Use of a handheld terahertz pulsed imaging device to differentiate benign and malignant breast tissue

Biomedical application of terahertz imaging technology: a narrative review

Background and Objective

Terahertz (THz) imaging has wide applications in biomedical research due to its properties, such as non-ionizing, non-invasive and distinctive spectral fingerprints. Over the past 6 years, the application of THz imaging in tumor tissue has made encouraging progress. However, due to the strong absorption of THz by water, the large size, high cost, and low sensitivity of THz devices, it is still difficult to be widely used in clinical practice. This paper provides ideas for researchers and promotes the development of THz imaging in clinical research.

Methods

The literature search was conducted in the Web of Science and PubMed databases using the keywords "Terahertz imaging", "Breast", "Brain", "Skin" and "Cancer". A total of 94 English language articles from 1 January, 2017 to 30 December, 2022 were reviewed.

Key Content and Findings

In this review, we briefly introduced the recent advances in THz near-field imaging, single-pixel imaging and real-time imaging, the applications of THz imaging for detecting breast, brain and skin tissues in the last 6 years were reviewed, and the advantages and existing challenges were identified. It is necessary to combine machine learning and metamaterials to develop real-time THz devices with small size, low cost and high sensitivity that can be widely used in clinical practice. More powerful THz detectors can be developed by combining graphene, designing structures and other methods to improve the sensitivity of the devices and obtain more accurate information. Establishing a THz database is one of the important methods to improve the repeatability and accuracy of imaging results.

Conclusions

THz technology is an effective method for tumor imaging. We believe that with the joint efforts of researchers and clinicians, accurate, real-time, and safe THz imaging will be widely applied in clinical practice in the future.

Revolutionary approaches for cancer diagnosis by terahertz-based spectroscopy and imaging

Most tumors are easily missed and misdiagnosed due to the lack of specific clinical signs and symptoms in the early stage. Thus, an accurate, rapid and reliable early tumor detection method is highly desirable. The application of terahertz (THz) spectroscopy and imaging in biomedicine has made remarkable progress in the past two decades, which addresses the shortcomings of existing technologies and provides an alternative for early tumor diagnosis. Although issues such as size mismatch and strong absorption of THz waves by water have set hurdles for cancer diagnosis by THz technology, innovative materials and biosensors in recent years have led to possibilities for new THz biosensing and imaging methods. In this article, we reviewed the issues that need to be solved before THz technology is used for tumor-related biological sample detection and clinical auxiliary diagnosis. We focused on the recent research progress of THz technology, with an emphasis on biosensing and imaging. Finally, the application of THz spectroscopy and imaging for tumor diagnosis in clinical practice and the main challenges in this process were also mentioned. Collectively, THz-based spectroscopy and imaging reviewed here is envisioned as a cutting-edge approach for cancer diagnosis.

Triage of in vivo burn injuries and prediction of wound healing outcome using neural networks and modeling of the terahertz permittivity based on the double Debye dielectric parameters

The initial assessment of the depth of a burn injury during triage forms the basis for determination of the course of the clinical treatment plan. However, severe skin burns are highly dynamic and hard to predict. This results in a low accuracy rate of about 60 - 75% in the diagnosis of partial-thickness burns in the acute post-burn period. Terahertz time-domain spectroscopy (THz-TDS) has demonstrated a significant potential for non-invasive and timely estimation of the burn severity. Here, we describe a methodology for the measurement and numerical modeling of the dielectric permittivity of the in vivo porcine skin burns. We use the double Debye dielectric relaxation theory to model the permittivity of the burned tissue. We further investigate the origins of dielectric contrast between the burns of various severity, as determined histologically based on the percentage of the burned dermis, using the empirical Debye parameters. We demonstrate that the five parameters of the double Debye model can form an artificial neural network classification algorithm capable of automatic diagnosis of the severity of the burn injuries, and predicting its ultimate wound healing outcome by forecasting its re-epithelialization status in 28 days. Our results demonstrate that the Debye dielectric parameters provide a physics-based approach for the extraction of the biomedical diagnostic markers from the broadband THz pulses. This method can significantly boost dimensionality reduction of THz training data in artificial intelligence models and streamline machine learning algorithms.

Accurate and early prediction of the wound healing outcome of burn injuries using the wavelet Shannon entropy of terahertz time-domain waveforms

Significance

Severe burn injuries cause significant hypermetabolic alterations that are highly dynamic, hard to predict, and require acute and critical care. The clinical assessments of the severity of burn injuries are highly subjective and have consistently been reported to be inaccurate. Therefore, the utilization of other imaging modalities is crucial to reaching an objective and accurate burn assessment modality.

Aim

We describe a non-invasive technique using terahertz time-domain spectroscopy (THz-TDS) and the wavelet packet Shannon entropy to automatically estimate the burn depth and predict the wound healing outcome of thermal burn injuries.

Approach

We created 40 burn injuries of different severity grades in two porcine models using scald and contact methods of infliction. We used our THz portable handheld spectral reflection (PHASR) scanner to obtain the in vivo THz-TDS images. We used the energy to Shannon entropy ratio of the wavelet packet coefficients of the THz-TDS waveforms on day 0 to create supervised support vector machine (SVM) classification models. Histological assessments of the burn biopsies serve as the ground truth.

Results

We achieved an accuracy rate of 94.7% in predicting the wound healing outcome, as determined by histological measurement of the re-epithelialization rate on day 28 post-burn induction, using the THz-TDS measurements obtained on day 0. Furthermore, we report the accuracy rates of 89%, 87.1%, and 87.6% in automatic diagnosis of the superficial partial-thickness, deep partial-thickness, and full-thickness burns, respectively, using a multiclass SVM model.

Conclusions

The THz PHASR scanner promises a robust, high-speed, and accurate diagnostic modality to improve the clinical triage of burns and their management.

Terahertz PHASR Scanner with 2 kHz, 100 picosecond Time-Domain Trace Acquisition Rate and an Extended Field-of-View Based on a Heliostat Design

Recently, we introduced a Portable HAndheld Spectral Reflection (PHASR) Scanner to allow THz Time-Domain Spectroscopic (THz-TDS) imaging in clinical and industrial settings using a fiber-coupled and alignment-free telecentric beam steering design. The key limitations of the version 1.0 of the PHASR Scanner were its field-of-view and speed of time-domain trace acquisition. In this paper, we address these limitations by introducing a heliostat geometry for beam scanning to achieve an extended field-of-view, and by reconfiguring the Asynchronous OPtical Sampling (ASOPS) system to perform Electronically Controlled OPtical Sampling (ECOPS) measurements. The former change improved the deflection range of the beam, while also drastically reducing the coupling of the two scanning axes, the combination of which resulted in a larger than four-fold increase in the FOV area. The latter change significantly improves the acquisition speed and frequency domain performance simultaneously by improving measurement efficiency. To accomplish this, we characterized the non-linear time-axis sampling behavior of the electro-mechanical system in the ECOPS mode. We proposed methods to model and correct the non-linear time-axis distortions and tested the performance of the high-speed ECOPS trace acquisition. Therefore, here we introduce the PHASR Scanner version 2.0, which is capable of imaging a 40×27 mm2 FOV with 2000 traces per second over a 100 picosecond TDS range. This new scanner represents a significant leap towards translating the THz-TDS technology from the lab bench to the bedside for real-time clinical imaging applications.

Selected Applications of Terahertz Pulses in Medicine and Industry

This article contains a brief summary of areas where terahertz technology is making an impact in research and industrial applications. We cover some of its uses in the pharmaceutical setting, where both imaging and spectroscopy play important roles. Medical applications are also being pursued in many research laboratories, primarily for imaging purposes and following on from the first results just over 20 years ago. The three-dimensional imaging capability of pulsed terahertz allows for the observation of tumours below the surface of tissue, such as basal cell carcinoma of skin. The recent use of the technology in studies of cultural heritage has shown to increase our understanding of the past. The power of terahertz is exemplified by the discussion on its importance in different industries, such as semiconductor circuit manufacturing and automotive assembly.

In Vivo Assessment and Monitoring of Burn Wounds Using a Handheld Terahertz Hyperspectral Scanner

The accuracy of clinical assessment techniques in diagnosing partial-thickness burn injuries has remained as low as 50-76%. Depending on the burn depth and environmental factors in the wound, such as reactive oxygen species, inflammation, and autophagy, partial-thickness burns can heal spontaneously or require surgical intervention. Herein, it is demonstrated that terahertz time-domain spectral imaging (THz-TDSI) is a promising tool for in vivo quantitative assessment and monitoring of partial-thickness burn injuries in large animals. We used a novel handheld THz-TDSI scanner to characterize burn injuries in a porcine scald model with histopathological controls. Statistical analysis (n= 40) indicates that the THz-TDSI modality can accurately differentiate between partial-thickness and full-thickness burn injuries (1-way ANOVA, p< 0.05). THz-TDSI has the potential to improve burn care outcomes by helping surgeons in making objective decisions for early excision of the wound.

Deep neural network classification of in vivo burn injuries with different etiologies using terahertz time-domain spectral imaging

Thermal injuries can occur due to direct exposure to hot objects or liquids, flames, electricity, solar energy and several other sources. If the resulting injury is a deep partial thickness burn, the accuracy of a physician's clinical assessment is as low as 50-76% in determining the healing outcome. In this study, we show that the Terahertz Portable Handheld Spectral Reflection (THz-PHASR) Scanner combined with a deep neural network classification algorithm can accurately differentiate between partial-, deep partial-, and full-thickness burns 1-hour post injury, regardless of the etiology, scanner geometry, or THz spectroscopy sampling method (ROC-AUC = 91%, 88%, and 86%, respectively). The neural network diagnostic method simplifies the classification process by directly using the pre-processed THz spectra and removing the need for any hyperspectral feature extraction. Our results show that deep learning methods based on THz time-domain spectroscopy (THz-TDS) measurements can be used to guide clinical treatment plans based on objective and accurate classification of burn injuries.

Supervised machine learning for automatic classification of in vivo scald and contact burn injuries using the terahertz Portable Handheld Spectral Reflection (PHASR) Scanner

We present an automatic classification strategy for early and accurate assessment of burn injuries using terahertz (THz) time-domain spectroscopic imaging. Burn injuries of different severity grades, representing superficial partial-thickness (SPT), deep partial-thickness (DPT), and full-thickness (FT) wounds, were created by a standardized porcine scald model. THz spectroscopic imaging was performed using our new fiber-coupled Portable HAndheld Spectral Reflection Scanner, incorporating a telecentric beam steering configuration and an f-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\theta$$\end{document}θ scanning lens. ASynchronous Optical Sampling in a dual-fiber-laser THz spectrometer with 100 MHz repetition rate enabled high-speed spectroscopic measurements. Given twenty-four different samples composed of ten scald and ten contact burns and four healthy samples, supervised machine learning algorithms using THz-TDS spectra achieved areas under the receiver operating characteristic curves of 0.88, 0.93, and 0.93 when differentiating between SPT, DPT, and FT burns, respectively, as determined by independent histological assessments. These results show the potential utility of our new broadband THz PHASR Scanner for early and accurate triage of burn injuries.

Improving the accuracy of tumor surgery by THz imaging and making the results of pathological anatomy faster by THz spectroscopy

Background

The terahertz radiation is a specific part of the electromagnetic radiation spectrum and has multiple significant applications in multiple scientific researches such as the applications in the medicine. An important application of the terahertz is its use in tumor imaging which is very important in the tumor surgery; however, lots of physicians and workers in the medical field have little information or having no information at all, dealing with this significant part of the electromagnetic spectrum.

Results

In this work, we interviewed a number of local surgeons in Syrian Arab Republic, who reported that they visually delineate the contour of tumors to be removed, and in order to reduce the number of future possible interventions, a large margin of healthy tissue is often excised. Furthermore, a number of pathologists who reported that preparing samples of excised tissues for examination takes a long period of time which may extend to several days, and that the results of histopathology indicate in some cases the integrity of removed tissues.

Conclusion

We have found that a significant number of participants in the survey demonstrated that the importance of dealing with terahertz imaging and terahertz spectroscopy, encouraging to implement the technique in the Syrian Arab Republic.

A Review of Feasible Applications of THz Waves in Medical Diagnostics and Treatments

Introduction: Terahertz (THz) waves with frequencies in the range of 0.1 to 10 THz are electromagnetic radiation with growing applications in various fields of science and technology. Attractive features of this radiation have brought out many novel possibilities for medical diagnostics and treatments with considerable advantages compared to other conventional methods. Methods: In this paper, we present a review of more recent reports on practical applications of THz radiation for diagnostic, biosensing and clinical treatments. The review includes the diagnosis of breast, skin, mouth, cervical, lungs, small intestine, prostate, colon, and stomach cancers, the evaluation of biomolecules, the detection of genetic mutations, the determination of burn depth, the diagnosis of tooth decay, diabetes, and emotional-psychological states, the evaluation of corneal water to diagnose visual diseases, and wound healing monitoring. Further, it embraces the use of THz therapy in reducing the size of the tumor, treating skin cancer, and healing burn wounds, cardiovascular disease, corneal epithelium, angina, and THz heating. Results: This review has emphasized the capabilities of THz waves as a novel tool for future clinical diagnostics and treatments. Conclusion: The paper provides a comprehensive understanding of the feasible potential application of THz waves for clinical purposes and its advantages in comparison with other conventional tools.

Applications of THz Spectral Imaging in the Detection of Agricultural Products

Agricultural products need to be inspected for quality and safety, and the issue of safety of agricultural products caused by quality is frequently investigated. Safety testing should be carried out before agricultural products are consumed. The existing technologies for inspecting agricultural products are time-consuming and require complex operation, and there is motivation to develop a rapid, safe, and non-destructive inspection technology. In recent years, with the continuous progress of THz technology, THz spectral imaging, with the advantages of its unique characteristics, such as low energies, superior spatial resolution, and high sensitivity to water, has been recognized as an efficient and feasible identification tool, which has been widely used for the qualitative and quantitative analyses of agricultural production. In this paper, the current main performance achievements of the use of THz images are presented. In addition, recent advances in the application of THz spectral imaging technology for inspection of agricultural products are reviewed, including internal component detection, seed classification, pesticide residues detection, and foreign body and packaging inspection. Furthermore, machine learning methods applied in THz spectral imaging are discussed. Finally, the existing problems of THz spectral imaging technology are analyzed, and future research directions for THz spectral imaging technology are proposed. Recent rapid development of THz spectral imaging has demonstrated the advantages of THz radiation and its potential application in agricultural products. The rapid development of THz spectroscopic imaging combined with deep learning can be expected to have great potential for widespread application in the fields of agriculture and food engineering.

Terahertz Imaging for Breast Cancer Detection

Terahertz (THz) imaging has the potential to detect breast tumors during breast-conserving surgery accurately. Over the past decade, many research groups have extensively studied THz imaging and spectroscopy techniques for identifying breast tumors. This manuscript presents the recent development of THz imaging techniques for breast cancer detection. The dielectric properties of breast tissues in the THz range, THz imaging and spectroscopy systems, THz radiation sources, and THz breast imaging studies are discussed. In addition, numerous chemometrics methods applied to improve THz image resolution and data collection processing are summarized. Finally, challenges and future research directions of THz breast imaging are presented.

Non-contact terahertz spectroscopic measurement of the intraocular pressure through corneal hydration mapping

Elevated intraocular pressure (IOP) results in endothelial layer damage that can induce corneal hydration perturbations. We investigated the potential of terahertz spectroscopy in measuring the IOP levels through mapping corneal water content. We controlled the IOP levels in ex vivo rabbit and porcine eye samples while monitoring the change in corneal hydration using a terahertz time-domain spectroscopy (THz-TDS) scanner. Our results showed a statistically significant increase in the THz reflectivity between 0.4 and 0.6 THz corresponding to the increase in the IOP. Endothelial layer damage was confirmed using scanning electron microscopy (SEM) of the corneal biopsy samples. Our empirical results indicate that the THz-TDS can be used to track IOP levels through the changes in corneal hydration.

Label-Free Observation of Micrometric Inhomogeneity of Human Breast Cancer Cell Density Using Terahertz Near-Field Microscopy

Terahertz-light imaging is attracting great attention as a new approach in non-invasive/non-staining biopsy of cancerous tissues. Positively, terahertz light has been shown to be sensitive to the cell density, the hydration content, and the chemical composition of biological samples. However, the spatial resolution of terahertz imaging is typically limited to several millimeters, making it difficult to apply the technology to image biological tissues which have sub-terahertz-wavelength-scale inhomogeneity. For overcoming the resolution, we have recently developed a terahertz near-field microscope with a spatial resolution of 10 µm, named scanning point terahertz source (SPoTS) microscope. In contrast to conventional far-field terahertz techniques, this microscope features the near-field interactions between samples and point terahertz sources on a sub-terahertz-wavelength scale. Herein, to evaluate the usefulness of terahertz imaging in cancer tissue biopsy in greater detail, we performed terahertz near-field imaging of a paraffin-embedded human-breast-cancer section having sub-terahertz-wavelength-scale inhomogeneity of the cancer cell density using the SPoTS microscope. The observed terahertz images successfully visualized local (~250 µm) inhomogeneities of the cell density in breast invasive ductal carcinoma. These results may bypass the terahertz limitation in terms of spatial resolution and may further motivate the application of terahertz light to cancer tissue biopsy.

Diagnosis of Glioma Molecular Markers by Terahertz Technologies

This review considers glioma molecular markers in brain tissues and body fluids, shows the pathways of their formation, and describes traditional methods of analysis. The most important optical properties of glioma markers in the terahertz (THz) frequency range are also presented. New metamaterial-based technologies for molecular marker detection at THz frequencies are discussed. A variety of machine learning methods, which allow the marker detection sensitivity and differentiation of healthy and tumor tissues to be improved with the aid of THz tools, are considered. The actual results on the application of THz techniques in the intraoperative diagnosis of brain gliomas are shown. THz technologies’ potential in molecular marker detection and defining the boundaries of the glioma’s tissue is discussed.

Terahertz Imaging and Spectroscopy in Cancer Diagnostics: A Technical Review

Terahertz (THz) waves are electromagnetic waves with frequency in the range from 0.1 to 10 THz. THz waves have great potential in the biomedical field, especially in cancer diagnosis, because they exhibit low ionization energy and can be used to discern most biomolecules based on their spectral fingerprints. In this paper, we review the recent progress in two applications of THz waves in cancer diagnosis: imaging and spectroscopy. THz imaging is expected to help researchers and doctors attain a direct intuitive understanding of a cancerous area. THz spectroscopy is an efficient tool for component analysis of tissue samples to identify cancer biomarkers. Additionally, the advantages and disadvantages of the developed technologies for cancer diagnosis are discussed. Furthermore, auxiliary techniques that have been used to enhance the spectral signal-to-noise ratio (SNR) are also reviewed.

Terahertz time-domain spectral imaging using telecentric beam steering and an f-θscanning lens: distortion compensation and determination of resolution limits

We report on the development and performance characterization of a telecentric terahertz spectroscopic scanner using an f-θ objective lens and a single gimballed scanning mirror for image formation. We derived a beam steering transform to compensate for the intercoupling of the gimballed mirror axes and the distortions caused by an imperfect scanning lens. We characterize the optical performance of the system in both the time and spatial domains, demonstrating a constant diffraction-limited imaging resolution over the entire field of view. Finally, given the large depth of focus of the objective lens, we demonstrate the broadband imaging capability at different depths using a Boehler star target. This imaging setup has the potential to be miniaturized into portable form factors for field-deployable scenarios.

Terahertz Portable Handheld Spectral Reflection (PHASR) Scanner

We report on the development and characterization of a handheld terahertz (THz) time-domain spectroscopic scanner for broadband imaging between approximately 0.25 and 1.25 THz. We designed and fabricated a 3D-printed fiber-coupled housing which provides an alignment-free strategy for the placement and operation of the THz optics. Image formation is achieved through telecentric beam steering over a planar surface through a custom f-θ scanning lens. This design achieves a consistent resolution over the full 12 × 19 mm field of view. Broadband spectral imaging is demonstrated using a 1951 United States Air Force Resolution Test Target. The consistency of the resolution over the wide field is validated through Boehler Star resolution measurements. Finally, a practical scenario of subsurface imaging on a damaged section of an aircraft wing is demonstrated. The THz PHASR is a field-deployable imaging system with the versatility to be applied to a much broader range of targets and imaging scenarios than previously possible, from industrial non-destructive testing to clinical diagnostic imaging.

Terahertz tomographic imaging of freshly excised human breast tissues

Terahertz imaging and spectroscopy characterization of freshly excised breast cancer tumors are presented in the range 0.15 to 3.5 THz. Cancerous breast tissues were obtained from partial or full removal of malignant tumors while healthy breast tissues were obtained from breast reduction surgeries. The reflection spectroscopy to obtain the refractive index and absorption coefficient is performed on experimental data at each pixel of the tissue, forming tomographic images. The transmission spectroscopy of the refractive index and absorption coefficient are retrieved from experimental data at few tissue points. The average refractive index and absorption coefficients for cancer, fat, and collagen tissue regions are compared between transmission and reflection modes. The reflection mode offers the advantage of retrieving the electrical properties across a significantly greater number of points without the need for sectioning or altering the freshly excised tissue as in the transmission mode. The terahertz spectral power images and the tomographic images demonstrated good qualitative comparison with pathology.

Towards mm-wave spectroscopy for dielectric characterization of breast surgical margins

PURPOSE

The evaluation of the surgical margin in breast conservative surgery is a matter of general interest as such treatments are subject to the critical issue of margin status as positive surgical margins can undermine the effectiveness of the procedure. The relatively unexplored ability of millimeter-wave (mm-wave) spectroscopy to provide insight into the dielectric properties of breast tissues was investigated as a precursor to their possible use in assessment of surgical margins.

METHODS

We assessed the ability of a mm-wave system with a roughly hemispherical sensitive volume of ∼3 mm radius to distinguish malignant breast lesions in prospectively and consecutively collected tumoral and non-tumoral ex-vivo breast tissue samples from 91 patients. We characterized the dielectric properties of 346 sites in these samples, encompassing malignant, fibrocystic disease and normal breast tissues. An expert pathologist subsequently evaluated all measurement sites.

RESULTS

At multivariate analysis, mm-wave dielectric properties were significantly correlated to histologic diagnosis and fat content. Further, using 5-fold cross-validation in a Bayesian logistic mixed model that considered the patient as a random effect, the mm-wave dielectric properties of neoplastic tissues were significantly different from normal breast tissues, but not from fibrocystic tissue.

CONCLUSION

Reliable discrimination of malignant from normal, fat-rich breast tissue to a depth compatible with surgical margin assessment requirements was achieved with mm-wave spectroscopy.

Shape-from-focus for real-time terahertz 3D imaging

Thanks to significant advances in real-time terahertz imaging in terms of resolution and image quality, adapting and extending optical methods for 3D imaging at the millimeter scale is now promising. The shape-from-focus algorithm is a post-processing tool used in optical microscopy to reconstruct the external shape surface of a convex surface object. Images acquired at different distances from the object-side focal plane are implemented in this algorithm. We localize the best focus position in the stack of images for each pixel and then reconstruct the object in 3D due to the short depth of field. In this Letter, we propose an application of this algorithm in active and real-time terahertz imaging. We achieve the experimental reconstruction in 3D with a terahertz waves imaging system composed of a powerful source and a real-time terahertz camera.

Cancer detection in excised breast tumors using terahertz imaging and spectroscopy

Terahertz imaging and spectroscopy has demonstrated a potential for differentiating tissue types of excised breast cancer tumors. Pulsed terahertz technology provides a broadband frequency range from 0.1 THz to 4 THz for detecting cancerous tissue. Tumor tissue types of interest include cancer typically manifested as infiltrating ductal or lobular carcinomas, fibro-glandular (healthy connective tissues) and fat. In this work, images of breast tumors excised from human and animal models are reviewed. In addition to alternate fresh tissues, breast cancer tissue phantoms are developed to further evaluate terahertz imaging and the potential use of contrast agents. Terahertz results are successfully validated with pathology images, showing strong differentiation between cancerous and healthy tissues for all freshly excised tissues and types. The advantages, challenges and limitations of THz imaging of breast cancer are discussed.

Rapid tissue histology using multichannel confocal fluorescence microscopy with focus tracking

BACKGROUND

Simplified hematoxylin and eosin (H&E) staining followed by cryo-sectioning enables rapid identification of cancerous tissue within the procedure room during Mohs micrographic surgery. Yet, a faster evaluation method is desirable as the staining protocol requires physically sectioning of the tissue after freezing, which leads to prolonged sectioning time along with the frozen artifacts that may occur in frozen sectioning.

METHODS

We present a multichannel confocal microscopy system to rapidly evaluate cancerous tissue. Using the optical sectioning capability of the confocal microscope, optically sectioned images of the freshly excised mouse tissue were acquired and converted into images resembling H&E histology. To show details of the nuclei and structure of the tissue, we applied a newly developed rapid tissue staining method using Hoechst 33342 and Eosin-Y. Line scanning and stitching was performed to overcome the limited field of view of the confocal microscope. Unlike previous confocal systems requiring an additional mechanical device to tilt the sample and match the focus of the objective lens, we developed a focus tracking method to rapidly scan large sample area. The focus tracking provides an effective means of keeping the image of the thick tissue in focus without additional devices. We then evaluated the performance of the confocal microscope to obtain optically sectioned images in thick tissue by comparing fluorescence stained slide images. We also obtained the corresponding H&E histology image to assess the potential of the system as a diagnostic tool.

RESULTS

We successfully imaged freshly excised mouse organs including stomach, tumor, and heart within a few minutes using the developed multichannel confocal microscopy and the tissue staining method. Using the pseudocolor method, colors of the acquired confocal grayscale images are converted to furthermore resemble Hematoxylin and Eosin histology. Due to the focus tracking and the line scanning, optically sectioned images were obtained over the large field of view. Comparisons with H&E histology have shown that the confocal images can acquire large details such as the ventricle as well as small details such as muscle fibers and nuclei.

CONCLUSIONS

This study confirms the use of confocal fluorescence microscopy technique to acquire rapid pathology results using optical sectioning, line scanning and focus tracking. We anticipate that the presented method will enable intraoperative histology and significantly reduce stress on patients undergoing surgery requiring repeated histology examinations.

Skin cancer detection using non-invasive techniques

Skin cancer is the most common form of cancer and is globally rising. Historically, the diagnosis of skin cancers has depended on various conventional techniques which are of an invasive manner. A variety of commercial diagnostic tools and auxiliary techniques are available to detect skin cancer. This article explains in detail the principles and approaches involved for non-invasive skin cancer diagnostic methods such as photography, dermoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis. The characteristics of an ideal screening test are outlined, and the authors pose several points for clinicians and scientists to consider in the evaluation of current and future studies of skin cancer detection and diagnosis. This comprehensive review critically analyses the literature associated with the field and summarises the recent updates along with their merits and demerits.

Pilot study of freshly excised breast tissue response in the 300-600 GHz range

The failure to accurately define tumor margins during breast conserving surgery (BCS) results in a 20% re-excision rate. The present paper reports the investigation to evaluate the potential of terahertz imaging for breast tissue recognition within the under-explored 300 - 600 GHz range. Such a frequency window matches new BiCMOS technology capabilities and thus opens up the opportunity for near-field terahertz imaging using these devices. To assess the efficacy of this frequency band, data from 16 freshly excised breast tissue samples were collected and analyzed directly after excision. Complex refractive indices have been extracted over the as-mentioned frequency band, and amplitude frequency images show some contrast between tissue types. Principal component analysis (PCA) has also been applied to the data in an attempt to automate tissue classification. Our observations suggest that the dielectric response could potentially provide contrast for breast tissue recognition within the 300 - 600 GHz range. These results open the way for silicon-based terahertz subwavelength near field imager design, efficient up to 600 GHz to address ex vivo life-science applications.

High-sensitivity terahertz imaging of traumatic brain injury in a rat model

We demonstrated that different degrees of experimental traumatic brain injury (TBI) can be differentiated clearly in fresh slices of rat brain tissues using transmission-type terahertz (THz) imaging system. The high absorption region in THz images corresponded well with the injured area in visible images and magnetic resonance imaging results. The THz image and absorption characteristics of dehydrated paraffin-embedded brain slices and the hematoxylin and eosin (H&E)-stained microscopic images were investigated to account for the intrinsic differences in the THz images for the brain tissues suffered from different degrees of TBI and normal tissue aside from water. The THz absorption coefficients of rat brain tissues showed an increase in the aggravation of brain damage, particularly in the high-frequency range, whereas the cell density decreased as the order of mild, moderate, and severe TBI tissues compared with the normal tissue. Our results indicated that the different degrees of TBI were distinguishable owing to the different water contents and probable hematoma components distribution rather than intrinsic cell intensity. These promising results suggest that THz imaging has great potential as an alternative method for the fast diagnosis of TBI.

Concentration analysis of breast tissue phantoms with terahertz spectroscopy

Terahertz imaging has been previously shown to be capable of distinguishing normal breast tissue from its cancerous form, indicating its applicability to breast conserving surgery. The heterogeneous composition of breast tissue is among the main challenges to progressing this potential research towards a practical application. In this paper, two concentration analysis methods are proposed for analyzing phantoms mimicking breast tissue. The dielectric properties and the double Debye parameters were used to determine the phantom composition. The first method is wholly based on the conventional effective medium theory while the second one combines this theoretical model with empirical polynomial models. Through assessing the accuracy of these methods, their potential for application to quantifying breast tissue pathology was confirmed.