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Abstract
Wound care is a multidisciplinary field with significant economic burden to our healthcare system. Not only does wound care cost the US healthcare system $20 billion annually, but wounds also remarkably impact the quality of life of patients; wounds pose significant risk of mortality, as the five-year mortality rate for diabetic foot ulcers (DFUs) and ischemic ulcers is notably higher compared to commonly encountered cancers such as breast and prostate. Although it is important to measure how wounds may or may not be improving over time, the only relative "marker" for this is wound area measurement-area measurements can help providers determine if a wound is on a healing or non-healing trajectory. Because wound area measurements are currently the only readily available "gold standard" for predicting healing outcomes, there is a pressing need to understand how other relative biomarkers may play a role in wound healing. Currently, wound care centers across the nation employ various techniques to obtain wound area measurements; length and width of a wound can be measured with a ruler, but this carries a high amount of inter- and intrapersonal error as well as uncertainty. Acetate tracings could be used to limit the amount of error but do not account for depth, thereby making them inaccurate. Here, we discuss current imaging modalities and how they can serve to accurately measure wound size and serve as useful adjuncts in wound assessment. Moreover, new imaging modalities are also discussed and how up-and-coming technologies can provide important information on "biomarkers" for wound healing.
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2
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The Use of Supercontinuum Laser Sources in Biomedical Diffuse Optics: Unlocking the Power of Multispectral Imaging. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Optical techniques based on diffuse optics have been around for decades now and are making their way into the day-to-day medical applications. Even though the physics foundations of these techniques have been known for many years, practical implementation of these technique were hindered by technological limitations, mainly from the light sources and/or detection electronics. In the past 20 years, the developments of supercontinuum laser (SCL) enabled to unlock some of these limitations, enabling the development of system and methodologies relevant for medical use, notably in terms of spectral monitoring. In this review, we focus on the use of SCL in biomedical diffuse optics, from instrumentation and methods developments to their use for medical applications. A total of 95 publications were identified, from 1993 to 2021. We discuss the advantages of the SCL to cover a large spectral bandwidth with a high spectral power and fast switching against the disadvantages of cost, bulkiness, and long warm up times. Finally, we summarize the utility of using such light sources in the development and application of diffuse optics in biomedical sciences and clinical applications.
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
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4
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
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5
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Li S, Mohamedi AH, Senkowsky J, Nair A, Tang L. Imaging in Chronic Wound Diagnostics. Adv Wound Care (New Rochelle) 2020; 9:245-263. [PMID: 32226649 PMCID: PMC7099416 DOI: 10.1089/wound.2019.0967] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/14/2019] [Indexed: 01/18/2023] Open
Abstract
Significance: Chronic wounds affect millions of patients worldwide, placing a huge burden on health care resources. Although significant progress has been made in the development of wound treatments, very few advances have been made in wound diagnosis. Recent Advances: Standard imaging methods like computed tomography, single-photon emission computed tomography, magnetic resonance imaging, terahertz imaging, and ultrasound imaging have been widely employed in wound diagnostics. A number of noninvasive optical imaging modalities like optical coherence tomography, near-infrared spectroscopy, laser Doppler imaging, spatial frequency domain imaging, digital camera imaging, and thermal and fluorescence imaging have emerged over the years. Critical Issues: While standard diagnostic wound imaging modalities provide valuable information, they cannot account for dynamic changes in the wound environment. In addition, they lack the capability to predict the healing outcome. Thus, there remains a pressing need for more efficient methods that can not only indicate the current state of the wound but also help determine whether the wound is on track to heal normally. Future Directions: Many imaging probes have been fabricated and shown to provide real-time assessment of tissue microenvironment and inflammatory responses in vivo. These probes have been demonstrated to noninvasively detect various changes in the wound environment, which include tissue pH, reactive oxygen species, fibrin deposition, matrix metalloproteinase production, and macrophage accumulation. This review summarizes the creation of these probes and their potential implications in wound monitoring.
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Affiliation(s)
- Shuxin Li
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
| | - Ali H. Mohamedi
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
| | | | | | - Liping Tang
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
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6
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Shen S, Wang H, Qu Y, Huang K, Liu G, Chen Z, Ma C, Shao P, Hong J, Lemaillet P, Dong E, Xu RX. Simulating orientation and polarization characteristics of dense fibrous tissue by electrostatic spinning of polymeric fibers. BIOMEDICAL OPTICS EXPRESS 2019; 10:571-583. [PMID: 30800500 PMCID: PMC6377871 DOI: 10.1364/boe.10.000571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
Phantoms simulating polarization characteristics of soft tissue play an important role in the development, calibration, and validation of diagnostic polarized imaging devices and of therapeutic strategy, in both laboratory and clinical settings. We propose to fabricate optical phantoms that simulate polarization characteristics of dense fibrous tissues by bonding electrospun polylactic acid (PLA) fibers between polydimethylsiloxane (PDMS) substrate with a groove. Increasing the rotational speed of an electrospinning collector helps improve the orientation of the electrospun fibers. The phantoms simulate the polarization characteristics of dense fibrous tissue of collagenous fibroma and healthy skin with high fidelity. Our experiments demonstrate the technical potential of using such phantoms for validation and calibration of polarimetric medical devices.
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Affiliation(s)
- Shuwei Shen
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Haili Wang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Yingjie Qu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Kuiming Huang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Guangli Liu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Zexin Chen
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Canzhen Ma
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Pengfei Shao
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Jin Hong
- Key Laboratory of Environmental Optics and Technology, Anhui Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, Hefei 230031, China
| | - Paul Lemaillet
- National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899, USA
| | - Erbao Dong
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Ronald X. Xu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
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7
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Liu G, Wu Q, Dwivedi P, Hu C, Zhu Z, Shen S, Chu J, Zhao G, Si T, Xu R. Hemoglobin-Laden Microcapsules for Simulating Oxygen Dynamics of Biological Tissue. ACS Biomater Sci Eng 2018; 4:3177-3184. [DOI: 10.1021/acsbiomaterials.8b00830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Guangli Liu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Qiang Wu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Pankaj Dwivedi
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Chuanzhen Hu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Zhiqiang Zhu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Shuwei Shen
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Jiaru Chu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Gang Zhao
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Ting Si
- Department of Modern Mechanics, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
| | - Ronald Xu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Huangshan Road, Hefei, Anhui 230027, China
- Department of Biomedical Engineering, The Ohio State University, 1080 Carmack Road, Columbus, Ohio 43210, United States
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Lv X, Chen H, Liu G, Shen S, Wu Q, Hu C, Li J, Dong E, Xu RX. Design of a portable phantom device to simulate tissue oxygenation and blood perfusion. APPLIED OPTICS 2018; 57:3938-3946. [PMID: 29791363 DOI: 10.1364/ao.57.003938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
We propose a portable phantom system for calibration and validation of medical optical devices in a clinical setting. The phantom system comprises a perfusion module and an exchangeable tissue-simulating phantom that simulates tissue oxygenation and blood perfusion. The perfusion module consists of a peristaltic pump, two liquid storage units, and two pressure suppressors. The tissue-simulating phantom is fabricated by a three-dimensional (3D) printing process with microchannels embedded to simulate blood vessels. Optical scattering and absorption properties of biologic tissue are simulated by mixing graphite powder and titanium dioxide powder with clear photoreactive resin at specific ratios. Tissue oxygen saturation (StO2) and blood perfusion are simulated by circulating the mixture of blood and intralipid at different oxygenation levels and flow rates. A house-made multimodal imaging system that combines multispectral imaging and laser speckle imaging are used for non-invasive detection of phantom oxygenation and perfusion, and the measurements are compared with those of a commercial Moor device as well as numerical simulation. By acquiring multimodal imaging data from one phantom and applying the calibration factors in different settings, we demonstrate the technical feasibility to calibrate optical devices for consistent measurements. By simulating retina tissue vasculature and acquiring functional images at different tissue oxygenation and blood perfusion levels, we demonstrate the clinical potential to simulate tissue anomalies. Our experiments imply the clinical potential of a portable, low-cost, and traceable phantom standard to calibrate and validate medical optical devices for improved performance.
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Rink C, Wernke MM, Powell HM, Gynawali S, Schroeder RM, Kim JY, Denune JA, Gordillo GM, Colvin JM, Sen CK. Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial. ACTA ACUST UNITED AC 2018; 53:1121-1132. [PMID: 28355039 DOI: 10.1682/jrrd.2015.07.0145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/13/2016] [Indexed: 11/05/2022]
Abstract
A growing number of clinical trials and case reports support qualitative claims that use of an elevated vacuum suspension (EVS) prosthesis improves residual-limb health on the basis of self-reported questionnaires, clinical outcomes scales, and wound closure studies. Here, we report first efforts to quantitatively assess residual-limb circulation in response to EVS. Residual-limb skin health and perfusion of people with lower-limb amputation (N = 10) were assessed during a randomized crossover study comparing EVS with nonelevated vacuum suspension (control) over a 32 wk period using noninvasive probes (transepidermal water loss, laser speckle imaging, transcutaneous oxygen measurement) and functional hyperspectral imaging approaches. Regardless of the suspension system, prosthesis donning decreased perfusion in the residual limb under resting conditions. After 16 wk of use, EVS improved residual-limb oxygenation during treadmill walking. Likewise, prosthesis-induced reactive hyperemia was attenuated with EVS following 16 wk of use. Skin barrier function was preserved with EVS but disrupted after control socket use. Taken together, outcomes suggest chronic EVS use improves perfusion and preserves skin barrier function in people with lower-limb amputation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; "Evaluation of limb health associated with a prosthetic vacuum socket system": NCT01839123; https://clinicaltrials.gov/ct2/show/NCT01839123?term=NCT01839123&rank=1.
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Affiliation(s)
- Cameron Rink
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Heather M Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | - Surya Gynawali
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Jayne Y Kim
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | | | - Gayle M Gordillo
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Chandan K Sen
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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10
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Wahabzada M, Besser M, Khosravani M, Kuska MT, Kersting K, Mahlein AK, Stürmer E. Monitoring wound healing in a 3D wound model by hyperspectral imaging and efficient clustering. PLoS One 2017; 12:e0186425. [PMID: 29216188 PMCID: PMC5720791 DOI: 10.1371/journal.pone.0186425] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Wound healing is a complex and dynamic process with different distinct and overlapping phases from homeostasis, inflammation and proliferation to remodelling. Monitoring the healing response of injured tissue is of high importance for basic research and clinical practice. In traditional application, biological markers characterize normal and abnormal wound healing. Understanding functional relationships of these biological processes is essential for developing new treatment strategies. However, most of the present techniques (in vitro or in vivo) include invasive microscopic or analytical tissue sampling. In the present study, a non-invasive alternative for monitoring processes during wound healing is introduced. Within this context, hyperspectral imaging (HSI) is an emerging and innovative non-invasive imaging technique with different opportunities in medical applications. HSI acquires the spectral reflectance of an object, depending on its biochemical and structural characteristics. An in-vitro 3-dimensional (3-D) wound model was established and incubated without and with acute and chronic wound fluid (AWF, CWF), respectively. Hyperspectral images of each individual specimen of this 3-D wound model were assessed at day 0/5/10 in vitro, and reflectance spectra were evaluated. For analysing the complex hyperspectral data, an efficient unsupervised approach for clustering massive hyperspectral data was designed, based on efficient hierarchical decomposition of spectral information according to archetypal data points. It represents, to the best of our knowledge, the first application of an advanced Data Mining approach in context of non-invasive analysis of wounds using hyperspectral imagery. By this, temporal and spatial pattern of hyperspectral clusters were determined within the tissue discs and among the different treatments. Results from non-invasive imaging were compared to the number of cells in the various clusters, assessed by Hematoxylin/Eosin (H/E) staining. It was possible to correlate cell quantity and spectral reflectance during wound closure in a 3-D wound model in vitro.
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Affiliation(s)
| | - Manuela Besser
- Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - Milad Khosravani
- Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | | | - Kristian Kersting
- CS Department, Technical University of Darmstadt, Darmstadt, Germany
| | - Anne-Katrin Mahlein
- INRES-Phytomedicine, University of Bonn, Nussalle 9, Bonn, Germany
- Institute of Sugar Beet Research (IfZ), Göttingen, Germany
| | - Ewa Stürmer
- Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
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11
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Patil P, Martin JR, Sarett SM, Pollins AC, Cardwell NL, Davidson JM, Guelcher SA, Nanney LB, Duvall CL. Porcine Ischemic Wound-Healing Model for Preclinical Testing of Degradable Biomaterials. Tissue Eng Part C Methods 2017; 23:754-762. [PMID: 28762881 DOI: 10.1089/ten.tec.2017.0202] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Impaired wound healing that mimics chronic human skin pathologies is difficult to achieve in current animal models, hindering testing and development of new therapeutic biomaterials that promote wound healing. In this article, we describe a refinement and simplification of the porcine ischemic wound model that increases the size and number of experimental sites per animal. By comparing three flap geometries, we adopted a superior configuration (15 × 10 cm) that enabled testing of twenty 1 cm2 wounds in each animal: 8 total ischemic wounds within 4 bipedicle flaps and 12 nonischemic wounds. The ischemic wounds exhibited impaired skin perfusion for ∼1 week. To demonstrate the utility of the model for comparative testing of tissue regenerative biomaterials, we evaluated the healing process in wounds implanted with highly porous poly (thioketal) urethane (PTK-UR) scaffolds that were fabricated through reaction of reactive oxygen species (ROS)-cleavable PTK macrodiols with isocyanates. PTK-lysine triisocyanate (LTI) scaffolds degraded significantly in vitro under both oxidative and hydrolytic conditions whereas PTK-hexamethylene diisocyanate trimer (HDIt) scaffolds were resistant to hydrolytic breakdown and degraded exclusively through an ROS-dependent mechanism. Upon placement into porcine wounds, both types of PTK-UR materials fostered new tissue ingrowth over 10 days in both ischemic and nonischemic tissue. However, wound perfusion, tissue infiltration and the abundance of pro-regenerative, M2-polarized macrophages were markedly lower in ischemic wounds independent of scaffold type. The PTK-LTI implants significantly improved tissue infiltration and perfusion compared with analogous PTK-HDIt scaffolds in ischemic wounds. Both LTI and HDIt-based PTK-UR implants enhanced M2 macrophage activity, and these cells were selectively localized at the scaffold/tissue interface. In sum, this modified porcine wound-healing model decreased animal usage, simplified procedures, and permitted a more robust evaluation of tissue engineering materials in preclinical wound healing research. Deployment of the model for a relevant biomaterial comparison yielded results that support the use of the PTK-LTI over the PTK-HDIt scaffold formulation for future advanced therapeutic studies.
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Affiliation(s)
- Prarthana Patil
- 1 Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee
| | - John R Martin
- 1 Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee
| | - Samantha M Sarett
- 1 Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee
| | - Alonda C Pollins
- 2 Department of Plastic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Nancy L Cardwell
- 2 Department of Plastic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Jeffrey M Davidson
- 3 Department of Pathology Microbiology and Immunology, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Scott A Guelcher
- 1 Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee.,4 Department of Chemical and Biomolecular Engineering, Vanderbilt University , Nashville, Tennessee.,5 Department of Medicine and Division of Clinical Pharmacology, Vanderbilt Center for Bone Biology, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Lillian B Nanney
- 2 Department of Plastic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Craig L Duvall
- 1 Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee
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12
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Rink CL, Wernke MM, Powell HM, Tornero M, Gnyawali SC, Schroeder RM, Kim JY, Denune JA, Albury AW, Gordillo GM, Colvin JM, Sen CK. Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation. Adv Wound Care (New Rochelle) 2017; 6:225-232. [PMID: 28736682 DOI: 10.1089/wound.2017.0737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 12/29/2022] Open
Abstract
Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial (n = 5) and transfemoral (n = 5) amputation were compared to able-limb controls (n = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.
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Affiliation(s)
- Cameron L. Rink
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Heather M. Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Mark Tornero
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Surya C. Gnyawali
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Jayne Y. Kim
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | | | | | - Gayle M. Gordillo
- Department of Plastic Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Chandan K. Sen
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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13
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Diagnostic and Prognostic Utility of Non-Invasive Multimodal Imaging in Chronic Wound Monitoring: a Systematic Review. J Med Syst 2017; 41:46. [PMID: 28194684 DOI: 10.1007/s10916-016-0679-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
Monitoring chronic wound [CW] healing is a challenging issue for clinicians across the world. Moreover, the health and cost burden of CW are escalating at a disturbing rate due to a global rise in population of elderly and diabetic cases. The conventional approach includes visual contour, sketches, or more rarely tracings. However, such conventional techniques bring forth infection, pain, allergies. Furthermore, these methods are subjective as well as time-consuming. As such, nowadays, non-touching and non-invasive CW monitoring system based on imaging techniques are gaining importance. They not only reduce patients' discomfort but also provide rapid wound diagnosis and prognosis. This review provides a survey of different types of CW characteristics, their healing mechanism and the multimodal non-invasive imaging methods that have been used for their diagnosis and prognosis. Current clinical practices as well as personal health systems [m-health and e-health] for CW monitoring have been discussed.
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14
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Sen CK, Ghatak S, Gnyawali SC, Roy S, Gordillo GM. Cutaneous Imaging Technologies in Acute Burn and Chronic Wound Care. Plast Reconstr Surg 2016; 138:119S-128S. [PMID: 27556752 PMCID: PMC5207795 DOI: 10.1097/prs.0000000000002654] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Wound assessment relies on visual evaluation by physicians. Such assessment is largely subjective and presents the opportunity to explore the use of emergent technologies. METHODS Emergent and powerful noninvasive imaging technologies applicable to assess burn and chronic wounds are reviewed. RESULTS The need to estimate wound depth is critical in both chronic wound and burn injury settings. Harmonic ultrasound technology is powerful to study wound depth. It addresses the limitations of optical imaging with limited depth of penetration. What if a wound appears epithelialized by visual inspection, which shows no discharge yet is covered by repaired skin that lacks barrier function? In this case although the wound is closed as defined by current standards, it remains functionally open, presenting the risk of infection and other postclosure complications. Thus, assessment of skin barrier function is valuable in the context of assessing wound closure. Options for the study of tissue vascularization are many. If noncontact and noninvasive criteria are of importance, laser speckle imaging is powerful. Fluorescence imaging is standard in several clinical settings and is likely to serve the wound clinics well as long as indocyanine green injection is not of concern. A major advantage of harmonic ultrasound imaging of wound depth is that the same system is capable of providing information on blood flow dynamics in arterial perforators. CONCLUSION With many productive imaging platforms to choose from, wound care is about to be transformed by technology that would help assess wound severity.
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Affiliation(s)
- Chandan K Sen
- Columbus, Ohio
- From the Center for Regenerative Medicine & Cell-Based Therapies, Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center
| | - Subhadip Ghatak
- Columbus, Ohio
- From the Center for Regenerative Medicine & Cell-Based Therapies, Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center
| | - Surya C Gnyawali
- Columbus, Ohio
- From the Center for Regenerative Medicine & Cell-Based Therapies, Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center
| | - Sashwati Roy
- Columbus, Ohio
- From the Center for Regenerative Medicine & Cell-Based Therapies, Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center
| | - Gayle M Gordillo
- Columbus, Ohio
- From the Center for Regenerative Medicine & Cell-Based Therapies, Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center
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Paul DW, Ghassemi P, Ramella-Roman JC, Prindeze NJ, Moffatt LT, Alkhalil A, Shupp JW. Noninvasive imaging technologies for cutaneous wound assessment: A review. Wound Repair Regen 2015; 23:149-62. [PMID: 25832563 DOI: 10.1111/wrr.12262] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 02/02/2023]
Abstract
The ability to phenotype wounds for the purposes of assessing severity, healing potential and treatment is an important function of evidence-based medicine. A variety of optical technologies are currently in development for noninvasive wound assessment. To varying extents, these optical technologies have the potential to supplement traditional clinical wound evaluation and research, by providing detailed information regarding skin components imperceptible to visual inspection. These assessments are achieved through quantitative optical analysis of tissue characteristics including blood flow, collagen remodeling, hemoglobin content, inflammation, temperature, vascular structure, and water content. Technologies that have, to this date, been applied to wound assessment include: near infrared imaging, thermal imaging, optical coherence tomography, orthogonal polarization spectral imaging, fluorescence imaging, laser Doppler imaging, microscopy, spatial frequency domain imaging, photoacoustic detection, and spectral/hyperspectral imaging. We present a review of the technologies in use or development for these purposes with three aims: (1) providing basic explanations of imaging technology concepts, (2) reviewing the wound imaging literature, and (3) providing insight into areas for further application and exploration. Noninvasive imaging is a promising advancement in wound assessment and all technologies require further validation.
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Affiliation(s)
- Dereck W Paul
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Pejhman Ghassemi
- Department of Electrical Engineering and Computer Science, The Catholic University of America, Washington, DC
| | - Jessica C Ramella-Roman
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Nicholas J Prindeze
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Lauren T Moffatt
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Abdulnaser Alkhalil
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Jeffrey W Shupp
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC
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16
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Dong E, Zhao Z, Wang M, Xie Y, Li S, Shao P, Cheng L, Xu RX. Three-dimensional fuse deposition modeling of tissue-simulating phantom for biomedical optical imaging. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:121311. [PMID: 26603611 DOI: 10.1117/1.jbo.20.12.121311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/23/2015] [Indexed: 05/08/2023]
Abstract
Biomedical optical devices are widely used for clinical detection of various tissue anomalies. However, optical measurements have limited accuracy and traceability, partially owing to the lack of effective calibration methods that simulate the actual tissue conditions. To facilitate standardized calibration and performance evaluation of medical optical devices, we develop a three-dimensional fuse deposition modeling (FDM) technique for freeform fabrication of tissue-simulating phantoms. The FDM system uses transparent gel wax as the base material, titanium dioxide (TiO2 ) powder as the scattering ingredient, and graphite powder as the absorption ingredient. The ingredients are preheated, mixed, and deposited at the designated ratios layer-by-layer to simulate tissue structural and optical heterogeneities. By printing the sections of human brain model based on magnetic resonance images, we demonstrate the capability for simulating tissue structural heterogeneities. By measuring optical properties of multilayered phantoms and comparing with numerical simulation, we demonstrate the feasibility for simulating tissue optical properties. By creating a rat head phantom with embedded vasculature, we demonstrate the potential for mimicking physiologic processes of a living system.
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Affiliation(s)
- Erbao Dong
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, China
| | - Zuhua Zhao
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, China
| | - Minjie Wang
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, China
| | - Yanjun Xie
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, China
| | - Shidi Li
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, China
| | - Pengfei Shao
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, China
| | - Liuquan Cheng
- 301th PLA Hospital, Department of Radiology, Beijing 100000, China
| | - Ronald X Xu
- University of Science and Technology of China, Department of Precision Machinery and Precision Instrumentation, Hefei, Anhui 230027, ChinacThe Ohio State University, Department of Biomedical Engineering, Columbus, Ohio 43210, United States
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Chon B, Tokumasu F, Lee JY, Allen DW, Rice JP, Hwang J. Digital phantoms generated by spectral and spatial light modulators. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:121309. [PMID: 26361340 DOI: 10.1117/1.jbo.20.12.121309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/05/2015] [Indexed: 06/05/2023]
Abstract
A hyperspectral image projector (HIP) based on liquid crystal on silicon spatial light modulators is explained and demonstrated to generate data cubes. The HIP-constructed data cubes are three-dimensional images of the spatial distribution of spectrally resolved abundances of intracellular light-absorbing oxyhemoglobin molecules in single erythrocytes. Spectrally and spatially resolved image data indistinguishable from the real scene may be used as standard data cubes, so-called digital phantoms, to calibrate image sensors and validate image analysis algorithms for their measurement quality, performance consistency, and interlaboratory comparisons for quantitative biomedical imaging applications.
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Affiliation(s)
- Bonghwan Chon
- National Institute of Standards and Technology, Quantum Electronics and Photonics Division, 325 Broadway Street, Boulder, Colorado 80305, United States
| | - Fuyuki Tokumasu
- National Institutes of Health, Laboratory of Malaria and Vector Research, 9000 Rockville Pike, Bethesda, Maryland 20892, United States
| | - Ji Youn Lee
- National Institute of Standards and Technology, Quantum Electronics and Photonics Division, 325 Broadway Street, Boulder, Colorado 80305, United States
| | - David W Allen
- National Institute of Standards and Technology, Sensor Science Division, 100 Bureau Drive, Gaithersburg, Maryland 20899, United States
| | - Joseph P Rice
- National Institute of Standards and Technology, Sensor Science Division, 100 Bureau Drive, Gaithersburg, Maryland 20899, United States
| | - Jeeseong Hwang
- National Institute of Standards and Technology, Quantum Electronics and Photonics Division, 325 Broadway Street, Boulder, Colorado 80305, United States
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18
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Ghassemi P, Wang J, Melchiorri AJ, Ramella-Roman JC, Mathews SA, Coburn JC, Sorg BS, Chen Y, Joshua Pfefer T. Rapid prototyping of biomimetic vascular phantoms for hyperspectral reflectance imaging. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:121312. [PMID: 26662064 PMCID: PMC4881289 DOI: 10.1117/1.jbo.20.12.121312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/20/2015] [Indexed: 05/03/2023]
Abstract
The emerging technique of rapid prototyping with three-dimensional (3-D) printers provides a simple yet revolutionary method for fabricating objects with arbitrary geometry. The use of 3-D printing for generating morphologically biomimetic tissue phantoms based on medical images represents a potentially major advance over existing phantom approaches. Toward the goal of image-defined phantoms, we converted a segmented fundus image of the human retina into a matrix format and edited it to achieve a geometry suitable for printing. Phantoms with vessel-simulating channels were then printed using a photoreactive resin providing biologically relevant turbidity, as determined by spectrophotometry. The morphology of printed vessels was validated by x-ray microcomputed tomography. Channels were filled with hemoglobin (Hb) solutions undergoing desaturation, and phantoms were imaged with a near-infrared hyperspectral reflectance imaging system. Additionally, a phantom was printed incorporating two disjoint vascular networks at different depths, each filled with Hb solutions at different saturation levels. Light propagation effects noted during these measurements—including the influence of vessel density and depth on Hb concentration and saturation estimates, and the effect of wavelength on vessel visualization depth—were evaluated. Overall, our findings indicated that 3-D-printed biomimetic phantoms hold significant potential as realistic and practical tools for elucidating light–tissue interactions and characterizing biophotonic system performance.
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Affiliation(s)
- Pejhman Ghassemi
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
| | - Jianting Wang
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
- University of Maryland, Fischell Department of Bioengineering, 3142 Jeong H. Kim Engineering Building, College Park, Maryland 20742, United States
| | - Anthony J. Melchiorri
- University of Maryland, Fischell Department of Bioengineering, 3142 Jeong H. Kim Engineering Building, College Park, Maryland 20742, United States
| | - Jessica C. Ramella-Roman
- Florida International University, Department of Biomedical Engineering and Herbert Wertheim College of Medicine, E6 2610, 10555 West Flagler Street, Miami, Florida 33174, United States
| | - Scott A. Mathews
- The Catholic University of America, Department of Electrical Engineering and Computer Science, 620 Michigan Avenue NE, Washington, District of Columbia 20064, United States
| | - James C. Coburn
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
| | - Brian S. Sorg
- National Institutes of Health, National Cancer Institute, 9609 Medical Center Drive, Rockville, Maryland 20852, United States
| | - Yu Chen
- University of Maryland, Fischell Department of Bioengineering, 3142 Jeong H. Kim Engineering Building, College Park, Maryland 20742, United States
| | - T. Joshua Pfefer
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
- Address all correspondence to: T. Joshua Pfefer, E-mail:
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Neittaanmäki-Perttu N, Grönroos M, Tani T, Pölönen I, Ranki A, Saksela O, Snellman E. Detecting field cancerization using a hyperspectral imaging system. Lasers Surg Med 2014; 45:410-7. [PMID: 24037822 DOI: 10.1002/lsm.22160] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Field cancerization denotes subclinical abnormalities in a tissue chronically exposed to UV radiation. These abnormalities can be found surrounding the clinically visible actinic keratoses. OBJECTIVES The aim of this study was to test the feasibility of a hyperspectral imaging system in the detection of multiple clinical and subclinical AKs for early treatment of the affected areas. MATERIALS AND METHODS Altogether 52 clinical AKs in 12 patients were included in this study. In six patients digital photos were taken of the naive AKs, and again after methylaminolevulinate(MAL)-fluorescence diagnosis which was used to teach HIS to find subclinical lesions. After 2-3 days when the MAL had vanished, the hyperspectral images were taken. Biopsies were taken from clinical AKs, healthy-looking skin and several suspected subclinical AKs. In the other six patients digital and hyperspectral images were taken of the naive AKs followed by one biopsy per patient. RESULTS HIS detected all clinically visible 52 AKs and numerous subclinical lesions. The histopathology of the 33 biopsied lesions were concordant with the HIS results showing either AK (n = 28) or photodamage (n = 5). Of the 28 histopathologically confirmed AKs, 16 were subclinical. A specific diffuse reflectance spectrum of an AK and healthy skin was defined. CONCLUSION The hyperspectral imaging system offers a new, non-invasive method for early detection of field cancerization. Lasers Surg. Med. 45:410-417, 2013. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Noora Neittaanmäki-Perttu
- Department of Dermatology and Allergology, Päijät-Häme Social and Health Care Group, Lahti, Finland; Department of Mathematical Information Technology, University of Jyväskylä, Jyväskylä, Finland
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Mitra K, Melvin J, Chang S, Park K, Yilmaz A, Melvin S, Xu RX. Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:116025. [PMID: 23214186 PMCID: PMC3500502 DOI: 10.1117/1.jbo.17.11.116025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 05/25/2023]
Abstract
We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy.
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Affiliation(s)
- Kinshuk Mitra
- Ohio State University, Department of Biomedical Engineering, Columbus, Ohio 43210
| | - James Melvin
- Ohio State University, Department of Biomedical Engineering, Columbus, Ohio 43210
| | - Shufang Chang
- Ohio State University, Department of Biomedical Engineering, Columbus, Ohio 43210
| | - Kyoungjin Park
- Ohio State University, Photogrammetric Computer Vision Lab, Columbus, Ohio 43210
| | - Alper Yilmaz
- Ohio State University, Photogrammetric Computer Vision Lab, Columbus, Ohio 43210
| | - Scott Melvin
- Ohio State University, Department of Surgery, Columbus, Ohio 43210
| | - Ronald X. Xu
- Ohio State University, Department of Biomedical Engineering, Columbus, Ohio 43210
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