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Dickey AK, Berkovich J, Leaf RK, Jiang PY, Lopez-Galmiche G, Rebeiz L, Wheeden K, Kochevar I, Savage W, Zhao S, Campisi E, Heo SY, Trueb J, LaRochelle EPM, Rogers J, Banks A, Chang JK. Observational pilot study of multi-wavelength wearable light dosimetry for erythropoietic protoporphyria. Int J Dermatol 2024. [PMID: 38602089 DOI: 10.1111/ijd.17166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Erythropoietic protoporphyria (EPP) causes painful light sensitivity, limiting quality of life. Our objective was to develop and validate a wearable light exposure device and correlate measurements with light sensitivity in EPP to predict and prevent symptoms. METHODS A wearable light dosimeter was developed to capture light doses of UVA, blue, and red wavelengths. A prospective observational pilot study was performed in which five EPP patients wore two light dosimeters for 3 weeks, one as a watch, and one as a shirt clip. RESULTS Standard deviation (SD) increases from the mean in the daily blue light dose increased the odds ratio (OR) for symptom risk more than the self-reported outdoor time (OR 2.76 vs. 2.38) or other wavelengths, and a one SD increase from the mean in the daily blue light wristband device dose increased the OR for symptom risk more than the daily blue light shirt clip (OR 2.45 vs. 1.62). The area under the receiver operator curve for the blue light wristband dose was 0.78, suggesting 78% predictive accuracy. CONCLUSION These data demonstrate that wearable blue light dosimetry worn as a wristband is a promising method for measuring light exposure and predicting and preventing symptoms in EPP.
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Affiliation(s)
- Amy K Dickey
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Jaime Berkovich
- Wearifi, Inc., Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Northwestern University Department of Materials Science and Engineering, Evanston, IL, USA
| | - Rebecca K Leaf
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paul Y Jiang
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Lina Rebeiz
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Irene Kochevar
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Seung Y Heo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Jacob Trueb
- Wearifi, Inc., Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | | | - John Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Northwestern University Department of Materials Science and Engineering, Evanston, IL, USA
| | - Anthony Banks
- Wearifi, Inc., Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Jan-Kai Chang
- Wearifi, Inc., Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
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Ruiz AJ, Allen R, Giallorenzi MK, Samkoe KS, Shane Chapman M, Pogue BW. Smartphone-based dual radiometric fluorescence and white-light imager for quantification of protoporphyrin IX in skin. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:086003. [PMID: 37638107 PMCID: PMC10460113 DOI: 10.1117/1.jbo.28.8.086003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 08/29/2023]
Abstract
Significance The quantification of protoporphyrin IX (PpIX) in skin can be used to study photodynamic therapy (PDT) treatments, understand porphyrin mechanisms, and enhance preoperative mapping of non-melanoma skin cancers. Aim We aim to develop a smartphone-based imager for performing simultaneous radiometric fluorescence (FL) and white light (WL) imaging to study the baseline levels, accumulation, and photobleaching of PpIX in skin. Approach A smartphone-based dual FL and WL imager (sDUO) is introduced alongside new radiometric calibration methods for providing SI-units of measurements in both pre-clinical and clinical settings. These radiometric measurements and corresponding PpIX concentration estimations are applied to clinical measurements to understand mechanistic differences between PDT treatments, accumulation differences between normal tissue and actinic keratosis lesions, and the correlation of photosensitizer concentrations to treatment outcomes. Results The sDUO alongside the developed methods provided radiometric FL measurements (nW / cm 2 ) with a demonstrated sub nanomolar PpIX sensitivity in 1% intralipid phantoms. Patients undergoing PDT treatment of actinic keratosis (AK) lesions were imaged, capturing the increase and subsequent decrease in FL associated with the incubation and irradiation timepoints of lamp-based PDT. Furthermore, the clinical measurements showed mechanistic differences in new daylight-based treatment modalities alongside the selective accumulation of PpIX within AK lesions. The use of the radiometric calibration enabled the reporting of detected PpIX FL in units of nW / cm 2 with the use of liquid phantom measurements allowing for the estimation of in-vivo molar concentrations of skin PpIX. Conclusions The phantom, pre-clinical, and clinical measurements demonstrated the capability of the sDUO to provide quantitative measurements of PpIX FL. The results demonstrate the use of the sDUO for the quantification of PpIX accumulation and photobleaching in a clinical setting, with implications for improving the diagnosis and treatment of various skin conditions.
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Affiliation(s)
- Alberto J. Ruiz
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- QUEL Imaging, LLC, White River Junction, Vermont, United States
| | - Richard Allen
- QUEL Imaging, LLC, White River Junction, Vermont, United States
| | - Mia K. Giallorenzi
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Kimberley S. Samkoe
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - M. Shane Chapman
- Dartmouth Health, Department of Dermatology, Lebanon, 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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Efendiev K, Alekseeva P, Shiryaev A, Voitova A, Linkov K, Pisareva T, Reshetov I, Loschenov V. Near-infrared phototheranostics of tumors with protoporphyrin IX and chlorin e6 photosensitizers. Photodiagnosis Photodyn Ther 2023; 42:103566. [PMID: 37059163 DOI: 10.1016/j.pdpdt.2023.103566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND The study aims to develop a method for phototheranostics of tumors in the near-infrared (NIR) range using protoporphyrin IX (PpIX) and chlorin e6 (Ce6) photosensitizers (PSs) MATERIALS AND METHODS: Phototheranostics includes spectral fluorescence diagnostics of PS distribution and photodynamic therapy (PDT) using a single laser in the red spectral range. PpIX and Ce6 fluorescence were registered in the NIR range. PpIX and Ce6 photobleaching was determined during PDT by the change in PS fluorescence. NIR phototheranostics with PpIX and Ce6 were performed on optical phantoms and tumors of patients with oral leukoplakia and basal cell carcinoma. RESULTS NIR spectral fluorescence diagnostics of optical phantoms with PpIX or Ce6 is possible when fluorescence is excited by 635 or 660 nm lasers. Fluorescence intensity of PpIX and Ce6 was measured in the range of 725-780 nm. The highest values of signal-to-noise in the case of phantoms with PpIX were observed at λexc=635 nm, and for phantoms with Ce6 at λexc=660 nm. NIR phototheranostics provides the detection of tumor tissues with PpIX or Ce6 accumulation. The PSs photobleaching in the tumor during PDT occurs according to a bi-exponential law. CONCLUSION Phototheranostics of tumors containing PpIX or Ce6 allows fluorescent monitoring of PS distribution in the NIR range and measuring PSs photobleaching during light exposure that provides personalization of the photodynamic exposure duration to deeper tumors. Using a single laser for fluorescence diagnostics and PDT reduces patient treatment time.
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Affiliation(s)
- Kanamat Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; Department of Laser Micro-, Nano-, and Biotechnology, Institute of Engineering Physics for Biomedicine, National Research Nuclear University "MEPhI", 115409 Moscow, Russia.
| | - Polina Alekseeva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia.
| | - Artem Shiryaev
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Levshin Institute of Cluster Oncology, University Clinical Hospital No.1, 119435 Moscow, Russia.
| | | | - Kirill Linkov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia.
| | - Tatiana Pisareva
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Levshin Institute of Cluster Oncology, University Clinical Hospital No.1, 119435 Moscow, Russia.
| | - Igor Reshetov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Levshin Institute of Cluster Oncology, University Clinical Hospital No.1, 119435 Moscow, Russia.
| | - Victor Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; Department of Laser Micro-, Nano-, and Biotechnology, Institute of Engineering Physics for Biomedicine, National Research Nuclear University "MEPhI", 115409 Moscow, Russia.
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4
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Ruiz AJ, LaRochelle EPM, Fahrner MP, Emond JA, Samkoe KS, Pogue BW, Chapman MS. Equivalent efficacy of indoor daylight and lamp‐based 5‐aminolevulinic acid photodynamic therapy for treatment of actinic keratosis. SKIN HEALTH AND DISEASE 2023. [PMID: 37538332 PMCID: PMC10395623 DOI: 10.1002/ski2.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Background Photodynamic therapy (PDT) is widely used as a treatment for actinic keratoses (AK), with new sunlight-based regimens proposed as alternatives to lamp-based treatments. Prescribing indoor daylight activation could help address the seasonal temperature, clinical supervision, and access variability associated with outdoor treatments. Objective To compare the AK lesion clearance efficacy of indoor daylight PDT treatment (30 min of 5-aminolevulinic acid (ALA) pre-incubation, followed by 2 h of indoor sunlight) versus a lamp-based PDT treatment (30 min of ALA preincubation, followed by 10 min of red light). Methods A prospective clinical trial was conducted with 41 patients. Topical 10% ALA was applied to the entire treatment site (face, forehead, scalp). Patients were assigned to either the lamp-based or indoor daylight treatment. Actinic keratosis lesion counts were determined by clinical examination and recorded for pre-treatment, 1-month, and 6-month follow-up visits. Results There was no statistical difference in the efficacy of AK lesion clearance between the red-lamp (1-month clearance = 57 ± 17%, 6-month clearance = 57 ± 20%) and indoor daylight treatment (1-month clearance = 61 ± 19%, 6-month clearance = 67 ± 20%). A 95% confidence interval of the difference of the means was measured between -4.4% and 13.4% for 1-month, and -2.2% and +23.6% for 6-month timepoints when comparing the indoor daylight to the red-lamp treatment, with a priori interval of equivalence of ±20%. Limitations Ensuring an equivalent dose between the indoor and lamp treatment cohorts limited randomisation since it required performing indoor daylight treatments only during sunny days. Conclusion Indoor-daylight PDT provided equivalent AK treatment efficacy to a lamp-based regimen while overcoming temperature limitations and UV-block sunscreen issues associated with outdoor sunlight treatments in the winter. Clinical trial registration Clinicaltrials.gov listing: NCT03805737.
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Affiliation(s)
- Alberto J. Ruiz
- Thayer School of Engineering at Dartmouth Hanover New Hampshire USA
| | | | | | | | | | - Brian W. Pogue
- Thayer School of Engineering at Dartmouth Hanover New Hampshire USA
| | - M. Shane Chapman
- Department of Dermatology Geisel School of Medicine at Dartmouth Hanover New Hampshire USA
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5
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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. JOURNAL OF BIOMEDICAL OPTICS 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] [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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6
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Ruiz AJ, LaRochelle EPM, Samkoe KS, Chapman MS, Pogue BW. Effective fluence and dose at skin depth of daylight and lamp sources for PpIX-based photodynamic therapy. Photodiagnosis Photodyn Ther 2023; 41:103260. [PMID: 36627070 DOI: 10.1016/j.pdpdt.2022.103260] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
SIGNIFICANCE Skin-based photodynamic therapy (PDT) is used for the clinical treatment of actinic keratosis (AKs) and other skin lesions with continued expansion into the standard of care. Due to the spectral dependency of photosensitizer activation and skin optical fluence, there is a need for more accurate methods to estimate the delivered dose at depth from different PDT light sources and treatment regimens. AIM Develop radiometric methods for calculating photosensitizer-effective fluence and dose at depth and determine differences between red-lamp, blue-lamp, and daylight-based PDT treatments. METHODS Radiometric measurements of FDA-approved PDT lamp sources, outdoor daylight, and indoor daylight were performed for clinically relevant AK treatments. The protoporphyrin IX (PpIX) equivalent irradiance, fluence, and dose for each light source were calculated from the PpIX absorption spectrum and a 7-layer skin fluence model. The effective fluence and dose at depth was estimated by combining the spectral attenuation predicted at each wavelength and depth with the source fluence at each wavelength. RESULTS The red-lamp source had the highest illuminance (112,000 lumen/m2), but lowest PpIX-effective irradiance (9.6 W/m2), and highest effective fluence at depth (10.8 W/m2 at 500 µm). In contrast, the blue light source had the lowest illuminance (2300 lumen/m2), but highest PpIX effective irradiance (37.0 W/m2), and ultimately the lowest effective fluence at depth (0.18 W/cm2 at 500 µm). The daylight source had values of (outdoor | indoor) illuminance of (49,200 | 37,800 lumen/m2), effective irradiance of (19.2 | 10.7 W/m2), and effective fluence of (1.50 | 1.08 W/m2 at 500 µm). The effective fluence and dose at depth facilitated the comparison of treatment regimens, for example, calculating an equivalent dose for a 2 hr indoor daylight treatment and a 10 min red-light treatment for the 300-1000 μm depth range. CONCLUSIONS The consideration of PpIX-effective fluence at varying depths is necessary to provide adequate comparisons of the delivered dose from PDT light sources. Methods for calculating radiometric fluence and delivered dose at depth were introduced, with open source MATLAB code, to help overcome the limitations of commonly used photometric and irradiance-based reporting.
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Affiliation(s)
- Alberto J Ruiz
- Dartmouth Engineering, 15 Thayer Drive, Hanover, NH 03755, USA; QUEL Imaging, LLC, White River Junction, VT 0500, USA.
| | | | | | - M Shane Chapman
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Brian W Pogue
- Dartmouth Engineering, 15 Thayer Drive, Hanover, NH 03755, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53715, USA
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Daylight-PDT: everything under the sun. Biochem Soc Trans 2022; 50:975-985. [PMID: 35385082 PMCID: PMC9162453 DOI: 10.1042/bst20200822] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 12/18/2022]
Abstract
5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) was first implemented over three decades ago and has since been mainly part of clinical practice for the management of pre-cancerous and cancerous skin lesions. Photodynamic therapy relies on the combination of a photosensitizer, light and oxygen to cause photo-oxidative damage of cellular components. 5-Aminolevulinic acid (ALA) is a natural precursor of the heme biosynthetic pathway, which when exogenously administered leads to the accumulation of the photoactivatable protoporphyrin IX. Although, effective and providing excellent cosmetic outcomes, its use has been restricted by the burning, stinging, and prickling sensation associated with treatment, as well as cutaneous adverse reactions that may be induced. Despite intense research in the realm of drug delivery, pain moderation, and light delivery, a novel protocol design using sunlight has led to some of the best results in terms of treatment response and patient satisfaction. Daylight PDT is the protocol of choice for the management of treatment of multiple or confluent actinic keratoses (AK) skin lesions. This review aims to revisit the photophysical, physicochemical and biological characteristics of ALA-PDT, and the underlying mechanisms resulting in daylight PDT efficiency and limitations.
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8
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Austin E, Geisler AN, Nguyen J, Kohli I, Hamzavi I, Lim HW, Jagdeo J. Visible light. Part I: Properties and cutaneous effects of visible light. J Am Acad Dermatol 2021; 84:1219-1231. [PMID: 33640508 DOI: 10.1016/j.jaad.2021.02.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022]
Abstract
Approximately 50% of the sunlight reaching the Earth's surface is visible light (400-700 nm). Other sources of visible light include lasers, light-emitting diodes, and flash lamps. Photons from visible light are absorbed by photoreceptive chromophores (e.g., melanin, heme, and opsins), altering skin function by activating and imparting energy to chromophores. Additionally, visible light can penetrate the full thickness of the skin and induce pigmentation and erythema. Clinically, lasers and light devices are used to treat skin conditions by utilizing specific wavelengths and treatment parameters. Red and blue light from light-emitting diodes and intense pulsed light have been studied as antimicrobial and anti-inflammatory treatments for acne. Pulsed dye lasers are used to treat vascular lesions in adults and infants. Further research is necessary to determine the functional significance of visible light on skin health without confounding the influence of ultraviolet and infrared wavelengths.
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Affiliation(s)
- Evan Austin
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | | | - Julie Nguyen
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | - Indermeet Kohli
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Iltefat Hamzavi
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Henry W Lim
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Jared Jagdeo
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York.
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Stringasci MD, Ciol H, Romano RA, Buzza HH, Leite IS, Inada NM, Bagnato VS. MAL-associated methyl nicotinate for topical PDT improvement. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 213:112071. [PMID: 33242779 DOI: 10.1016/j.jphotobiol.2020.112071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/29/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
Photosensitization of all tissue in sufficient quantity to generate damage is one of the limiting factors for Photodynamic Therapy (PDT) efficiency. Methyl nicotinate (MN) is a thermogenic and vasodilating substance that facilitates the topical tissue penetration of some compounds. The topical MAL (methyl aminolevulinate) PDT is commonly used as a precursor of protoporphyrin IX (PpIX). This study investigates the safety of topical use in NM, as well as its ability to improve the efficiency of topical PDT. For this, we investigate the cytotoxicity of MN, as well as its actions in increasing cellular metabolism and vasodilation. Besides, its ability to optimize the formation of PpIX in the tissue when associated with MAL cream was investigated, besides assessing the severity of necrosis obtained by treatments. The cytotoxicity of MN was tested for concentrations of 0, 0.1, 0.25, 0.5, 0.75 and 1% in cell culture. For the concentration of 0.5%, the cellular metabolism was evaluated using confocal microscopy to calculate the redox rate. In the Chorioallantoic Membrane Model, vasodilation was evaluated for concentrations of 0.5 and 1% MN during 1 h of incubation. In the animal model, the healthy skin of Wistar rat was used to evaluate the production of PpIX in the tissue and the degree of necrosis obtained by Photodynamic therapy when using NM associated with methyl aminolevulinate. It was observed the non-cytotoxicity in vitro of MN in the concentration used (0.5%) and its ability to increase cellular metabolism. In a chorioallantoic model, the MN vasodilation power was demonstrated for different caliber of vessels. In vivo studies are showing that the incorporation of MN in the MAL cream increases the amount of PpIX produced in the tissue causing a higher effect on the epidermis after PDT. This improvement of the protocol may make the procedure more effective both in the destruction of tumor tissue and in the treatment of deeper cells decreasing possible recurrence, in addition to allowing improvements in the protocol, such as reducing the cream's incubation time.
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Affiliation(s)
| | - Heloísa Ciol
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil
| | | | - Hilde Harb Buzza
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil
| | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Brazil; Hagler Fellow, Texas A&M University, College Station, Texas, USA
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10
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LaRochelle EPM, Pogue BW. Theoretical lateral and axial sensitivity limits and choices of molecular reporters for Cherenkov-excited luminescence in tissue during x-ray beam scanning. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200235R. [PMID: 33185051 PMCID: PMC7658603 DOI: 10.1117/1.jbo.25.11.116004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/21/2020] [Indexed: 05/03/2023]
Abstract
PURPOSE Unlike fluorescence imaging utilizing an external excitation source, Cherenkov emissions and Cherenkov-excited luminescence occur within a medium when irradiated with high-energy x-rays. Methods to improve the understanding of the lateral spread and axial depth distribution of these emissions are needed as an initial step to improve the overall system resolution. METHODS Monte Carlo simulations were developed to investigate the lateral spread of thin sheets of high-energy sources and compared to experimental measurements of similar sources in water. Additional simulations of a multilayer skin model were used to investigate the limits of detection using both 6- and 18-MV x-ray sources with fluorescence excitation for inclusion depths up to 1 cm. RESULTS Simulations comparing the lateral spread of high-energy sources show approximately 100 × higher optical yield from electrons than photons, although electrons showed a larger penumbra in both the simulations and experimental measurements. Cherenkov excitation has a roughly inverse wavelength squared dependence in intensity but is largely redshifted in excitation through any distance of tissue. The calculated emission spectra in tissue were convolved with a database of luminescent compounds to produce a computational ranking of potential Cherenkov-excited luminescence molecular contrast agents. CONCLUSIONS Models of thin x-ray and electron sources were compared with experimental measurements, showing similar trends in energy and source type. Surface detection of Cherenkov-excited luminescence appears to be limited by the mean free path of the luminescence emission, where for the given simulation only 2% of the inclusion emissions reached the surface from a depth of 7 mm in a multilayer tissue model.
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Affiliation(s)
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
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11
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Chatterjee S, Budidha K, Kyriacou PA. Investigating the origin of photoplethysmography using a multiwavelength Monte Carlo model. Physiol Meas 2020; 41:084001. [PMID: 32585642 DOI: 10.1088/1361-6579/aba008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Photoplethysmography (PPG) is a photometric technique used for the measurement of volumetric changes in the blood. The recent interest in new applications of PPG has invigorated more fundamental research regarding the origin of the PPG waveform, which since its discovery in 1937, remains inconclusive. A handful of studies in the recent past have explored various hypotheses for the origin of PPG. These studies relate PPG to mechanical movement, red blood cell orientation or blood volume variations. OBJECTIVE Recognising the significance and need to corroborate a theory behind PPG formation, the present work rigorously investigates the origin of PPG based on a realistic model of light-tissue interactions. APPROACH A three-dimensional comprehensive Monte Carlo model of finger-PPG was developed and explored to quantify the optical entities pertinent to PPG (e.g. absorbance, reflectance, and penetration depth) as the functions of multiple wavelengths and source-detector separations. Complementary to the simulations, a pilot in vivo investigation was conducted on eight healthy volunteers. PPG signals were recorded using a custom-made multiwavelength sensor with an adjustable source-detector separation. MAIN RESULTS Simulated results illustrate the distribution of photon-tissue interactions in the reflectance PPG geometry. The depth-selective analysis quantifies the contributions of the dermal and subdermal tissue layers in the PPG wave formation. A strong negative correlation (r = -0.96) is found between the ratios of the simulated absorbances and measured PPG amplitudes. SIGNIFICANCE This work quantified for the first time the contributions of different tissue layers and sublayers in the formation of the PPG signal.
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Affiliation(s)
- Subhasri Chatterjee
- Research Centre for Biomedical Engineering, City, University of London, United Kingdom
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12
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Sánchez V, Garcia MR, Requena MB, Romano RA, de Boni L, Guimarães FEG, Pratavieira S. Theoretical and Experimental Analysis of Protoporphyrin IX Photodegradation Using Multi-Wavelength Light Sources. Photochem Photobiol 2020; 96:1208-1214. [PMID: 32668506 DOI: 10.1111/php.13311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022]
Abstract
Photodynamic procedures have been used in many applications, ranging from cancer treatment to microorganism inactivation. Photodynamic reactions start with the activation of a photosensitizing molecule with light, leading to the production of cytotoxic molecules that promote cell death. However, establishing the correct light and photosensitizer dosimetry for a broadband light source remains challenging. In this study, we proposed a theoretical mathematical model for the photodegradation of protoporphyrin IX (PpIX), when irradiated by multi-wavelength light sources. The theoretical model predicts the experimental photobleaching (temporal change in PpIX concentration) of PpIX for different light sources. We showed that photobleaching occurs independently of the light source wavelengths but instead depends only on the number of absorbed photons. The model presented here can be used as an important mathematical approach to better understand current photodynamic therapy protocols and help achieve optimization of the doses delivered.
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Affiliation(s)
- Víctor Sánchez
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil.,Gleb Wataghin Physics Institute, University of Campinas, Campinas, SP, Brazil
| | | | | | - Renan Arnon Romano
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - Leonardo de Boni
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
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13
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Wu RWK, Chu ESM, Yow CMN. Evaluation of the effect of 5-aminolevulinic acid hexyl ester (H-ALA) PDT on EBV LMP1 protein expression in human nasopharyngeal cells. Photodiagnosis Photodyn Ther 2020; 30:101801. [PMID: 32360854 DOI: 10.1016/j.pdpdt.2020.101801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023]
Abstract
Nasopharyngeal carcinoma (NPC) is of high prevalence in Hong Kong and southern China. The pathogenesis of NPC is closely associated with Epstein-Barr virus (EBV) infection via regulation of viral oncoprotein latent membrane protein 1 (LMP1). The conventional treatment for NPC is chemo-radiotherapy, but the prognosis remains poor for advanced stage, recurrent and metastatic NPC. Photodynamic therapy (PDT) is a therapeutic approach to combat tumors. PDT effectiveness depends on the interaction of photosensitizers, light and molecular oxygen. 5- aminolevulinic acid hexyl derivative (H-ALA) is one of the photosensitizers derived from 5-ALA. H-ALA with improved lipophilic properties by adding a long lipophilic chain (hexyl group) to 5-ALA, resulted in better penetration into cell cytoplasm. In this study, the effect of H-ALA-PDT on NPC cells (EBV positive C666-1 and EBV negative CNE2) was investigated. The H-ALA mediated cellular uptake and cytotoxicity was revealed via flow cytometry analysis and MTT assay respectively. H-ALA PDT mediated protein modulation was analysed by western blot analysis. Our finding reported that the cellular uptake of H-ALA in C666-1 and CNE2 cells was in a time dependent manner. H-ALA PDT was effective to C666-1 and CNE2 cells. EBV LMP1 proteins was expressed in C666-1 cells only and its expression was responsive to H-ALA PDT in a dose dependent manner. This work revealed the potential of H-ALA PDT as a treatment regiment for EBV positive NPC cells. Understanding the mechanism of H-ALA mediated PDT could develop improved strategies for the treatment of NPC.
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Affiliation(s)
- R W K Wu
- School of Medical and Health Sciences, Tung Wah College, Hong Kong Special Administrative Region; Medical Laboratory Science, Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
| | - E S M Chu
- School of Medical and Health Sciences, Tung Wah College, Hong Kong Special Administrative Region
| | - C M N Yow
- Medical Laboratory Science, Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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14
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O'Mahoney P, Eadie E. Bring the Sunshine Indoors: Easy Dosimetry for Indoor Daylight Photodynamic Therapy. Photochem Photobiol 2020; 96:434-436. [PMID: 31837154 DOI: 10.1111/php.13192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/16/2019] [Indexed: 11/27/2022]
Abstract
Daylight photodynamic therapy (DPDT) is an effective and patient preferred treatment for the management of field change actinic keratosis. An important factor in DPDT is light dosimetry, to ensure that patients receive sufficient daylight for effective treatment, and this is the focus of the contribution to this issue by (La Rochelle et al. [2019] Photochem. Photobiol., https://doi.org/10.1111/php.13170). In this work, the authors present an easy-to-use method for obtaining real-time information about patient received light dose during treatment and for determining indoor locations best suited to DPDT.
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Affiliation(s)
- Paul O'Mahoney
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, UK.,The Scottish Photodynamic Therapy Centre, Dundee, UK.,School of Medicine, University of Dundee, Dundee, UK
| | - Ewan Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, UK.,The Scottish Photodynamic Therapy Centre, Dundee, UK
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15
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Sheng T, Ong Y, Guo W, Zhu TC. Reactive oxygen species explicit dosimetry to predict tumor growth for benzoporphyrin derivative-mediated vascular photodynamic therapy. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-13. [PMID: 31912689 PMCID: PMC6952881 DOI: 10.1117/1.jbo.25.6.063805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
Photodynamic therapy (PDT) is a well-established treatment modality for cancer and other malignant diseases; however, quantities such as light fluence and PDT dose do not fully account for all of the dynamic interactions between the key components involved. In particular, fluence rate (ϕ) effects, which impact the photochemical oxygen consumption rate, are not accounted for. In this preclinical study, reacted reactive oxygen species ([ROS]rx) was investigated as a dosimetric quantity for PDT outcome. The ability of [ROS]rx to predict the cure index (CI) of tumor growth, CI = 1 - k / kctr, where k and kctr are the growth rate of tumor under PDT study and the control tumor without PDT, respectively, for benzoporphyrin derivative (BPD)-mediated PDT, was examined. Mice bearing radiation-induced fibrosarcoma (RIF) tumors were treated with different in-air fluences (Φ = 22.5 to 166.7 J / cm2) and in-air fluence rates (ϕair = 75 to 250 mW / cm2) with a BPD dose of 1 mg / kg and a drug-light interval (DLI) of 15 min. Treatment was delivered with a collimated laser beam of 1-cm-diameter at 690 nm. Explicit measurements of in-air light fluence rate, tissue oxygen concentration, and BPD concentration were used to calculate for [ROS]rx. Light fluence rate at 3-mm depth (ϕ3 mm), determined based on Monte-Carlo simulations, was used in the calculation of [ROS]rx at the base of tumor. CI was used as an endpoint for three dose metrics: light fluence, PDT dose, and [ROS]rx. PDT dose was defined as the product of the time-integral of photosensitizer concentration and ϕ3 mm. Preliminary studies show that [ROS]rx best correlates with CI and is an effective dosimetric quantity that can predict treatment outcome. The threshold dose for [ROS]rx for vascular BPD-mediated PDT using DLI of 15 min is determined to be 0.26 mM and is about 3.8 times smaller than the corresponding value for conventional BPD-mediated PDT using DLI of 3 h.
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Affiliation(s)
- Tianqi Sheng
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Yihong Ong
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Wensheng Guo
- University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania, United States
| | - Timothy C. Zhu
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
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16
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Walter AB, Simpson J, Jenkins JL, Skaar EP, Jansen ED. Optimization of optical parameters for improved photodynamic therapy of Staphylococcus aureus using endogenous coproporphyrin III. Photodiagnosis Photodyn Ther 2019; 29:101624. [PMID: 31866531 DOI: 10.1016/j.pdpdt.2019.101624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/28/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND It has recently been shown that endogenous photosensitization of Gram-positive bacteria is achieved through the accumulation of the heme precursor coproporphyrin III and not protoporphyrin IX, as was previously assumed. As previous studies have operated under this assumption, the efficacy of optimal targeting of the absorption peaks of coproporphyrin III has not been explored. METHODS Staphylococcus aureus was endogenously photosensitized through the addition of either the small molecule VU0038882, aminolevulinic acid, or both. The efficacy of five different LEDs whose wavelengths target different coproporphyrin III absorption peaks were determined in vitro. Based on these in vitro measurements, the effectiveness of utilizing these LEDs to treat a skin infection was predicted using a Monte Carlo simulation to estimate the fluence rates and resulting bacterial reductions as a function of depth. RESULTS Optimal targeting of the Soret band provided a 4.7-log improvement as compared to previously utilized wavelengths. Activation of the Q-bands was found to provide similar cytotoxic effects but required significantly larger doses of light. Despite near sterilization in vitro, it was predicted that Soret band targeted light would only provide at least a 2 log-reduction up to 430 μm into the skin while Q-band targeted light could remain effective up to 1 mm in depth. Multiplexing these different wavelengths was found to provide a further 0.5-1.0 log-reduction in bacterial viability. CONCLUSIONS Accurate targeting of coproporphyrin III has shown that endogenous photodynamic therapy has the potential to be further developed into an effective treatment of skin and soft tissue infections caused by Gram-positive bacteria.
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Affiliation(s)
- Alec B Walter
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Biophotonics Center, Vanderbilt University, Nashville, TN, USA
| | - Jocelyn Simpson
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Logan Jenkins
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Biophotonics Center, Vanderbilt University, Nashville, TN, USA
| | - Eric P Skaar
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Duco Jansen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Biophotonics Center, Vanderbilt University, Nashville, TN, USA.
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17
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Todd BK, Lesar A, O'Mahoney P, Eadie E, Ibbotson SH. Is there an optimal irradiation dose for photodynamic therapy: 37 J cm -2 or 75 J cm -2 ? Br J Dermatol 2019; 182:1287-1288. [PMID: 31677268 DOI: 10.1111/bjd.18644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B K Todd
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K
| | - A Lesar
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K
| | - P O'Mahoney
- The Scottish Photodynamic Therapy Centre, Dundee, U.K.,School of Medicine, University of Dundee, Dundee, U.K
| | - E Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K
| | - S H Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K.,The Scottish Photodynamic Therapy Centre, Dundee, U.K.,School of Medicine, University of Dundee, Dundee, U.K
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18
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LaRochelle EPM, Chapman MS, Maytin EV, Hasan T, Pogue BW. Weather-informed Light-tissue Model-Based Dose Planning for Indoor Daylight Photodynamic Therapy. Photochem Photobiol 2019; 96:320-326. [PMID: 31581341 DOI: 10.1111/php.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022]
Abstract
Daylight activation for photodynamic therapy (PDT) of skin lesions is now widely adopted in many countries as a less painful and equally effective treatment mechanism, as compared to red or blue light activation. However, seasonal daylight availability and transient weather conditions complicate light dose estimations. A method is presented for dose planning without placing a large burden on clinical staff, by limiting spectral measurements to a one-time site assessment, and then using automatically acquired weather reports to track transient conditions. The site assessment tools are used to identify appropriate treatment locations for the annual and daily variations in sunlight exposure for clinical center planning. The spectral information collected from the site assessment can then be integrated with real-time daily electronic weather data. It was shown that a directly measured light exposure has strong correlation (R2 : 0.87) with both satellite cloud coverage data and UV index, suggesting that the automated weather indexes can be surrogates for daylight PDT optical dose. These updated inputs can be used in a dose-planning treatment model to estimate photodynamic dose at depth in tissue. A simple standardized method for estimating light dose during daylight-PDT could help improve intersite reproducibility while minimizing treatment times.
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Affiliation(s)
| | | | - Edward V Maytin
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH.,Department of Surgery, Geisel School of Medicine, Dartmouth College, Lebanon, NH
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