APPLICATION OF REFLECTANCE CONFOCAL MICROSCOPY FOR EARLY DIAGNOSIS OF RADIATION-INDUCED ACUTE DERMATITIS IN RADIOSENSITIVE PATIENT: CASE STUDY

Development and performance validation of a low-cost algorithms-based hyperspectral imaging system for radiodermatitis assessment

Whilst radiotherapy (RT) is widely used for cancer treatment, radiodermatitis caused by RT is one most common severe side effect affecting 95% cancer patients. Accurate radiodermatitis assessment and classification is essential to adopt timely treatment, management and monitoring, which all depend on reliable and objective tools for radiodermatitis grading. We therefore, in this work, reported the development and grading performance validation of a low-cost (∼2318.2 CNY) algorithms-based hyperspectral imaging (aHSI) system for radiodermatitis assessment. The low-cost aHSI system was enabled through Monte Carlo (MC) simulations conducted on multi-spectra acquired from a custom built low-cost multispectral imaging (MSI) system, deriving algorithms-based hyper-spectra with spectral resolution of 1 nm. The MSI system was based on sequentially illuminated narrow-band light-emitting diodes (LEDs) and a CMOS camera. Erythema induced artificially on healthy volunteers was measured by the aHSI system developed, with algorithms-based hyper-spectra and skin layer resolved physiological parameters (i.e., the blood volume fraction (BVF) and the oxygen saturation of hemoglobin in blood, et. al.) derivation using MC simulations. The MC simulations derived BVF and the oxygen saturation of hemoglobin in blood showed significant (P < 0.001, analysis of variance: ANOVA) increase with erythema. Further 1D-convolution neural network (CNN) implemented on the algorithms-based hyper-spectra leads to an overall classification accuracy of 93.1%, suggesting the great potential of low-cost aHSI system developed for radiodermatitis assessment.

Potential Use of Novel Image and Signal Processing Methods to Develop a Quantitative Assessment of the Severity of Acute Radiation Dermatitis in Breast Cancer Radiotherapy

More than 95% of patients who undergo radiotherapy report symptoms of radiation dermatitis, which is a side effect of this therapy. Erythema, edema, dry and moist desquamation intensify with each fraction of irradiation and can significantly reduce a patient's quality of life. Therefore, an effective skin care procedure is needed for skin that has been exposed to ionizing radiation in order to avoid unplanned treatment interruptions. The methods that are currently used to assess the severity of an acute radiation reaction are based on visual scales (RTOG, EORTC, NCI CTCAE, LENT-SOMA). Because the assessment is made subjectively, the results depend on the researchers, their experience and perceptiveness. Until now, several studies have been carried out to check the possibility of using an objective methods like hyperspectral imaging, thermal imaging, laser Doppler flowmetry, dielectric and electrochemical methods, reflection spectrophotometry and Courage-Khazaka Multi-skin instrument to radiation-induced dermatitis assessment. Unfortunately, due to various limitations that occurred in the research, none of these techniques was successfully implement as alternative for visual assessment. The continuous development of technology enables researchers to access new techniques that might constitute useful diagnostic and cognitive tools. Infrared thermal imaging, hyperspectral imaging and reflectance spectroscopy are examples of the visual techniques that have been used for many years in various fields of medicine, including dermatology and chronic wound or burn care. They provide information on the skin parameters, such as the temperature, concentration and distribution of chromophores (eg, hemoglobin and melanin), saturation or perfusion changes. The aim of this study is to review the available literature on the use of imaging methods in the clinical assessment of skin with lesions of various origins, evaluation of their suitability for the assessment of radiation reaction and consideration the possibility of creating a quantitative scale for assessing severity of acute radiation dermatitis.

Acute Radiation Dermatitis Evaluation with Reflectance Confocal Microscopy: A Prospective Study

Background: During radiotherapy (RT), most breast cancer patients experience ionizing radiation (IR)-induced skin injury—acute radiation dermatitis (ARD). The severity of ARD is determined by a physician according to CTCAE or RTOG scales, which are subjective. Reflectance confocal microscopy (RCM) is a noninvasive skin imaging technique offering cellular resolution. Digital dermoscopy (DD) performed in conjugation with RCM can provide more information regarding skin toxicity. The purpose of this study is to create an RCM and DD features-based ARD assessment scale, to assess the association with CTCAE scale and possible predictive value. Methods: One hundred and three breast cancer patients during RT were recruited; every week, clinical symptoms of ARD (CTCAE scale) were evaluated and RCM, together with digital dermoscopy (DD), was performed. Results: According to RCM; after 2 RT weeks, exocytosis and/or spongiosis were present in 94% of patients; after 3 weeks, mild contrast cells (MMCs) were detected in 45%; disarrayed epidermis (DE) was present in 66% of patients after 4 weeks and in 93% after 5 weeks; abnormal dermal papillae (ADP) were present in 68% of patients after 5 weeks. The coefficients of RCM features (RCM_coef) alone and together with dermoscopically determined erythema (RCM-ERY_coef) were significantly associated with ARD severity grade. RCM_coef is a significant predictive factor for the clinical manifestation of ARD. Conclusions: RCM features of irradiated skin appear earlier than clinical symptoms, have a characteristic course, and allow the severity of ARD to be predicted.

Overview of the Active Ingredients in Cosmetic Products for the Care of Skin That Has Been Exposed to Ionizing Radiation - Analysis of Their Effectiveness in Breast Cancer Radiotherapy

Treatment that uses ionizing radiation is one of the most common therapeutic methods in case of breast cancer. However, it often results in radiation dermatitis, which manifests itself, among others, as erythema, burning, itching and pain as well as dry or moist desquamation of the epidermis in the irradiated areas. The intensity of these symptoms significantly reduces the patient's quality of life, which could affect the effectiveness of the entire therapy. There are more and more cosmetic preparations on the market for daily care of skin that has been exposed to radiation. The composition of the active ingredients in these preparations is designed to support the protective functions of the skin, delay the occurrence of the side effects of ionizing radiation, reduce their intensity, and accelerate the regeneration of the irradiated areas. Unfortunately, there is little scientific evidence of the effectiveness of the active ingredients that are contained in these preparations. This paper presents a narrative review of the most commonly used ingredients and compares them with the current state of knowledge on their effectiveness in preventing radiodermatitis.

Characterization of early-stage cutaneous radiation injury by using optical coherence tomography angiography

Cutaneous radiation injury (CRI) is a skin injury caused by exposure to high dose ionizing radiation (IR). Diagnosis and treatment of CRI is difficult due to its initial clinically latent period and the following inflammatory bursts. Early detection of CRI before clinical symptoms will be helpful for effective treatment, and various optical methods have been applied with limitations. Here we show that optical coherence tomography angiography (OCTA) could detect changes in the skin during the latent period in CRI mouse models non-invasively. CRI was induced on the mouse hindlimb with exposure to various IR doses and the injured skin regions were imaged longitudinally by OCTA until the onset of clinical symptoms. OCTA detected several changes in the skin including the skin thickening, the dilation of large blood vessels, and the irregularity in vessel boundaries. Some of OCTA findings were confirmed by histology. The study results showed that OCTA could be used for early CRI detection.