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Chaudhry N, Albinsson J, Cinthio M, Kröll S, Malmsjö M, Rydén L, Sheikh R, Reistad N, Zackrisson S. Breast Cancer Diagnosis Using Extended-Wavelength-Diffuse Reflectance Spectroscopy (EW-DRS)-Proof of Concept in Ex Vivo Breast Specimens Using Machine Learning. Diagnostics (Basel) 2023; 13:3076. [PMID: 37835819 PMCID: PMC10572577 DOI: 10.3390/diagnostics13193076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
This study aims to investigate the feasibility of using diffuse reflectance spectroscopy (DRS) to distinguish malignant breast tissue from adjacent healthy tissue, and to evaluate if an extended-wavelength range (450-1550 nm) has an advantage over the standard wavelength range (450-900 nm). Multivariate statistics and machine learning algorithms, either linear discriminant analysis (LDA) or support vector machine (SVM) are used to distinguish the two tissue types in breast specimens (total or partial mastectomy) from 23 female patients with primary breast cancer. EW-DRS has a sensitivity of 94% and specificity of 91% as compared to a sensitivity of 40% and specificity of 71% using the standard wavelength range. The results suggest that DRS can discriminate between malignant and healthy breast tissue, with improved outcomes using an extended wavelength. It is also possible to construct a simple analytical model to improve the diagnostic performance of the DRS technique.
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Affiliation(s)
- Nadia Chaudhry
- Department of Translational Medicine, Diagnostic Radiology, Lund University, 205 02 Malmö, Sweden;
- Department of Medical Imaging and Physiology, Skåne University Hospital, 214 28 Malmö, Sweden
| | - John Albinsson
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University Hospital, Lund University, 223 62 Lund, Sweden; (J.A.); (M.M.)
| | - Magnus Cinthio
- Department of Biomedical Engineering, Lund University, 221 00 Lund, Sweden;
| | - Stefan Kröll
- Department of Physics, Lund University, 221 00 Lund, Sweden; (S.K.); (N.R.)
| | - Malin Malmsjö
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University Hospital, Lund University, 223 62 Lund, Sweden; (J.A.); (M.M.)
| | - Lisa Rydén
- Department of Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
- Department of Clinical Sciences Lund, Surgery, Lund University, 221 85 Lund, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University Hospital, Lund University, 223 62 Lund, Sweden; (J.A.); (M.M.)
| | - Nina Reistad
- Department of Physics, Lund University, 221 00 Lund, Sweden; (S.K.); (N.R.)
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, 205 02 Malmö, Sweden;
- Department of Medical Imaging and Physiology, Skåne University Hospital, 214 28 Malmö, Sweden
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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. JOURNAL OF BIOMEDICAL OPTICS 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] [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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Kang S, Xu X, Navarro E, Wang Y, Liu JTC, Tichauer KM. Modeling the binding and diffusion of receptor-targeted nanoparticles topically applied on fresh tissue specimens. Phys Med Biol 2019; 64:045013. [PMID: 30654346 DOI: 10.1088/1361-6560/aaff81] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nanoparticle (NP) contrast agents targeted to cancer biomarkers are increasingly being engineered for the early detection of cancer, guidance of therapy, and monitoring of response. There have been recent efforts to topically apply biomarker-targeted NPs on tissue surfaces to image the expression of cell-surface receptors over large surface areas as a means of evaluating tumor margins to guide wide local excision surgeries. However, diffusion and nonspecific binding of the NPs present challenges for relating NP retention on the tissue surface with the expression of cancer cell receptors. Paired-agent methods that employ a secondary 'control' NP to account for these nonspecific effects can improve cancer detection. Yet these paired-agent methods introduce multidimensional complexity (with tissue staining, rinsing, imaging, and data analysis protocols all being subject to alteration), and could be greatly simplified with accurate, predictive in silico models of NP binding and diffusion. Here, we outline and validate such a model to predict the diffusion, as well as specific and nonspecific binding, of targeted and control NPs topically applied on tissue surfaces. In order to inform the model, in vitro experiments were performed to determine relevant NP diffusion and binding rate constants in tissues. The predictive capacity of the model was validated by comparing simulated distributions of various sizes of NPs in comparison with experimental results. The regression of predicted and experimentally measured concentration-depth profiles yielded <15% error (compared to ~70% error obtained using a previous model of NP diffusion and binding).
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Affiliation(s)
- Soyoung Kang
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98105, United States of America. These authors contributed equally to this work
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McEvoy MP, Landercasper J, Naik HR, Feldman S. Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic. Gland Surg 2018; 7:536-553. [PMID: 30687627 DOI: 10.21037/gs.2018.11.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool. The original ten tools were updated with the latest evidence from the literature and our strength of recommendation. We added an additional section looking at new tools and techniques that may provide more accurate intraoperative assessment of margins. The updates on the CALLER Toolbox for lumpectomy will help guide surgeons to various resources to aid in the removal of breast cancer, while being aware of cosmesis and decreasing re excision rates.
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Affiliation(s)
- Maureen P McEvoy
- Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | - Jeffrey Landercasper
- Gundersen Health System, Norma J. Vinger Center for Breast Cancer, La Crosse, WI, USA
| | - Himani R Naik
- Gundersen Health System, Norma J. Vinger Center for Breast Cancer, La Crosse, WI, USA
| | - Sheldon Feldman
- Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
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Pogue BW, Wilson BC. Optical and x-ray technology synergies enabling diagnostic and therapeutic applications in medicine. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-17. [PMID: 30350489 PMCID: PMC6197862 DOI: 10.1117/1.jbo.23.12.121610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/24/2018] [Indexed: 05/10/2023]
Abstract
X-ray and optical technologies are the two central pillars for human imaging and therapy. The strengths of x-rays are deep tissue penetration, effective cytotoxicity, and the ability to image with robust projection and computed-tomography methods. The major limitations of x-ray use are the lack of molecular specificity and the carcinogenic risk. In comparison, optical interactions with tissue are strongly scatter dominated, leading to limited tissue penetration, making imaging and therapy largely restricted to superficial or endoscopically directed tissues. However, optical photon energies are comparable with molecular energy levels, thereby providing the strength of intrinsic molecular specificity. Additionally, optical technologies are highly advanced and diversified, being ubiquitously used throughout medicine as the single largest technology sector. Both have dominant spatial localization value, achieved with optical surface scanning or x-ray internal visualization, where one often is used with the other. Therapeutic delivery can also be enhanced by their synergy, where radio-optical and optical-radio interactions can inform about dose or amplify the clinical therapeutic value. An emerging trend is the integration of nanoparticles to serve as molecular intermediates or energy transducers for imaging and therapy, requiring careful design for the interaction either by scintillation or Cherenkov light, and the nanoscale design is impacted by the choices of optical interaction mechanism. The enhancement of optical molecular sensing or sensitization of tissue using x-rays as the energy source is an important emerging field combining x-ray tissue penetration in radiation oncology with the molecular specificity and packaging of optical probes or molecular localization. The ways in which x-rays can enable optical procedures, or optics can enable x-ray procedures, provide a range of new opportunities in both diagnostic and therapeutic medicine. Taken together, these two technologies form the basis for the vast majority of diagnostics and therapeutics in use in clinical medicine.
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Affiliation(s)
- Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Geisel School of Medicine, Hanover, New Hampshire, United States
| | - Brian C. Wilson
- University of Toronto, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
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Maloney BW, McClatchy DM, Pogue BW, Paulsen KD, Wells WA, Barth RJ. Review of methods for intraoperative margin detection for breast conserving surgery. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-19. [PMID: 30369108 PMCID: PMC6210801 DOI: 10.1117/1.jbo.23.10.100901] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 05/18/2023]
Abstract
Breast conserving surgery (BCS) is an effective treatment for early-stage cancers as long as the margins of the resected tissue are free of disease according to consensus guidelines for patient management. However, 15% to 35% of patients undergo a second surgery since malignant cells are found close to or at the margins of the original resection specimen. This review highlights imaging approaches being investigated to reduce the rate of positive margins, and they are reviewed with the assumption that a new system would need high sensitivity near 95% and specificity near 85%. The problem appears to be twofold. The first is for complete, fast surface scanning for cellular, structural, and/or molecular features of cancer, in a lumpectomy volume, which is variable in size, but can be large, irregular, and amorphous. A second is for full, volumetric imaging of the specimen at high spatial resolution, to better guide internal radiologic decision-making about the spiculations and duct tracks, which may inform that surfaces are involved. These two demands are not easily solved by a single tool. Optical methods that scan large surfaces quickly are needed with cellular/molecular sensitivity to solve the first problem, but volumetric imaging with high spatial resolution for soft tissues is largely outside of the optical realm and requires x-ray, micro-CT, or magnetic resonance imaging if they can be achieved efficiently. In summary, it appears that a combination of systems into hybrid platforms may be the optimal solution for these two very different problems. This concept must be cost-effective, image specimens within minutes and be coupled to decision-making tools that help a surgeon without adding to the procedure. The potential for optical systems to be involved in this problem is emerging and clinical trials are underway in several of these technologies to see if they could reduce positive margin rates in BCS.
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Affiliation(s)
- Benjamin W. Maloney
- 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
| | - 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
| | - 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
| | - Richard J. Barth
- 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
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
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Wang YW, Reder NP, Kang S, Glaser AK, Yang Q, Wall MA, Javid SH, Dintzis SM, Liu JTC. Raman-Encoded Molecular Imaging with Topically Applied SERS Nanoparticles for Intraoperative Guidance of Lumpectomy. Cancer Res 2017; 77:4506-4516. [PMID: 28615226 DOI: 10.1158/0008-5472.can-17-0709] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/28/2017] [Accepted: 06/08/2017] [Indexed: 12/30/2022]
Abstract
Intraoperative identification of carcinoma at lumpectomy margins would enable reduced re-excision rates, which are currently as high as 20% to 50%. Although imaging of disease-associated biomarkers can identify malignancies with high specificity, multiplexed imaging of such biomarkers is necessary to detect molecularly heterogeneous carcinomas with high sensitivity. We have developed a Raman-encoded molecular imaging (REMI) technique in which targeted nanoparticles are topically applied on excised tissues to enable rapid visualization of a multiplexed panel of cell surface biomarkers at surgical margin surfaces. A first-ever clinical study was performed in which 57 fresh specimens were imaged with REMI to simultaneously quantify the expression of four biomarkers HER2, ER, EGFR, and CD44. Combined detection of these biomarkers enabled REMI to achieve 89.3% sensitivity and 92.1% specificity for the detection of breast carcinoma. These results highlight the sensitivity and specificity of REMI to detect biomarkers in freshly resected tissue, which has the potential to reduce the rate of re-excision procedures in cancer patients. Cancer Res; 77(16); 4506-16. ©2017 AACR.
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Affiliation(s)
- Yu Winston Wang
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.
| | - Nicholas P Reder
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.,Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Soyoung Kang
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Adam K Glaser
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Qian Yang
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.,Department of Pharmacy, Chengdu Medical College, Chengdu, Sichuan, China
| | - Matthew A Wall
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Sara H Javid
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Suzanne M Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, Washington.
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Yanina IY, Navolokin NA, Svenskaya YI, Bucharskaya AB, Maslyakova GN, Gorin DA, Sukhorukov GB, Tuchin VV. Morphology alterations of skin and subcutaneous fat at NIR laser irradiation combined with delivery of encapsulated indocyanine green. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:55008. [PMID: 28541446 DOI: 10.1117/1.jbo.22.5.055008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
The goal of this study is to quantify the impact of the in vivo photochemical treatment of rats with obesity using indocyanine green (ICG) dissolved in saline or dispersed in an encapsulated form at NIR laser irradiation, which was monitored by tissue sampling and histochemistry. The subcutaneous injection of the ICG solution or ICG encapsulated into polyelectrolyte microcapsules, followed by diode laser irradiation (808 nm, 8 ?? W / cm 2 , 1 min), resulted in substantial differences in lipolysis of subcutaneous fat. Most of the morphology alterations occurred in response to the laser irradiation if a free-ICG solution had been injected. In such conditions, membrane disruption, stretching, and even delamination in some cases were observed for a number of cells. The encapsulated ICG aroused similar morphology changes but with weakly expressed adipocyte destruction under the laser irradiation. The Cochran Q test rendered the difference between the treatment alternatives statistically significant. By this means, laser treatment using the encapsulated form of ICG seems more promising and could be used for safe layerwise laser treatment of obesity and cellulite.
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Affiliation(s)
- Irina Yu Yanina
- Saratov National Research State University, Research-Educational Institute of Optics and Biophotonics, Saratov, RussiabNational Research Tomsk State University, Interdisciplinary Laboratory of Biophotonics, Tomsk, RussiacEducational and Research Institute of Nanostructures and Biosystems, Remote Controlled Theranostic Systems Lab, Saratov, Russia
| | - Nikita A Navolokin
- Educational and Research Institute of Nanostructures and Biosystems, Remote Controlled Theranostic Systems Lab, Saratov, RussiadSaratov State Medical University, Saratov, Russia
| | - Yulia I Svenskaya
- Educational and Research Institute of Nanostructures and Biosystems, Remote Controlled Theranostic Systems Lab, Saratov, Russia
| | | | | | - Dmitry A Gorin
- Educational and Research Institute of Nanostructures and Biosystems, Remote Controlled Theranostic Systems Lab, Saratov, Russia
| | - Gleb B Sukhorukov
- Educational and Research Institute of Nanostructures and Biosystems, Remote Controlled Theranostic Systems Lab, Saratov, RussiaeQueen Mary University of London, School of Engineering and Materials Sciences, London, United Kingdom
| | - Valery V Tuchin
- Saratov National Research State University, Research-Educational Institute of Optics and Biophotonics, Saratov, RussiabNational Research Tomsk State University, Interdisciplinary Laboratory of Biophotonics, Tomsk, RussiafInstitute of the Russian Academy of Sciences, Laboratory of Laser Diagnostics of Technical and Living Systems of Precision Mechanics and Control, Saratov, Russia
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McClatchy DM, Krishnaswamy V, Kanick SC, Elliott JT, Wells WA, Barth RJ, Paulsen KD, Pogue BW. High spatial frequency structured light imaging for intraoperative breast tumor margin assessment. ACTA ACUST UNITED AC 2015. [DOI: 10.1117/12.2080134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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