics provided consistent improvement in prediction accuracy and false positive rate (FPR) and similar false negative rate (FNR) on all testing set slices, irrespective of dose, compared to fluorescence intensity thresholding (mean accuracies of 89% vs. 81%, P = 0.0072; mean FPRs of 12% vs. 21%, P = 0.0035; and mean FNRs of 13% vs. 17%, P = 0.35). Conclusions Optomics outperformed conventional fluorescence intensity thresholding for tumor identification using sub-image patches as the unit of analysis. Optomics mitigate diagnostic uncertainties introduced through physiological variability, imaging agent dose, and inter-specimen biases of fluorescence molecular imaging by probing textural image information. This preliminary study provides a proof-of-concept that applying radiomics to fluorescence molecular imaging data offers a promising image analysis technique for cancer detection in fluorescence-guided surgery.
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Affiliation(s)
- Yao Chen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Samuel S. Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Brady Hunt
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Hira S. Sardar
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Jason R. Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Laura J. Tafe
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Pathology, Dartmouth Health, Lebanon, NH, United States
| | - Joseph A. Paydarfar
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Surgery, Dartmouth Health, Lebanon, NH, United States
- Department of Otolaryngology, Dartmouth Health, Lebanon, NH, United States
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Kimberley S. Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Surgery, Dartmouth Health, Lebanon, NH, United States
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11
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LaRochelle EPM, Streeter SS, Littler EA, Ruiz AJ. 3D-Printed Tumor Phantoms for Assessment of In Vivo Fluorescence Imaging Analysis Methods. Mol Imaging Biol 2023; 25:212-220. [PMID: 36307633 PMCID: PMC9970939 DOI: 10.1007/s11307-022-01783-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Interventional fluorescence imaging is increasingly being utilized to quantify cancer biomarkers in both clinical and preclinical models, yet absolute quantification is complicated by many factors. The use of optical phantoms has been suggested by multiple professional organizations for quantitative performance assessment of fluorescence guidance imaging systems. This concept can be further extended to provide standardized tools to compare and assess image analysis metrics. PROCEDURES 3D-printed fluorescence phantoms based on solid tumor models were developed with representative bio-mimicking optical properties. Phantoms were produced with discrete tumors embedded with an NIR fluorophore of fixed concentration and either zero or 3% non-specific fluorophore in the surrounding material. These phantoms were first imaged by two fluorescence imaging systems using two methods of image segmentation, and four assessment metrics were calculated to demonstrate variability in the quantitative assessment of system performance. The same analysis techniques were then applied to one tumor model with decreasing tumor fluorophore concentrations. RESULTS These anatomical phantom models demonstrate the ability to use 3D printing to manufacture anthropomorphic shapes with a wide range of reduced scattering (μs': 0.24-1.06 mm-1) and absorption (μa: 0.005-0.14 mm-1) properties. The phantom imaging and analysis highlight variability in the measured sensitivity metrics associated with tumor visualization. CONCLUSIONS 3D printing techniques provide a platform for demonstrating complex biological models that introduce real-world complexities for quantifying fluorescence image data. Controlled iterative development of these phantom designs can be used as a tool to advance the field and provide context for consensus-building beyond performance assessment of fluorescence imaging platforms, and extend support for standardizing how quantitative metrics are extracted from imaging data and reported in literature.
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Affiliation(s)
- Ethan P M LaRochelle
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA.
| | - Samuel S Streeter
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA.,Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH, 03755, USA
| | - Eammon A Littler
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA
| | - Alberto J Ruiz
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA.,Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH, 03755, USA
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12
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Streeter SS, Hebert KA, Bateman LM, Ray GS, Dean RE, Geffken KT, Resnick CT, Austin DC, Bell JE, Sparks MB, Gibbs SL, Samkoe KS, Gitajn IL, Elliott JT, Henderson ER. Current and Future Applications of Fluorescence Guidance in Orthopaedic Surgery. Mol Imaging Biol 2023; 25:46-57. [PMID: 36447084 PMCID: PMC10106269 DOI: 10.1007/s11307-022-01789-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
Fluorescence-guided surgery (FGS) is an evolving field that seeks to identify important anatomic structures or physiologic phenomena with helpful relevance to the execution of surgical procedures. Fluorescence labeling occurs generally via the administration of fluorescent reporters that may be molecularly targeted, enzyme-activated, or untargeted, vascular probes. Fluorescence guidance has substantially changed care strategies in numerous surgical fields; however, investigation and adoption in orthopaedic surgery have lagged. FGS shows the potential for improving patient care in orthopaedics via several applications including disease diagnosis, perfusion-based tissue healing capacity assessment, infection/tumor eradication, and anatomic structure identification. This review highlights current and future applications of fluorescence guidance in orthopaedics and identifies key challenges to translation and potential solutions.
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Affiliation(s)
- Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
| | - Kendra A Hebert
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Logan M Bateman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Gabrielle S Ray
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Ryan E Dean
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Kurt T Geffken
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Corey T Resnick
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Daniel C Austin
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - John-Erik Bell
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Michael B Sparks
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - I Leah Gitajn
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Jonathan Thomas Elliott
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.,Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
| | - Eric R Henderson
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Orthopaedics, Dartmouth Health, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.,Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, 03756, USA
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13
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Henderson ER, Elliott J, Jiang S, Gitajn IL, Lee J, Gibbs S, Bouvet M, Mahadevan-Jansen A, Daly M, Streeter SS, Paulsen KD, Pogue BW, Samkoe KS, Singhal S. Proceduralist criteria for evaluating interface utility of novel imaging modalities in early phase clinical trials: evaluating the need for standardized criteria. Proc SPIE Int Soc Opt Eng 2023; 12361:123610F. [PMID: 37034554 PMCID: PMC10078963 DOI: 10.1117/12.2650756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Accelerating innovation in the space of fluorescence imaging for surgical applications has increased interest in safely and expediently advancing these technologies to clinic through Food and Drug Administration-(FDA-) compliant trials. Conventional metrics for early phase trials include drug safety, tolerability, dosing, and pharmacokinetics. Most procedural imaging technologies rely on administration of an exogenous fluorophore and concurrent use of an imaging system; both of which must receive FDA approval to proceed to clinic. Because fluorophores are classified as medical imaging agents, criteria for establishing dose are different, and arguably more complicated, than therapeutic drugs. Since no therapeutic effect is desired, medical imaging agents are ideally administered at the lowest dose that achieves adequate target differentiation. Because procedural imaging modalities are intended to enhance and/or ease proceduralists' identification or assessment of tissues, beneficial effects of these technologies may manifest in the form of qualitative endpoints such as: 1) confidence; 2) decision-making; and 3) satisfaction with the specified procedure. Due to the rapid expansion of medical imaging technologies, we believe that our field requires standardized criteria to evaluate existing and emerging technologies objectively so that both quantitative and qualitative aspects of their use may be measured and useful comparisons to assess their relative value may occur. Here, we present a 15-item consensus-based survey instrument to assess the utility of novel imaging technologies from the proceduralist's standpoint.
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Affiliation(s)
- Eric R Henderson
- Thayer school of Engineering, Dartmouth College, Hanover, NH
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH
- Dartmouth Health, Lebanon, NH
| | - Jonathan Elliott
- Thayer school of Engineering, Dartmouth College, Hanover, NH
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH
- Dartmouth Health, Lebanon, NH
| | - Shudong Jiang
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - I Leah Gitajn
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH
- Dartmouth Health, Lebanon, NH
| | - John Lee
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Summer Gibbs
- Oregon Health & Science University, Portland, OR
| | | | | | - Michael Daly
- TECHNA Institute, University Health Network, Toronto, Ontario
| | | | - Keith D Paulsen
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Brian W Pogue
- University of Wisconsin-Madison School of Medicine, Madison, WI
| | | | - Sunil Singhal
- University of Pennsylvania School of Medicine, Philadelphia, PA
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14
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Bateman LM, Hebert KA, Streeter SS, Nunziata JA, Barth CW, Wang LG, Gibbs SL, Henderson ER. Use of Freshly Amputated Human Limbs for Pre-Clinical Evaluation of Molecular-Targeted Fluorescent Probes. Proc SPIE Int Soc Opt Eng 2023; 12361:1236109. [PMID: 37009433 PMCID: PMC10065840 DOI: 10.1117/12.2650356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
We have co-developed a first-in-kind model of fluorophore testing in freshly amputated human limbs. Ex vivo human tissue provides a unique opportunity for the testing of pre-clinical fluorescent agents, collection of imaging data, and histopathologic examination in human tissue prior to performing in vivo experiments. Existing pre-clinical fluorescent agent studies rely primarily on animal models, which do not directly predict fluorophore performance in humans and can result in wasted resources and time if an agent proves ineffective in early human trials. Because fluorophores have no desired therapeutic effect, their clinical utility is based solely on their safety and ability to highlight tissues of interest. Advancing to human trials even via the FDA's phase 0/microdose pathway still requires substantial resources, single-species pharmacokinetic testing, and toxicity testing. In a recently concluded study using amputated human lower limbs, we were able to test successfully a nerve-specific fluorophore in pre-clinical development. This study used systemic administration via vascular cannulization and a cardiac perfusion pump. We envision that this model may assist with early lead agent testing selection for fluorophores with various targets and mechanisms.
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Affiliation(s)
- Logan M Bateman
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, United States
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
| | - Kendra A Hebert
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
| | - Samuel S Streeter
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States
| | - Jenna A Nunziata
- Heart and Vascular Center, Dartmouth Health, Lebanon, New Hampshire, United States
| | - Connor W Barth
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, United States
| | - Lei G Wang
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, United States
| | - Summer L Gibbs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, United States
| | - Eric R Henderson
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, United States
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States
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15
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Streeter SS, Ray GS, Bateman LM, Hebert KA, Bushee FE, Rodi SW, Gitajn IL, Ahn J, Singhal S, Martin ND, Bernthal NM, Lee C, Obremskey WT, Schoenecker JG, Elliott JT, Henderson ER. Early identification of life-threatening soft-tissue infection using dynamic fluorescence imaging: first-in-kind clinical study of first-pass kinetics. Proc SPIE Int Soc Opt Eng 2023; 12361:123610B. [PMID: 37034555 PMCID: PMC10078977 DOI: 10.1117/12.2648408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Necrotizing soft-tissue infections (NSTIs) are aggressive and deadly. Immediate surgical debridement is standard-of-care, but patients often present with non-specific symptoms, thereby delaying treatment. Because NSTIs cause microvascular thrombosis, we hypothesized that perfusion imaging using indocyanine green (ICG) would show diminished fluorescence signal in NSTI-affected tissues, particularly compared to non-necrotizing, superficial infections. Through a first-in-kind clinical study, we performed first-pass ICG fluorescence perfusion imaging of patients with suspected NSTIs. Early results support our hypothesis that ICG signal voids occur in NSTI-affected tissues and that dynamic contrast-enhanced fluorescence parameters reveal tissue kinetics that may be related to disease progression and extent.
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Affiliation(s)
- Samuel S. Streeter
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH 03756
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755
| | - Gabrielle S. Ray
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH 03756
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755
| | - Logan M. Bateman
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755
| | - Kendra A. Hebert
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755
| | | | - Scott W. Rodi
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755
| | - I. Leah Gitajn
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH 03756
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755
| | - Jaimo Ahn
- Michigan Medicine, U. of Michigan, Ann Arbor, MI 48109
| | - Sunil Singhal
- Perelman School of Medicine, U. of Pennsylvania, Philadelphia, PA 19104
| | - Niels D. Martin
- Perelman School of Medicine, U. of Pennsylvania, Philadelphia, PA 19104
| | - Nicholas M. Bernthal
- David Geffen School of Medicine, U. of California Los Angeles, Santa Monica, CA 90404
| | - Christopher Lee
- David Geffen School of Medicine, U. of California Los Angeles, Santa Monica, CA 90404
| | | | | | - Jonathan Thomas Elliott
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH 03756
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755
| | - Eric R. Henderson
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH 03756
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755
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16
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Elliott JT, Henderson E, Streeter SS, Demidov V, Han X, Tang Y, Sottosanti JS, Bateman L, Brůža P, Jiang S, Gitajn IL. Fluorescence-guided and molecularly-guided debridement: identifying devitalized and infected tissue in orthopaedic trauma. Proc SPIE Int Soc Opt Eng 2023; 12361:1236108. [PMID: 37056956 PMCID: PMC10091097 DOI: 10.1117/12.2661243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Following orthopaedic trauma, bone devitalization is a critical determinant of complications such as infection or nonunion. Intraoperative assessment of bone perfusion has thus far been limited. Furthermore, treatment failure for infected fractures is unreasonably high, owing to the propensity of biofilm to form and become entrenched in poorly vascularized bone. Fluorescence-guided surgery and molecularly-guided surgery could be used to evaluate the viability of bone and soft tissue and detect the presence of planktonic and biofilm-forming bacteria. This proceedings paper discusses the motivation behind developing this technology and our most recent preclinical and clinical results.
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Affiliation(s)
- Jonathan Thomas Elliott
- Department of Orthopaedics, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH USA 03755
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH USA 03755
| | - Eric Henderson
- Department of Orthopaedics, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH USA 03755
| | - Samuel S. Streeter
- Department of Orthopaedics, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH USA 03755
| | - Valentin Demidov
- Department of Orthopaedics, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH USA 03755
| | - Xinyue Han
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH USA 03755
| | - Yue Tang
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH USA 03755
| | - J. Scott Sottosanti
- Department of Orthopaedics, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756
| | - Logan Bateman
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH USA 03755
| | - Petr Brůža
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH USA 03755
| | - Shudong Jiang
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH USA 03755
| | - I. Leah Gitajn
- Department of Orthopaedics, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH USA 03755
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17
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Hunt B, Streeter SS, Ruiz AJ, Chapman MS, Pogue BW. Ultracompact fluorescence smartphone attachment using built-in optics for protoporphyrin-IX quantification in skin. Biomed Opt Express 2021; 12:6995-7008. [PMID: 34858694 PMCID: PMC8606126 DOI: 10.1364/boe.439342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 05/02/2023]
Abstract
Smartphone-based fluorescence imaging systems have the potential to provide convenient quantitative image guidance at the point of care. However, common approaches have required the addition of complex optical attachments, which reduce translation potential. In this study, a simple clip-on attachment appropriate for fluorescence imaging of protoporphyrin-IX (PpIX) in skin was designed using the built-in light source and ultrawide camera sensor of a smartphone. Software control for image acquisition and quantitative analysis was developed using the 10-bit video capability of the phone. Optical performance was characterized using PpIX in liquid tissue phantoms and endogenously produced PpIX in mice and human skin. The proposed system achieves a very compact form factor (<30 cm3) and can be readily fabricated using widely available low-cost materials. The limit of detection of PpIX in optical phantoms was <10 nM, with good signal linearity from 10 to 1000 nM (R2 >0.99). Both murine and human skin imaging verified that in vivo PpIX fluorescence was detected within 1 hour of applying aminolevulinic acid (ALA) gel. This ultracompact handheld system for quantification of PpIX in skin is well-suited for dermatology clinical workflows. Due to its simplicity and form factor, the proposed system can be readily adapted for use with other smartphone devices and fluorescence imaging applications. Hardware design and software for the system is made freely available on GitHub (https://github.com/optmed/CompactFluorescenceCam).
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Affiliation(s)
- Brady Hunt
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
| | - Samuel S. Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
| | - Alberto J. Ruiz
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
| | - M. Shane Chapman
- Geisel School of Medicine, Department of Dermatology, Hanover, New Hampshire 03755, USA
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
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18
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Ruiz AJ, Garg S, Streeter SS, Giallorenzi MK, LaRochelle EPM, Samkoe KS, Pogue BW. 3D printing fluorescent material with tunable optical properties. Sci Rep 2021; 11:17135. [PMID: 34429467 PMCID: PMC8384872 DOI: 10.1038/s41598-021-96496-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023] Open
Abstract
The 3D printing of fluorescent materials could help develop, validate, and translate imaging technologies, including systems for fluorescence-guided surgery. Despite advances in 3D printing techniques for optical targets, no comprehensive method has been demonstrated for the simultaneous incorporation of fluorophores and fine-tuning of absorption and scattering properties. Here, we introduce a photopolymer-based 3D printing method for manufacturing fluorescent material with tunable optical properties. The results demonstrate the ability to 3D print various individual fluorophores at reasonably high fluorescence yields, including IR-125, quantum dots, methylene blue, and rhodamine 590. Furthermore, tuning of the absorption and reduced scattering coefficients is demonstrated within the relevant mamalian soft tissue coefficient ranges of 0.005-0.05 mm-1 and 0.2-1.5 mm-1, respectively. Fabrication of fluorophore-doped biomimicking and complex geometric structures validated the ability to print feature sizes less than 200 μm. The presented methods and optical characterization techniques provide the foundation for the manufacturing of solid 3D printed fluorescent structures, with direct relevance to biomedical optics and the broad adoption of fast manufacturing methods in fluorescence imaging.
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Affiliation(s)
- Alberto J Ruiz
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA.
- QUEL Imaging LLC, 85 N Main Streeet, White River Junction, VT, 05001, USA.
| | - Sadhya Garg
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
| | - Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
| | - Mia K Giallorenzi
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
| | | | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
- QUEL Imaging LLC, 85 N Main Streeet, White River Junction, VT, 05001, USA
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19
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Streeter SS, Jacques SL, Pogue BW. Perspective on diffuse light in tissue: subsampling photon populations. J Biomed Opt 2021; 26:JBO-210114-PER. [PMID: 34216136 PMCID: PMC8253553 DOI: 10.1117/1.jbo.26.7.070601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/17/2021] [Indexed: 05/15/2023]
Abstract
SIGNIFICANCE Diffuse light is ubiquitous in biomedical optics and imaging. Understanding the process of migration of an initial photon population entering tissue to a completely randomized, diffusely scattered population provides valuable insight to the interpretation and design of optical measurements. AIM The goal of this perspective is to present a brief, unifying analytical framework to describe how properties of light transition from an initial state to a distributed state as light diffusion occurs. APPROACH First, measurement parameters of light are introduced, and Monte Carlo simulations along with a simple analytical expression are used to explore how these individual parameters might exhibit diffusive behavior. Second, techniques to perform optical measurements are considered, highlighting how various measurement parameters can be leveraged to subsample photon populations. RESULTS Simulation results reinforce the fact that light undergoes a transition from a non-diffuse population to one that is first subdiffuse and then fully diffuse. Myriad experimental methods exist to isolate subpopulations of photons, which can be broadly categorized as source- and/or detector-encoded techniques, as well as methods of tagging the tissue of interest. CONCLUSIONS Characteristic properties of light progressing to diffusion can be described by some form of Gaussian distribution that grows in space, time, angle, wavelength, polarization, and coherence. In some cases, these features can be approximated by simpler exponential behavior. Experimental methods to subsample features of the photon distribution can be achieved or theoretical methods can be used to better interpret the data with this framework.
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Affiliation(s)
- Samuel S. Streeter
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
- Address all correspondence to Samuel S. Streeter,
| | - Steven L. Jacques
- University of Washington, Department of Bioengineering, Seattle, Washington, United States
| | - Brian W. Pogue
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
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20
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Pardo A, Streeter SS, Maloney BW, Gutierrez-Gutierrez JA, McClatchy DM, Wells WA, Paulsen KD, Lopez-Higuera JM, Pogue BW, Conde OM. Modeling and Synthesis of Breast Cancer Optical Property Signatures With Generative Models. IEEE Trans Med Imaging 2021; 40:1687-1701. [PMID: 33684035 PMCID: PMC8224479 DOI: 10.1109/tmi.2021.3064464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Is it possible to find deterministic relationships between optical measurements and pathophysiology in an unsupervised manner and based on data alone? Optical property quantification is a rapidly growing biomedical imaging technique for characterizing biological tissues that shows promise in a range of clinical applications, such as intraoperative breast-conserving surgery margin assessment. However, translating tissue optical properties to clinical pathology information is still a cumbersome problem due to, amongst other things, inter- and intrapatient variability, calibration, and ultimately the nonlinear behavior of light in turbid media. These challenges limit the ability of standard statistical methods to generate a simple model of pathology, requiring more advanced algorithms. We present a data-driven, nonlinear model of breast cancer pathology for real-time margin assessment of resected samples using optical properties derived from spatial frequency domain imaging data. A series of deep neural network models are employed to obtain sets of latent embeddings that relate optical data signatures to the underlying tissue pathology in a tractable manner. These self-explanatory models can translate absorption and scattering properties measured from pathology, while also being able to synthesize new data. The method was tested on a total of 70 resected breast tissue samples containing 137 regions of interest, achieving rapid optical property modeling with errors only limited by current semi-empirical models, allowing for mass sample synthesis and providing a systematic understanding of dataset properties, paving the way for deep automated margin assessment algorithms using structured light imaging or, in principle, any other optical imaging technique seeking modeling. Code is available.
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21
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Streeter SS, Maloney BW, Zuurbier RA, Wells WA, Barth RJ, Paulsen KD, Pogue BW. Optical scatter imaging of resected breast tumor structures matches the patterns of micro-computed tomography. Phys Med Biol 2021; 66. [PMID: 34061046 DOI: 10.1088/1361-6560/ac01f1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022]
Abstract
In patients undergoing breast-conserving surgery (BCS), the rate of re-excision procedures to remove residual tumor left behind after initial resection can be high. Projection radiography, and recently, volumetric x-ray imaging are used to assess margin adequacy, but x-ray imaging lacks contrast between healthy, abnormal benign, and malignant fibrous tissues important for surgical decision making. The purpose of this study was to compare micro-CT and optical scatter imagery of surgical breast specimens and to demonstrate enhanced contrast-to intra-tumoral morphologies and tumor boundary features revealed by optical scatter imaging. A total of 57 breast tumor slices from 57 patients were imagedex vivoby spatially co-registered micro-CT and optical scatter scanning. Optical scatter exhibited greater similarity with micro-CT in 89% (51/57) of specimens versus diffuse white light (DWL) luminance using mutual information (mean ± standard deviation of 0.48 ± 0.21 versus 0.24 ± 0.12;p < 0.001) and in 81% (46/57) of specimens using the Sørensen-Dice coefficient (0.48 ± 0.21 versus 0.33 ± 0.18;p < 0.001). The coefficient of variation (CV) quantified the feature content in each image. Optical scatter exhibited the highest CV in every specimen (optical scatter: 0.70 ± 0.17; diffuse luminance: 0.24 ± 01; micro-CT: 0.15 ± 0.03 for micro-CT;p < 0.001). Optical scatter also exhibited the highest contrast ratios across representative tumor boundaries with adjacent healthy/benign fibrous tissues (1.5-3.7 for optical scatter; 1.0-1.1 for diffuse luminance; 1.0-1.1 for micro-CT). The two main findings from this study were: first, optical scatter contrast was in general similar to the radiological view of the tissue relative to DWL imaging; and second, optical scatter revealed additional features associated with fibrous tissue structures of similar radiodensity that may be relevant to diagnosis. The value of micro-CT lies in its rapid three-dimensional scanning of specimen morphology, and combined with optical scatter imaging with sensitivity to fibrous surface tissues, may be an attractive solution for margin assessment during BCS.
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Affiliation(s)
- Samuel S Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
| | - Benjamin W Maloney
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
| | - Rebecca A Zuurbier
- Departments of Radiology (RAZ), Pathology and Laboratory Medicine (WAW), and Surgery (RJB), Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America
| | - Wendy A Wells
- Departments of Radiology (RAZ), Pathology and Laboratory Medicine (WAW), and Surgery (RJB), Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America
| | - Richard J Barth
- Departments of Radiology (RAZ), Pathology and Laboratory Medicine (WAW), and Surgery (RJB), Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States of America
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Streeter SS, Maloney BW, Paulsen KD, Pogue BW. Active line scan with spatial gating for sub-diffuse reflectance imaging of scatter microtexture. Opt Lett 2020; 45:6378-6381. [PMID: 33258816 PMCID: PMC9161375 DOI: 10.1364/ol.404415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/12/2020] [Indexed: 06/01/2023]
Abstract
We examine the value of an active line scan with spatial gating for imaging sub-diffuse, wide-field reflectance microtexture. Line scanning combined with spatial gating and linear translation can be used for localized detection of features in the surface layer of a turbid target. The line scan provides broadband spatial frequency modulation, and the spatial gating effectively high-pass filters the reflectance. The major benefit of this approach is that of high dynamic range (70%-90%) signal preservation and high contrast to noise when imaging at high spatial frequencies. Alternative approaches, such as spatial frequency domain imaging, are degraded by low dynamic range in demodulated images, making it nearly impossible to image over a wide field of view at frequencies over 1.5mm-1 using commercial technology. As such, active line scanning with spatial gating presents as an inherently high sensitivity and high dynamic range method of imaging microscopic scattering features in only the surface layer of a turbid medium.
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Affiliation(s)
- Samuel S. Streeter
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, USA
| | - Benjamin W. Maloney
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, USA
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, USA
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, USA
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23
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LaRochelle EPM, Soter J, Barrios L, Guzmán M, Streeter SS, Gunn JR, Bejarano S, Pogue BW. Imaging luminescent tattoo inks for direct visualization of linac and cobalt irradiation. Med Phys 2020; 47:1807-1812. [PMID: 32056218 PMCID: PMC7198205 DOI: 10.1002/mp.14094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/16/2020] [Accepted: 02/08/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Tattoo fiducials are commonly used in radiotherapy patient alignment, and recent studies have examined the use of UV-excited luminescent tattoo ink as a cosmetic substitute to make these visible under UV illumination. The goal of this study was to show how luminescent tattoo inks could be excited with MV radiation and imaged during beam delivery for direct visualization of field position. METHODS A survey of nine UV-sensitive tattoo inks with various emission spectra were investigated using both UV and MV excitation. Images of liquid solutions were collected under MV excitation using an intensified-CMOS imager. Solid skin-simulating phantoms were imaged with both surface-painted ink and in situ tattooing during dose delivery by both a clinical linear accelerator and cobalt-60 source. RESULTS The UV inks have peak fluorescence emission ranging from approximately 440 to 600 nm with lifetimes near 11-16 μs. The luminescence intensity is approximately 6x higher during the x-ray pulse than after the pulse, however, the signal-to-noise is only approximately twice as large. Spatial resolution for imaging was achieved at 1.6 mm accuracy in a skin test phantom. Optical filtering allows for continuous imaging using a cobalt source and provides a mechanism to discriminate ink colors using a monochromatic image sensor. CONCLUSIONS This study demonstrates how low-cost inks can be used as fiducial markers and imaged both using time-gated and continuous modes during MV dose delivery. Phantom studies demonstrate the potential application of real-time field verification. Further studies are required to understand if this technique could be used as a tool for radiation dosimetry.
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Affiliation(s)
| | - Jennifer Soter
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | | | | | | | - Jason R. Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | | | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
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24
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Streeter SS, Maloney BW, McClatchy DM, Jermyn M, Pogue BW, Rizzo EJ, Wells WA, Paulsen KD. Structured light imaging for breast-conserving surgery, part II: texture analysis and classification. J Biomed Opt 2019; 24:1-12. [PMID: 31522486 PMCID: PMC6744928 DOI: 10.1117/1.jbo.24.9.096003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/14/2019] [Indexed: 05/08/2023]
Abstract
Subdiffuse spatial frequency domain imaging (sd-SFDI) data of 42 freshly excised, bread-loafed tumor resections from breast-conserving surgery (BCS) were evaluated using texture analysis and a machine learning framework for tissue classification. Resections contained 56 regions of interest (RoIs) determined by expert histopathological analysis. RoIs were coregistered with sd-SFDI data and sampled into ∼4 × 4 mm2 subimage samples of confirmed and homogeneous histological categories. Sd-SFDI reflectance textures were analyzed using gray-level co-occurrence matrix pixel statistics, image primitives, and power spectral density curve parameters. Texture metrics exhibited statistical significance (p-value < 0.05) between three benign and three malignant tissue subtypes. Pairs of benign and malignant subtypes underwent texture-based, binary classification with correlation-based feature selection. Classification performance was evaluated using fivefold cross-validation and feature grid searching. Classification using subdiffuse, monochromatic reflectance (illumination spatial frequency of fx = 1.37 mm − 1, optical wavelength of λ = 490 nm) achieved accuracies ranging from 0.55 (95% CI: 0.41 to 0.69) to 0.95 (95% CI: 0.90 to 1.00) depending on the benign–malignant diagnosis pair. Texture analysis of sd-SFDI data maintains the spatial context within images, is free of light transport model assumptions, and may provide an alternative, computationally efficient approach for wide field-of-view (cm2) BCS tumor margin assessment relative to pixel-based optical scatter or color properties alone.
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Affiliation(s)
- Samuel S. Streeter
- Thayer School of Engineering at Dartmouth, Optics in Medicine, Hanover, New Hampshire, United States
- Address all correspondence to Samuel S. Streeter, E-mail:
| | - Benjamin W. Maloney
- Thayer School of Engineering at Dartmouth, Optics in Medicine, Hanover, New Hampshire, United States
| | - David M. McClatchy
- Thayer School of Engineering at Dartmouth, Optics in Medicine, Hanover, New Hampshire, United States
| | - Michael Jermyn
- Thayer School of Engineering at Dartmouth, Optics in Medicine, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Thayer School of Engineering at Dartmouth, Optics in Medicine, Hanover, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Department of Surgery, Hanover, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Department of Pathology, Hanover, New Hampshire, United States
| | - Elizabeth J. Rizzo
- Geisel School of Medicine at Dartmouth, Department of Pathology, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Wendy A. Wells
- Geisel School of Medicine at Dartmouth, Department of Pathology, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Keith D. Paulsen
- Thayer School of Engineering at Dartmouth, Optics in Medicine, Hanover, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Department of Surgery, Hanover, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Department of Pathology, Hanover, New Hampshire, United States
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Maloney BW, Streeter SS, McClatchy DM, Pogue BW, Rizzo EJ, Wells WA, Paulsen KD. Structured light imaging for breast-conserving surgery, part I: optical scatter and color analysis. J Biomed Opt 2019; 24:1-8. [PMID: 31512442 PMCID: PMC6737988 DOI: 10.1117/1.jbo.24.9.096002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/05/2019] [Indexed: 05/08/2023]
Abstract
Structured light imaging (SLI) with high spatial frequency (HSF) illumination provides a method to amplify native tissue scatter contrast and better differentiate superficial tissues. This was investigated for margin analysis in breast-conserving surgery (BCS) and imaging gross clinical tissues from 70 BCS patients, and the SLI distinguishability was examined for six malignancy subtypes relative to three benign/normal breast tissue subtypes. Optical scattering images recovered were analyzed with five different color space representations of multispectral demodulated reflectance. Excluding rare combinations of invasive lobular carcinoma and fibrocystic disease, SLI was able to classify all subtypes of breast malignancy from surrounding benign tissues (p-value < 0.05) based on scatter and color parameters. For color analysis, HSF illumination of the sample generated more statistically significant discrimination than regular uniform illumination. Pathological information about lesion subtype from a presurgical biopsy can inform the search for malignancy on the surfaces of specimens during BCS, motivating the focus on pairwise classification analysis. This SLI modality is of particular interest for its potential to differentiate tissue classes across a wide field-of-view (∼100 cm2) and for its ability to acquire images of macroscopic tissues rapidly but with microscopic-level sensitivity to structural and morphological tissue constituents.
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Affiliation(s)
- Benjamin W. Maloney
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Address all correspondence to Benjamin W. Maloney,
| | - Samuel S. Streeter
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - David M. McClatchy
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Elizabeth J. Rizzo
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
| | - Wendy A. Wells
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
| | - Keith D. Paulsen
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
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Abstract
Regression equations relating pollen taxa from surface samples to temperature and precipitation are applied to a radiocarbon-dated pollen sequence in a lake core from Alerce. The resulting curves are a measure of the fluctuations of these climatic variables and show similarities to other late Quaternary records from the Southern Hemisphere.
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Abstract
Benthic foraminiferal faunas in a piston core from 3331 meters at 44 degrees N on the Mid-Atlantic Ridge show striking variations in the relative abundance of species. Uvigerina peregrina, which is broadly distributed today in the South Atlantic and in the Pacific in water that has been long isolated from the surface, is absent in the North and Equatorial Atlantic at depths occupied by highly oxygenated North Atlantic deep water. This species dominated the fauna at this site for much of the past 150,000 years. It is suggested that North Atlantic deepwater production was much reduced or eliminated at times of Uvigerina peregrina abundance, as a result of cooling and stratification of the Norwegian Sea surface, coincident with the times of the southward migration of the polar front in the North Atlantic.
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