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Pogue BW, Zhu TC, Ntziachristos V, Wilson BC, Paulsen KD, Gioux S, Nordstrom R, Pfefer TJ, Tromberg BJ, Wabnitz H, Yodh A, Chen Y, Litorja M. AAPM Task Group Report 311: Guidance for performance evaluation of fluorescence-guided surgery systems. Med Phys 2024; 51:740-771. [PMID: 38054538 DOI: 10.1002/mp.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
The last decade has seen a large growth in fluorescence-guided surgery (FGS) imaging and interventions. With the increasing number of clinical specialties implementing FGS, the range of systems with radically different physical designs, image processing approaches, and performance requirements is expanding. This variety of systems makes it nearly impossible to specify uniform performance goals, yet at the same time, utilization of different devices in new clinical procedures and trials indicates some need for common knowledge bases and a quality assessment paradigm to ensure that effective translation and use occurs. It is feasible to identify key fundamental image quality characteristics and corresponding objective test methods that should be determined such that there are consistent conventions across a variety of FGS devices. This report outlines test methods, tissue simulating phantoms and suggested guidelines, as well as personnel needs and professional knowledge bases that can be established. This report frames the issues with guidance and feedback from related societies and agencies having vested interest in the outcome, coming from an independent scientific group formed from academics and international federal agencies for the establishment of these professional guidelines.
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Affiliation(s)
- Brian W Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Timothy C Zhu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vasilis Ntziachristos
- Institute for Biological and Medical Imaging, Technical University of Munich, Helmholtz Zentrum Munich, Munich, Germany
| | - Brian C Wilson
- Department of Medical Biophysics, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Sylvain Gioux
- Department of Biomedical Engineering, University of Strasbourg, Strasbourg, France
| | - Robert Nordstrom
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - T Joshua Pfefer
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Bruce J Tromberg
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Arjun Yodh
- Department of Physics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yu Chen
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Maritoni Litorja
- Sensor Science Division, National Institute of Standards and Technology, Gaithersburg, Maryland, USA
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2
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Mc Larney BE, Kim M, Roberts S, Skubal M, Hsu HT, Ogirala A, Pratt EC, Pillarsetty NVK, Heller DA, Lewis JS, Grimm J. Ambient Light Resistant Shortwave Infrared Fluorescence Imaging for Preclinical Tumor Delineation via the pH Low-Insertion Peptide Conjugated to Indocyanine Green. J Nucl Med 2023; 64:1647-1653. [PMID: 37620049 PMCID: PMC10586478 DOI: 10.2967/jnumed.123.265686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Shortwave infrared (900-1,700 nm) fluorescence imaging (SWIRFI) has shown significant advantages over visible (400-650 nm) and near-infrared (700-900 nm) fluorescence imaging (reduced autofluorescence, improved contrast, tissue resolution, and depth sensitivity). However, there is a major lag in the clinical translation of preclinical SWIRFI systems and targeted SWIRFI probes. Methods: We preclinically show that the pH low-insertion peptide conjugated to indocyanine green (pHLIP ICG), currently in clinical trials, is an excellent candidate for cancer-targeted SWIRFI. Results: pHLIP ICG SWIRFI achieved picomolar sensitivity (0.4 nM) with binary and unambiguous tumor screening and resection up to 96 h after injection in an orthotopic breast cancer mouse model. SWIRFI tumor screening and resection had ambient light resistance (possible without gating or filtering) with outstanding signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values at exposures from 10 to 0.1 ms. These SNR and CNR values were also found for the extended emission of pHLIP ICG in vivo (>1,100 nm, 300 ms). Conclusion: SWIRFI sensitivity and ambient light resistance enabled continued tracer clearance tracking with unparalleled SNR and CNR values at video rates for tumor delineation (achieving a tumor-to-muscle ratio above 20). In total, we provide a direct precedent for the democratic translation of an ambient light resistant SWIRFI and pHLIP ICG ecosystem, which can instantly improve tumor resection.
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Affiliation(s)
| | - Mijin Kim
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Magdalena Skubal
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hsiao-Ting Hsu
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anuja Ogirala
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edwin C Pratt
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naga Vara Kishore Pillarsetty
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology, Weill Cornell Medicine, New York, New York; and
| | - Daniel A Heller
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pharmacology, Weill Cornell Medicine, New York, New York
| | - Jason S Lewis
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pharmacology, Weill Cornell Medicine, New York, New York
- Department of Radiology, Weill Cornell Medicine, New York, New York; and
| | - Jan Grimm
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York;
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pharmacology, Weill Cornell Medicine, New York, New York
- Department of Radiology, Weill Cornell Medicine, New York, New York; and
- Molecular Imaging Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
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3
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Ochoa MI, Ruiz A, LaRochelle E, Reed M, Berber E, Poultsides G, Pogue BW. Assessment of open-field fluorescence guided surgery systems: implementing a standardized method for characterization and comparison. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:096007. [PMID: 37745774 PMCID: PMC10513724 DOI: 10.1117/1.jbo.28.9.096007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
Significance Fluorescence guided surgery (FGS) has demonstrated improvements in decision making and patient outcomes for a wide range of surgical procedures. Not only can FGS systems provide a higher level of structural perfusion accuracy in tissue reconstruction cases but they can also serve for real-time functional characterization. Multiple FGS devices have been Food and Drug administration (FDA) cleared for use in open and laparoscopic surgery. Despite the rapid growth of the field, there has been a lack standardization methods. Aim This work overviews commonalities inherent to optical imaging methods that can be exploited to produce such a standardization procedure. Furthermore, a system evaluation pipeline is proposed and executed through the use of photo-stable indocyanine green fluorescence phantoms. Five different FDA-approved open-field FGS systems are used and evaluated with the proposed method. Approach The proposed pipeline encompasses the following characterization: (1) imaging spatial resolution and sharpness, (2) sensitivity and linearity, (3) imaging depth into tissue, (4) imaging system DOF, (5) uniformity of illumination, (6) spatial distortion, (7) signal to background ratio, (8) excitation bands, and (9) illumination wavelength and power. Results The results highlight how such a standardization approach can be successfully implemented for inter-system comparisons as well as how to better understand essential features within each FGS setup. Conclusions Despite clinical use being the end goal, a robust yet simple standardization pipeline before clinical trials, such as the one presented herein, should benefit regulatory agencies, manufacturers, and end-users to better assess basic performance and improvements to be made in next generation FGS systems.
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Affiliation(s)
- Marien I. Ochoa
- University of Wisconsin Madison, Department of Medical Physics, Madison, Wisconsin, United States
| | - Alberto Ruiz
- QUEL Imaging, White River Junction, Vermont, United States
| | | | - Matthew Reed
- University of Wisconsin Madison, Department of Medical Physics, Madison, Wisconsin, United States
| | - Eren Berber
- Cleveland Clinic - Marymount Hospital, Garfield Heights, Ohio, United States
| | - George Poultsides
- Stanford Medicine, Department of Surgery, Stanford, California, United States
| | - Brian W. Pogue
- University of Wisconsin Madison, Department of Medical Physics, Madison, Wisconsin, United States
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4
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Out-of-Phase Imaging after Optical Modulation (OPIOM) for Multiplexed Fluorescence Imaging Under Adverse Optical Conditions. Methods Mol Biol 2021; 2350:191-227. [PMID: 34331287 DOI: 10.1007/978-1-0716-1593-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fluorescence imaging has become a powerful tool for observations in biology. Yet it has also encountered limitations to overcome optical interferences of ambient light, autofluorescence, and spectrally interfering fluorophores. In this account, we first examine the current approaches which address these limitations. Then we more specifically report on Out-of-Phase Imaging after Optical Modulation (OPIOM), which has proved attractive for highly selective multiplexed fluorescence imaging even under adverse optical conditions. After exposing the OPIOM principle, we detail the protocols for successful OPIOM implementation.
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5
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Mendez CB, Gonda A, Shah JV, Siebert JN, Zhao X, He S, Riman RE, Tan MC, Moghe PV, Ganapathy V, Pierce MC. Short-Wave Infrared Emitting Nanocomposites for Fluorescence-Guided Surgery. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2021; 27:7300307. [PMID: 36710719 PMCID: PMC9881055 DOI: 10.1109/jstqe.2021.3066895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Fluorescence-guided surgery (FGS) is an emerging technique for tissue visualization during surgical procedures. Structures of interest are labeled with exogenous probes whose fluorescent emissions are acquired and viewed in real-time with optical imaging systems. This study investigated rare-earth-doped albumin-encapsulated nanocomposites (REANCs) as short-wave infrared emitting contrast agents for FGS. Experiments were conducted using an animal model of 4T1 breast cancer. The signal-to-background ratio (SBR) obtained with REANCs was compared to values obtained using indocyanine green (ICG), a near-infrared dye used in clinical practice. Prior to resection, the SBR for tumors following intratumoral administration of REANCs was significantly higher than for tumors injected with ICG. Following FGS, evaluation of fluorescence intensity levels in excised tumors and at the surgical bed demonstrated higher contrast between tissues at these sites with REANC contrast than ICG. REANCs also demonstrated excellent photostability over 2 hours of continuous illumination, as well as the ability to perform FGS under ambient lighting, establishing these nanocomposites as a promising contrast agent for FGS applications.
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Affiliation(s)
- Carolina Bobadilla Mendez
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Amber Gonda
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Jay V Shah
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Jake N Siebert
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Xinyu Zhao
- Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Shuqing He
- Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Richard E Riman
- Department of Materials Science and Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Mei Chee Tan
- Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Prabhas V Moghe
- Department of Biomedical Engineering, and the Department of Chemical and Biochemical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Vidya Ganapathy
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
| | - Mark C Pierce
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854 USA
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6
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van Schaik JE, Halmos GB, Witjes MJH, Plaat BEC. An overview of the current clinical status of optical imaging in head and neck cancer with a focus on Narrow Band imaging and fluorescence optical imaging. Oral Oncol 2021; 121:105504. [PMID: 34454339 DOI: 10.1016/j.oraloncology.2021.105504] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/25/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
Early and accurate identification of head and neck squamous cell carcinoma (HNSCC) is important to improve treatment outcomes and prognosis. New optical imaging techniques may assist in both the diagnostic process as well as in the operative setting by real-time visualization and delineation of tumor. Narrow Band Imaging (NBI) is an endoscopic technique that uses blue and green light to enhance mucosal and submucosal blood vessels, leading to better detection of (pre)malignant lesions showing aberrant blood vessel patterns. Fluorescence optical imaging makes use of near-infrared fluorescent agents to visualize and delineate HNSCC, resulting in fewer positive surgical margins. Targeted fluorescent agents, such as fluorophores conjugated to antibodies, show the most promising results. The aim of this review is: (1) to provide the clinical head and neck surgeon an overview of the current clinical status of various optical imaging techniques in head and neck cancer; (2) to provide an in-depth review of NBI and fluorescence optical imaging, as these techniques have the highest potential for clinical implementation; and (3) to describe future improvements and developments within the field of these two techniques.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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7
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Stewart HL, Birch DJS. Fluorescence Guided Surgery. Methods Appl Fluoresc 2021; 9. [PMID: 34399409 DOI: 10.1088/2050-6120/ac1dbb] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023]
Abstract
Fluorescence guided surgery (FGS) is an imaging technique that allows the surgeon to visualise different structures and types of tissue during a surgical procedure that may not be as visible under white light conditions. Due to the many potential advantages of fluorescence guided surgery compared to more traditional clinical imaging techniques such as its higher contrast and sensitivity, less subjective use, and ease of instrument operation, the research interest in fluorescence guided surgery continues to grow over various key aspects such as fluorescent probe development and surgical system development as well as its potential clinical applications. This review looks to summarise some of the emerging opportunities and developments that have already been made in fluorescence guided surgery in recent years while highlighting its advantages as well as limitations that need to be overcome in order to utilise the full potential of fluorescence within the surgical environment.
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Affiliation(s)
- Hazel L Stewart
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh BioQuarter, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom
| | - David J S Birch
- Department of Physics, The Photophysics Research Group, University of Strathclyde, SUPA, John Anderson Building, 107 Rottenrow East, Glasgow G4 0NG, United Kingdom
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8
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Kelemen Z, Zhang R, Gissot L, Chouket R, Bellec Y, Croquette V, Jullien L, Faure JD, Le Saux T. Dynamic Contrast for Plant Phenotyping. ACS OMEGA 2020; 5:15105-15114. [PMID: 32637783 PMCID: PMC7331089 DOI: 10.1021/acsomega.0c00957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
Noninvasiveness, minimal handling, and immediate response are favorable features of fluorescence readout for high-throughput phenotyping of labeled plants.Yet, remote fluorescence imaging may suffer from an autofluorescent background and artificial or natural ambient light. In this work, the latter limitations are overcome by adopting reversibly photoswitchable fluorescent proteins (RSFPs) as labels and Speed OPIOM (out-of-phase imaging after optical modulation), a fluorescence imaging protocol exploiting dynamic contrast. Speed OPIOM can efficiently distinguish the RSFP signal from autofluorescence and other spectrally interfering fluorescent reporters like GFP. It can quantitatively assess gene expressions, even when they are weak. It is as quantitative, sensitive, and robust in dark and bright light conditions. Eventually, it can be used to nondestructively record abiotic stress responses like water or iron limitations in real time at the level of individual plants and even of specific organs. Such Speed OPIOM validation could find numerous applications to identify plant lines in selection programs, design plants as environmental sensors, or ecologically monitor transgenic plants in the environment.
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Affiliation(s)
- Zsolt Kelemen
- Université
Paris-Saclay, INRAE, AgroParisTech, Institut Jean-Pierre Bourgin, F-78000 Versailles, France
| | - Ruikang Zhang
- PASTEUR,
Département de chimie, École
normale supérieure, PSL University, SorbonneUniversité,
CNRS, 24, rue Lhomond, 75005 Paris, France
| | - Lionel Gissot
- Université
Paris-Saclay, INRAE, AgroParisTech, Institut Jean-Pierre Bourgin, F-78000 Versailles, France
| | - Raja Chouket
- PASTEUR,
Département de chimie, École
normale supérieure, PSL University, SorbonneUniversité,
CNRS, 24, rue Lhomond, 75005 Paris, France
| | - Yannick Bellec
- Université
Paris-Saclay, INRAE, AgroParisTech, Institut Jean-Pierre Bourgin, F-78000 Versailles, France
| | - Vincent Croquette
- Laboratoire
de Physique Statistique, École normale
supérieure, PSL Research University, Université de Paris,
Sorbonne Université, CNRS, 75005 Paris, France
- Institut
de biologie de l’École normale supérieure (IBENS), École normale supérieure, CNRS, INSERM,
PSL Research University, 75005 Paris, France
| | - Ludovic Jullien
- PASTEUR,
Département de chimie, École
normale supérieure, PSL University, SorbonneUniversité,
CNRS, 24, rue Lhomond, 75005 Paris, France
| | - Jean-Denis Faure
- Université
Paris-Saclay, INRAE, AgroParisTech, Institut Jean-Pierre Bourgin, F-78000 Versailles, France
| | - Thomas Le Saux
- PASTEUR,
Département de chimie, École
normale supérieure, PSL University, SorbonneUniversité,
CNRS, 24, rue Lhomond, 75005 Paris, France
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9
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Lagarto JL, Shcheslavskiy V, Pavone FS, Cicchi R. Real-time fiber-based fluorescence lifetime imaging with synchronous external illumination: A new path for clinical translation. JOURNAL OF BIOPHOTONICS 2020; 13:e201960119. [PMID: 31742905 DOI: 10.1002/jbio.201960119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 05/22/2023]
Abstract
Time-correlated single photon counting is the "gold-standard" method for fluorescence lifetime measurements and has demonstrated potential for clinical deployment. However, the translation of the technology into clinic is hindered by the use of ultrasensitive detectors, which make the fluorescence acquisition impractical with bright lighting conditions such as in clinical settings. We address this limitation by interleaving periodic fluorescence detection with synchronous out-of-phase externally modulated light source, thus guaranteeing specimen illumination and a fluorescence signal free from bright background light upon temporal separation. Fluorescence lifetime maps are generated in real-time from single-point measurements by tracking a reference beam and using the phasor approach. We demonstrate the feasibility and practicality of this technique in a number of biological specimens, including real-time mapping of degraded articular cartilage. This method is compatible and can be integrated with existing clinical microscopic, endoscopic and robotic modalities, thus offering a new pathway towards label-free diagnostics and surgical guidance in a number of clinical applications.
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Affiliation(s)
- João L Lagarto
- National Institute of Optics, National Research Council (INO-CNR), Sesto Fiorentino, Italy
- European Laboratory for Non-linear Spectroscopy (LENS), Sesto Fiorentino, Italy
| | | | - Francesco S Pavone
- National Institute of Optics, National Research Council (INO-CNR), Sesto Fiorentino, Italy
- European Laboratory for Non-linear Spectroscopy (LENS), Sesto Fiorentino, Italy
- Department of Physics, University of Florence, Sesto Fiorentino, Italy
| | - Riccardo Cicchi
- National Institute of Optics, National Research Council (INO-CNR), Sesto Fiorentino, Italy
- European Laboratory for Non-linear Spectroscopy (LENS), Sesto Fiorentino, Italy
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10
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van Beurden F, van Willigen DM, Vojnovic B, van Oosterom MN, Brouwer OR, van der Poel HG, Kobayashi H, van Leeuwen FW, Buckle T. Multi-Wavelength Fluorescence in Image-Guided Surgery, Clinical Feasibility and Future Perspectives. Mol Imaging 2020; 19:1536012120962333. [PMID: 33125289 PMCID: PMC7607779 DOI: 10.1177/1536012120962333] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/22/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
With the rise of fluorescence-guided surgery, it has become evident that different types of fluorescence signals can provide value in the surgical setting. Hereby a different range of targets have been pursued in a great variety of surgical indications. One of the future challenges lies in combining complementary fluorescent readouts during one and the same surgical procedure, so-called multi-wavelength fluorescence guidance. In this review we summarize the current clinical state-of-the-art in multi-wavelength fluorescence guidance, basic technical concepts, possible future extensions of existing clinical indications and impact that the technology can bring to clinical care.
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Affiliation(s)
- Florian van Beurden
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Danny M. van Willigen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Borivoj Vojnovic
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Matthias N. van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar R. Brouwer
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Fijs W.B. van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Orsi Academy, Melle, Belgium
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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11
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van Keulen S, Nishio N, Fakurnejad S, Birkeland A, Martin BA, Lu G, Zhou Q, Chirita SU, Forouzanfar T, Colevas AD, van den Berg NS, Rosenthal EL. The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer. J Nucl Med 2019; 60:758-763. [PMID: 30733319 PMCID: PMC6581234 DOI: 10.2967/jnumed.118.222810] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/29/2018] [Indexed: 01/17/2023] Open
Abstract
Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision making. Methods: Head and neck cancer patients (n = 14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision making in 3 cases (21.4%): identification of a close margin (n = 1) and unanticipated regions of primary disease (n = 2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision making during resection of primary tumors.
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Affiliation(s)
- Stan van Keulen
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Naoki Nishio
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Shayan Fakurnejad
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Andrew Birkeland
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Brock A Martin
- Department of Clinical Pathology, Stanford University School of Medicine, Stanford, California
| | - Guolan Lu
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Quan Zhou
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Stefania U Chirita
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.,Cancer Clinical Trials Office, Stanford Cancer Center, Stanford University School of Medicine, Stanford, California; and
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - A Dimitrios Colevas
- Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Nynke S van den Berg
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Eben L Rosenthal
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
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Intraoperative Assessment of Parathyroid Viability using Laser Speckle Contrast Imaging. Sci Rep 2017; 7:14798. [PMID: 29093531 PMCID: PMC5665975 DOI: 10.1038/s41598-017-14941-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/18/2017] [Indexed: 11/08/2022] Open
Abstract
Post-surgical hypoparathyroidism and hypocalcemia are known to occur after nearly 50% of all thyroid surgeries as a result of accidental disruption of blood supply to healthy parathyroid glands, which are responsible for regulating calcium. However, there are currently no clinical methods for accurately identifying compromised glands and the surgeon relies on visual assessment alone to determine if any gland(s) should be excised and auto-transplanted. Here, we present Laser Speckle Contrast Imaging (LSCI) for real-time assessment of parathyroid viability. Taking an experienced surgeon's visual assessment as the gold standard, LSCI can be used to distinguish between well vascularized (n = 32) and compromised (n = 27) parathyroid glands during thyroid surgery with an accuracy of 91.5%. Ability to detect vascular compromise with LSCI was validated in parathyroidectomies. Results showed that this technique is able to detect parathyroid gland devascularization before it is visually apparent to the surgeon. Measurements can be performed in real-time and without the need to turn off operating room lights. LSCI shows promise as a real-time, contrast-free, objective method for helping reduce hypoparathyroidism after thyroid surgery.
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