Evaluation of burn severity in vivo in a mouse model using spectroscopic optical coherence tomography

Deep learning classification of ex vivo human colon tissues using spectroscopic optical coherence tomography

Screening for colorectal cancer (CRC) with colonoscopy has improved patient outcomes; however, it remains the third leading cause of cancer-related mortality, novel strategies to improve screening are needed. Here, we propose an optical biopsy technique based on spectroscopic optical coherence tomography (OCT). Depth resolved OCT images are analyzed as a function of wavelength to measure optical tissue properties and used as input to machine learning algorithms. Previously, we used this approach to analyze mouse colon polyps. Here, we extend the approach to examine human biopsied colonic epithelial tissue samples ex vivo. Optical properties are used as input to a novel deep learning architecture, producing accuracy of up to 97.9% in discriminating tissue type. SOCT parameters are used to create false colored en face OCT images and deep learning classifications are used to enable visual classification by tissue type. This study advances SOCT toward clinical utility for analysis of colonic epithelium.

Deep learning classification of ex vivo human colon tissues using spectroscopic OCT

Screening programs for colorectal cancer (CRC) have had a profound impact on the morbidity and mortality of this disease by detecting and removing early cancers and precancerous adenomas with colonoscopy. However, CRC continues to be the third leading cause of cancer-related mortality in both men and woman, partly because of limitations in colonoscopy-based screening. Thus, novel strategies to improve the efficiency and effectiveness of screening colonoscopy are urgently needed. Here, we propose to address this need using an optical biopsy technique based on spectroscopic optical coherence tomography (OCT). The depth resolved images obtained with OCT are analyzed as a function of wavelength to measure optical tissue properties. The optical properties can be used as input to machine learning algorithms as a means to classify adenomatous tissue in the colon. In this study, biopsied tissue samples from the colonic epithelium are analyzed ex vivo using spectroscopic OCT and tissue classifications are generated using a novel deep learning architecture, informed by machine learning methods including LSTM and KNN. The overall classification accuracy obtained was 88.9%, 76.0% and 97.9% in discriminating tissue type for these methods. Further, we apply an approach using false coloring of en face OCT images based on SOCT parameters and deep learning predictions to enable visual identification of tissue type. This study advances the spectroscopic OCT towards clinical utility for analyzing colonic epithelium for signs of adenoma.

Skin cancer margin detection using nanosensitive optical coherence tomography and a comparative study with confocal microscopy

Excision biopsy and histology represent the gold standard for morphological investigation of the skin, in particular for cancer diagnostics. Nevertheless, a biopsy may alter the original morphology, usually requires several weeks for results, is non-repeatable on the same site and always requires an iatrogenic trauma. Hence, diagnosis and clinical management of diseases may be substantially improved by new non-invasive imaging techniques. Optical Coherence Tomography (OCT) is a non-invasive depth-resolved optical imaging modality based on low coherence interferometry that enables high-resolution, cross-sectional imaging in biological tissues and it can be used to obtain both structural and functional information. Beyond the resolution limit, it is not possible to detect structural and functional information using conventional OCT. In this paper, we present a recently developed technique, nanosensitive OCT (nsOCT), improved using broadband supercontinuum laser, and demonstrate nanoscale sensitivity to structural changes within ex vivo human skin tissue. The extended spectral bandwidth permitted access to a wider distribution of spatial frequencies and improved the dynamic range of the nsOCT. Firstly, we demonstrate numerical and experimental detection of a few nanometers structural difference using the nsOCT method from single B-scan images of phantoms with sub-micron periodic structures, acting like Bragg gratings, along the depth. Secondly, our study shows that nsOCT can distinguish nanoscale structural changes at the skin cancer margin from the healthy region in en face images at clinically relevant depths. Finally, we compare the nsOCT en face image with a high-resolution confocal microscopy image to confirm the structural differences between the healthy and lesional/cancerous regions, allowing the detection of the skin cancer margin.

Semisupervised representative learning for measuring epidermal thickness in human subjects in optical coherence tomography by leveraging datasets from rodent models

SIGNIFICANCE

Morphological changes in the epidermis layer are critical for the diagnosis and assessment of various skin diseases. Due to its noninvasiveness, optical coherence tomography (OCT) is a good candidate for observing microstructural changes in skin. Convolutional neural network (CNN) has been successfully used for automated segmentation of the skin layers of OCT images to provide an objective evaluation of skin disorders. Such method is reliable, provided that a large amount of labeled data is available, which is very time-consuming and tedious. The scarcity of patient data also puts another layer of difficulty to make the model more generalizable.

AIM

We developed a semisupervised representation learning method to provide data augmentations.

APPROACH

We used rodent models to train neural networks for accurate segmentation of clinical data.

RESULT

The learning quality is maintained with only one OCT labeled image per volume that is acquired from patients. Data augmentation introduces a semantically meaningful variance, allowing for better generalization. Our experiments demonstrate the proposed method can achieve accurate segmentation and thickness measurement of the epidermis.

CONCLUSION

This is the first report of semisupervised representative learning applied to OCT images from clinical data by making full use of the data acquired from rodent models. The proposed method promises to aid in the clinical assessment and treatment planning of skin diseases.

Spectroscopic optical coherence tomography for classification of colorectal cancer in a mouse model

Noninvasive diagnosis of the malignant potential of colon polyps can improve prevention of colorectal cancer without the need for time-consuming and expensive biopsies. This study examines the use of spectroscopic optical coherence tomography (OCT) to classify tissue from genetically engineered mouse models of early-stage adenoma (APC) and advanced adenocarcinoma (AKP) in which tumors are induced in the distal colon. The optical tissue properties of scattering power and scattering attenuation coefficient are evaluated by analyzing the imaging data collected from tissues. Classifications are generated using 2D linear discriminant analysis with high levels of discrimination obtained. The overall classification accuracy obtained was 91.5%, with 100% sensitivity and 96.7% specificity in separating tumors from benign tissue, and 77.8% sensitivity and 99.4% specificity in separating adenocarcinoma from nonmalignant tissue. Thus, this study demonstrates the clinical potential of using spectroscopic OCT for rapid detection of colon adenoma and colorectal cancer.

Passive Millimeter-Wave Imaging for Burns Diagnostics under Dressing Materials

This paper presents a feasibility study of using a passive millimeter-wave imaging (PMMWI) system to assess burn wounds and the potential for monitoring the healing process under dressing materials, without their painful removal. Experimental images obtained from ex vivo porcine skin samples indicate that a ThruVision passive imager operating over the band 232-268 GHz can be used for diagnosing burns and for potentially monitoring the healing under dressing materials. Experimental images show that single and multiple burns are observed throughout dressing materials. As the interaction of millimeter-wave (MMW) radiation with the human body is almost exclusively with the skin, the major outcomes of the research are that PMMWI is capable of discriminating burn-damaged skin from unburned skin, and these measurements can be made through bandages without the imager making any physical contact with the skin or the bandage. This highlights the opportunity that the healing of burn wounds can be assessed and monitored without the removal of dressing materials. The key innovation in this work is in detecting single and multiple burns under dressing materials in noncontact with the skin and without exposing the skin to any type of manmade radiation (i.e., passive sensing technology). These images represent the first demonstration of burns wound under dressing materials using a passive sensing imager.

A review of low-cost and portable optical coherence tomography

Optical coherence tomography (OCT) is a powerful optical imaging technique capable of visualizing the internal structure of biological tissues at near cellular resolution. For years, OCT has been regarded as the standard of care in ophthalmology, acting as an invaluable tool for the assessment of retinal pathology. However, the costly nature of most current commercial OCT systems has limited its general accessibility, especially in low-resource environments. It is therefore timely to review the development of low-cost OCT systems as a route for applying this technology to population-scale disease screening. Low-cost, portable and easy to use OCT systems will be essential to facilitate widespread use at point of care settings while ensuring that they offer the necessary imaging performances needed for clinical detection of retinal pathology. The development of low-cost OCT also offers the potential to enable application in fields outside ophthalmology by lowering the barrier to entry. In this paper, we review the current development and applications of low-cost, portable and handheld OCT in both translational and research settings. Design and cost-reduction techniques are described for general low-cost OCT systems, including considerations regarding spectrometer-based detection, scanning optics, system control, signal processing, and the role of 3D printing technology. Lastly, a review of clinical applications enabled by low-cost OCT is presented, along with a detailed discussion of current limitations and outlook.

OCT-Based Angiography and Surface Topography in Burn-Damaged Skin

BACKGROUND AND OBJECTIVES

There is a clinical need for an accurate, non-invasive imaging tool that can provide the objective assessment of burn wounds. The aims of this study are to demonstrate the potential of optical coherence tomography (OCT) in evaluating burn wound healing, as well as exploring the physiological basis of human wound healing.

STUDY DESIGN/MATERIALS AND METHODS

This was a retrospective study. Seven patients with severe burn wounds who were admitted to Harborview Medical Center were imaged using an in-house-built, clinical-prototype OCT system. OCT imaging was carried out at multiple scan sites on the burned skin across two time points (imaging session #1 and #2) with a field of view of ~9 × 9 mm. Due to pathological differences among burn zones, scan sites were classified into red sites (zone of hyperemia), white sites (zone of coagulation), and mixed sites. In addition to obtaining qualitative en face vascular and surface topography maps, we quantified vascular area density and surface roughness for comparative purposes.

RESULTS

En face vascular and surface topography maps demonstrated numerous morphological changes over both imaging sessions associated with burn injury, such as altered blood flow and loss of regular texture. Quantitative analyses revealed that during imaging session #1, vascular area density was significantly increased within the red sites compared with that of a healthy control (P = 0.0130), while vascular area density was significantly decreased within the white sites compared with that of a healthy control (P < 0.0001). During imaging session #2, vascular area density was significantly reduced to a more normal range within the red sites compared with imaging session #1 (P = 0.0215); however, vascular area density was still significantly lower within the white sites compared with that of a healthy control (P < 0.0001). Furthermore, vascular area density and surface roughness were significantly increased within the white sites during imaging session #2 compared with imaging session #1 (both P < 0.0001).

CONCLUSIONS

OCT is clinically feasible to monitor vascular changes and alterations in skin surface roughness during the process of burn wound healing. Variations in vascular area density and roughness measurements within the burn wounds revealed by OCT offer some key insights into the underlying pathophysiological mechanisms responsible for wound healing, which may become critical biological indicators in future clinical evaluation and monitoring of wound healing. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Spectroscopic optical coherence refraction tomography

In optical coherence tomography (OCT), the axial resolution is often superior to the lateral resolution, which is sacrificed for long imaging depths. To address this anisotropy, we previously developed optical coherence refraction tomography (OCRT), which uses images from multiple angles to computationally reconstruct an image with isotropic resolution, given by the OCT axial resolution. On the other hand, spectroscopic OCT (SOCT), an extension of OCT, trades axial resolution for spectral resolution and hence often has superior lateral resolution. Here, we present spectroscopic OCRT (SOCRT), which uses SOCT images from multiple angles to reconstruct a spectroscopic image with isotropic spatial resolution limited by the OCT lateral resolution. We experimentally show that SOCRT can estimate bead size based on Mie theory at simultaneously high spectral and isotropic spatial resolution. We also applied SOCRT to a biological sample, achieving axial resolution enhancement limited by the lateral resolution.

Synthetic Aperture Radar Imaging for Burn Wounds Diagnostics

The need for technologies to monitor the wound healing under dressing materials has led us to investigate the feasibility of using microwave and millimetre wave radiations due to their sensitivity to water, non- ionising nature, and transparency to dressing materials and clothing. This paper presents synthetic aperture radar (SAR) images obtained from an active microwave and millimetre wave scanner operating over the band 15–40 GHz. Experimental images obtained from porcine skin samples with the presence of dressing materials and after the application of localised heat treatments reveal that SAR images can be used for diagnosing burns and for potentially monitoring the healing under dressing materials. The experimental images were extracted separately from the amplitude and phase measurements of the input reflection coefficient (S₁₁). The acquired images indicate that skin and burns can be detected and observed through dressing materials as well as features of the skin such as edges, irregularities, bends, burns, and variation in the reflectance of the skin. These unique findings enable a microwave and millimetre-wave scanner to be used for evaluating the wound healing progress under dressing materials without their often-painful removal: a capability that will reduce the cost of healthcare, distress caused by long waiting hours, and the healthcare interventional time.

Geometry-Dependent Spectroscopic Contrast in Deep Tissues

Nano-structures of biological systems can produce diverse spectroscopic effects through interactions with broadband light. Although structured coloration at the surface has been extensively studied, natural spectroscopic contrasts in deep tissues are poorly understood, which may carry valuable information for evaluating the anatomy and function of biological systems. Here we investigated the spectroscopic characteristics of an important geometry in deep tissues at the nanometer scale: packed nano-cylinders, in the near-infrared window, numerically predicted and experimentally proved that transversely oriented and regularly arranged nano-cylinders could selectively backscatter light of the long wavelengths. Notably, we found that the spectroscopic contrast of nanoscale fibrous structures was sensitive to the pressure load, possibly owing to the changes in the orientation, the degree of alignment, and the spacing. To explore the underlying physical basis, we further developed an analytical model based on the radial distribution function in terms of their radius, refractive index, and spatial distribution.

Ocular anterior chamber blood cell population differentiation using spectroscopic optical coherence tomography

There is potential clinical significance in identifying cellular responses in the anterior chamber (AC) of the eye, which can indicate hyphema (an accumulation of red blood cells [RBCs]) or aberrant intraocular inflammation (an accumulation of white blood cells [WBCs]). In this work, we developed a spectroscopic OCT analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both in vitro and in ACs of porcine eyes. We developed an algorithm to track single cells within OCT data sets, and extracted the backscatter reflectance spectrum of each single cell from the detected interferograms using the short-time Fourier transform (STFT). A look-up table of Mie back-scattering spectra was generated and used to correlate the backscatter spectral features of single cells to their characteristic sizes. The extracted size distributions based on the best Mie spectra fit were significantly different between each cell type. We also studied theoretical backscattering models of single RBCs to further validate our experimental results. The described work is a promising step towards clinically differentiating and quantifying AC blood cell types.

Optical coherence tomography correlates multiple measures of tissue damage following acute burn injury

Background

The visual assessment of burned skin is inherently subjective, and whilst a number of imaging modalities have identified quantifiable parameters to characterize vascular and structural changes following burn damage, none have become common place in the assessment protocol. Here, we use optical coherence tomography (OCT)-based angiography (OCTA) to introduce novel correlations between vessel depth, i.e., the depth of functional blood vessels beneath the tissue surface, edema depth, i.e., the depth of interstitial fluid buildup beneath the tissue surface, and tissue injury depth, i.e., the depth of collagen denaturation beneath the tissue surface, following burn injury.

Methods

A clinical prototype OCT system was used to collect OCT images from various sites of burned skin in patients. Optical microangiography (OMAG) algorithm was used to derive OCTA information from the acquired OCT images, from which the presence of blood vessels and edema were detected. The optical attenuation mapping of structural OCT information was used to detect tissue injury depth. The depths of vessel, edema and tissue injury were measured using a semi-automatic segmentation algorithm. Correlation analysis was performed using a Pearson correlation coefficient using one-tailed analysis with significance being established by a P value ≤0.05.

Results

Four burn patients were recruited and scanned at multiple sites using the prototype system within 3-6 days of injury. Approximate measurements include a vessel depth range of 320-1,360 µm, an edema depth range of 0-400 µm, and a tissue injury depth range of 130-420 µm. Correlations were subsequently observed between vessel depth and edema depth (r=0.8521, P=0.0001), and vessel depth and tissue injury depth (r=0.6296, P=0.0106).

Conclusions

OCT is feasible to provide the critical information of vessel depth, edema depth, and tissue injury depth of skin burns, which may represent viable assessment criteria for the characterization of cutaneous burns in future.

Light scattering methods for tissue diagnosis

Light scattering has become a common biomedical research tool, enabling diagnostic sensitivity to myriad tissue alterations associated with disease. Light-tissue interactions are particularly attractive for diagnostics due to the variety of contrast mechanisms that can be used, including spectral, angle-resolved, and Fourier-domain detection. Photonic diagnostic tools offer further benefit in that they are non-ionizing, non-invasive, and give real-time feedback. In this review, we summarize recent innovations in light scattering technologies, with a focus on clinical achievements over the previous ten years.

A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential

PURPOSE

Reliable and valid assessment of burn wound depth or healing potential is essential to treatment decision-making, to provide a prognosis, and to compare studies evaluating different treatment modalities. The aim of this review was to critically appraise, compare and summarize the quality of relevant measurement properties of techniques that aim to assess burn wound depth or healing potential.

METHODS

A systematic literature search was performed using PubMed, EMBASE and Cochrane Library. Two reviewers independently evaluated the methodological quality of included articles using an adapted version of the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A synthesis of evidence was performed to rate the measurement properties for each technique and to draw an overall conclusion on quality of the techniques.

RESULTS

Thirty-six articles were included, evaluating various techniques, classified as (1) laser Doppler techniques; (2) thermography or thermal imaging; (3) other measurement techniques. Strong evidence was found for adequate construct validity of laser Doppler imaging (LDI). Moderate evidence was found for adequate construct validity of thermography, videomicroscopy, and spatial frequency domain imaging (SFDI). Only two studies reported on the measurement property reliability. Furthermore, considerable variation was observed among comparator instruments.

CONCLUSIONS

Considering the evidence available, it appears that LDI is currently the most favorable technique; thereby assessing burn wound healing potential. Additional research is needed into thermography, videomicroscopy, and SFDI to evaluate their full potential. Future studies should focus on reliability and measurement error, and provide a precise description of which construct is aimed to measure.

Burn Wound Healing and Tissue Engineering

In 2016 the American Burn Association held a State of the Science conference to help identify burn research priorities for the next decade. The current paper summarizes the work of the sub-committee on Burn Wound Healing and Tissue Engineering. We first present the priorities in wound healing research over the next 10 years. We then summarize the current state of the science related to burn wound healing and tissue engineering including determination of burn depth, limiting burn injury progression, eschar removal, management of microbial contamination and wound infection, measuring wound closure, accelerating wound healing and durable wound closure, and skin substitutes and tissue engineering. Finally, a summary of the round table discussion is presented.

Multifocal spectral-domain optical coherence tomography based on Bessel beam for extended imaging depth

To advance the practical application of optical coherence tomography (OCT) in the field of biomedical imaging, the imaging depth must be extended without sacrificing resolution while maintaining sufficient sensitivity. However, there is an inherent trade-off between lateral resolution and depth of field (DOF) in OCT. To address this shortcoming, this article proposes a multifocal Bessel beam spectral-domain optical coherence tomography (MBSDOCT) capable of increasing the DOF with unchanged lateral resolution and a high signal-to-noise ratio. The proposed technique is demonstrated by simulation and experiment. A three-focal MBSDOCT with an axicon lens theoretically achieved a DOF of ∼6  mm with a lateral resolution of ∼13  μm. In imaging experiments performed on the acinar cells of orange tissue, a measured DOF of ∼4  mm was demonstrated with a sensitivity penalty of ∼18.1  dB, relative to the Gaussian beam spectral-domain OCT, with a 9-mW light source.

Thermal injury of skin and subcutaneous tissues: A review of experimental approaches and numerical models

Thermal injury to skin and subcutaneous tissue is common in both civilian and combat scenarios. Understanding the change in tissue morphologies and properties and the underlying mechanisms of thermal injury are of vital importance to clinical determination of the degree of burn and treatment approach. This review aims at summarizing the research involving experimental and numerical studies of skin and subcutaneous tissue subjected to thermal injury. The review consists of two parts. The first part deals with experimental studies including burn protocols and prevailing imaging approaches. The second part deals with existing numerical models for burns of tissue and related computational simulations. Based on this review, we conclude that though there is literature contributing to the knowledge of the pathology and pathogenesis of tissue burn, there is scant quantitative information regarding changes in tissue properties including mechanical, thermal, electrical and optical properties as a result of burns that are linked to altered tissue morphology.

Deep imaging of absorption and scattering features by multispectral multiple scattering low coherence interferometry

We have developed frequency domain multispectral multiple scattering low coherence interferometry (ms2/LCI) for deep imaging of absorption and scattering contrast. Using tissue-mimicking phantoms that match the full scattering phase function of human dermal tissue, we demonstrate that ms2/LCI can provide a signal/noise ratio (SNR) improvement of 15.4 dB over conventional OCT at an imaging depth of 1 mm. The enhanced SNR and penetration depth provided by ms2/LCI could be leveraged for a variety of clinical applications including the assessment of burn injuries where current clinical classification of severity only provides limited accuracy. The utility of the approach was demonstrated by imaging a tissue phantom simulating a partial-thickness burn revealing good spectroscopic contrast between healthy and injured tissue regions deep below the sample surface. Finally, healthy rat skin was imaged in vivo with both a commercial OCT instrument and our custom ms2/LCI system. The results demonstrate that ms2/LCI is capable of obtaining spectroscopic information far beyond the penetration depth provided by conventional OCT.

Characterization of lipid-rich plaques using spectroscopic optical coherence tomography

Intravascular optical coherence tomography (IV-OCT) is a high-resolution imaging method used to visualize the internal structures of walls of coronary arteries in vivo. However, accurate characterization of atherosclerotic plaques with gray-scale IV-OCT images is often limited by various intrinsic artifacts. In this study, we present an algorithm for characterizing lipid-rich plaques with a spectroscopic OCT technique based on a Gaussian center of mass (GCOM) metric. The GCOM metric, which reflects the absorbance properties of lipids, was validated using a lipid phantom. In addition, the proposed characterization method was successfully demonstrated in vivo using an atherosclerotic rabbit model and was found to have a sensitivity and specificity of 94.3% and 76.7% for lipid classification, respectively.

Introduction to the bio-optics: design and application

The "Bio-Optics: Design and Application" symposium, held on April 12-15, 2015, in Vancouver, BC, was an important step in a continuous journey to closely connect technological design advancement and biomedical applications. The symposium presented a broad range of innovations in diagnostic devices, endoscopy, optical microscopy, optical coherence tomography, multi-modal imaging, and highlighted specific applications including cancer diagnostics, detection of infectious disease and point of care, as well as microsurgery treatment.