Diffuse Optical Characterization of the Healthy Human Thyroid Tissue and Two Pathological Case Studies

In vivocharacterization of the optical and hemodynamic properties of the human sternocleidomastoid muscle through ultrasound-guided hybrid near-infrared spectroscopies

Objective.In this paper, we present a detailedin vivocharacterization of the optical and hemodynamic properties of the human sternocleidomastoid muscle (SCM), obtained through ultrasound-guided near-infrared time-domain and diffuse correlation spectroscopies.Approach.A total of sixty-five subjects (forty-nine females, sixteen males) among healthy volunteers and thyroid nodule patients have been recruited for the study. Their SCM hemodynamic (oxy-, deoxy- and total hemoglobin concentrations, blood flow, blood oxygen saturation and metabolic rate of oxygen extraction) and optical properties (wavelength dependent absorption and reduced scattering coefficients) have been measured by the use of a novel hybrid device combining in a single unit time-domain near-infrared spectroscopy, diffuse correlation spectroscopy and simultaneous ultrasound imaging.Main results.We provide detailed tables of the results related to SCM baseline (i.e. muscle at rest) properties, and reveal significant differences on the measured parameters due to variables such as side of the neck, sex, age, body mass index, depth and thickness of the muscle, allowing future clinical studies to take into account such dependencies.Significance.The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle during respiration became a topic of increased interest partially due to the increased use of mechanical ventilation during the COVID-19 pandemic. Near-infrared diffuse optical spectroscopies were proposed as potential practical monitors of increased recruitment of SCM during respiratory distress. They can provide clinically relevant information on the degree of the patient's respiratory effort that is needed to maintain an optimal minute ventilation, with potential clinical application ranging from evaluating chronic pulmonary diseases to more acute settings, such as acute respiratory failure, or to determine the readiness to wean from invasive mechanical ventilation.

Assessment of power spectral density of microvascular hemodynamics in skeletal muscles at very low and low-frequency via near-infrared diffuse optical spectroscopies

In this work, we used a hybrid time domain near-infrared spectroscopy (TD-NIRS) and diffuse correlation spectroscopy (DCS) device to retrieve hemoglobin and blood flow oscillations of skeletal muscle microvasculature. We focused on very low (VLF) and low-frequency (LF) oscillations (i.e., frequency lower than 0.145 Hz), that are related to myogenic, neurogenic and endothelial activities. We measured power spectral density (PSD) of blood flow and hemoglobin concentration in four muscles (thenar eminence, plantar fascia, sternocleidomastoid and forearm) of 14 healthy volunteers to highlight possible differences in microvascular hemodynamic oscillations. We observed larger PSDs for blood flow compared to hemoglobin concentration, in particular in case of distal muscles (i.e., thenar eminence and plantar fascia). Finally, we compared the PSDs measured on the thenar eminence of healthy subjects with the ones measured on a septic patient in the intensive care unit: lower power in the endothelial-dependent frequency band, and larger power in the myogenic ones were observed in the septic patient, in accordance with previous works based on laser doppler flowmetry.

Transcranial, Non-Invasive Evaluation of Potential Misery Perfusion During Hyperventilation Therapy of Traumatic Brain Injury Patients

Hyperventilation (HV) therapy uses vasoconstriction to reduce intracranial pressure (ICP) by reducing cerebral blood volume. However, as HV also lowers cerebral blood flow (CBF), it may provoke misery perfusion (MP), in which the decrease in CBF is coupled with increased oxygen extraction fraction (OEF). MP may rapidly lead to the exhaustion of brain energy metabolites, making the brain vulnerable to ischemia. MP is difficult to detect at the bedside, which is where transcranial hybrid, near-infrared spectroscopies are promising because they non-invasively measure OEF and CBF. We have tested this technology during HV (∼30 min) with bilateral, frontal lobe monitoring to assess MP in 27 sessions in 18 patients with traumatic brain injury. In this study, HV did not lead to MP at a group level (p > 0.05). However, a statistical approach yielded 89 events with a high probability of MP in 19 sessions. We have characterized each statistically significant event in detail and its possible relationship to clinical and radiological status (decompressive craniectomy and presence of a cerebral lesion), without detecting any statistically significant difference (p > 0.05). However, MP detection stresses the need for personalized, real-time assessment in future clinical trials with HV, in order to provide an optimal evaluation of the risk-benefit balance of HV. Our study provides pilot data demonstrating that bedside transcranial hybrid near-infrared spectroscopies could be utilized to assess potential MP.

Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia

SIGNIFICANCE

The optical measurement of cerebral oxygen metabolism was evaluated.

AIM

Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery.

APPROACH

Relative cerebral metabolic rate of oxygen ( rCMRO 2 ) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation.

RESULTS

In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], rCMRO 2 by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), rCMRO 2 (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, rCMRO 2 , and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for rCMRO 2 in the initial and final part, respectively). These changes were also correlated in time ( R > 0.69 to R = 1 , p - values < 0.05 ).

CONCLUSIONS

Optics can reliably monitor rCMRO 2 in such conditions.

Transcranial optical monitoring for detecting intracranial pressure alterations in children with benign external hydrocephalus: a proof-of-concept study

SIGNIFICANCE

Benign external hydrocephalus (BEH) is considered a self-limiting pathology with a good prognosis. However, some children present a pathological intracranial pressure (ICP) characterized by quantitative and qualitative alterations (the so-called B-waves) that can lead to neurological sequelae.

AIM

Our purpose was to evaluate whether there were cerebral hemodynamic changes associated with ICP B-waves that could be evaluated with noninvasive neuromonitoring.

APPROACH

We recruited eleven patients (median age 16 months, range 7 to 55 months) with BEH and an unfavorable evolution requiring ICP monitoring. Bedside, nocturnal monitoring using near-infrared time-resolved and diffuse correlation spectroscopies synchronized to the clinical monitoring was performed.

RESULTS

By focusing on the timing of different ICP patterns that were identified manually by clinicians, we detected significant tissue oxygen saturation ( StO 2 ) changes ( p = 0.002 ) and blood flow index (BFI) variability ( p = 0.005 ) between regular and high-amplitude B-wave patterns. A blinded analysis looking for analogs of ICP patterns in BFI time traces achieved 90% sensitivity in identifying B-waves and 76% specificity in detecting the regular patterns.

CONCLUSIONS

We revealed the presence of StO 2 and BFI variations-detectable with optical techniques-during ICP B-waves in BEH children. Finally, the feasibility of detecting ICP B-waves in hemodynamic time traces obtained noninvasively was shown.

Difference imaging from single measurements in diffuse optical tomography: a deep learning approach

SIGNIFICANCE

"Difference imaging," which reconstructs target optical properties using measurements with and without target information, is often used in diffuse optical tomography (DOT) in vivo imaging. However, taking additional reference measurements is time consuming, and mismatches between the target medium and the reference medium can cause inaccurate reconstruction.

AIM

We aim to streamline the data acquisition and mitigate the mismatch problems in DOT difference imaging using a deep learning-based approach to generate data from target measurements only.

APPROACH

We train an artificial neural network to output data for difference imaging from target measurements only. The model is trained and validated on simulation data and tested with simulations, phantom experiments, and clinical data from 56 patients with breast lesions.

RESULTS

The proposed method has comparable performance to the traditional approach using measurements without mismatch between the target side and the reference side, and it outperforms the traditional approach using measurements when there is a mismatch. It also improves the target-to-artifact ratio and lesion localization in patient data.

CONCLUSIONS

The proposed method can simplify the data acquisition procedure, mitigate mismatch problems, and improve reconstructed image quality in DOT difference imaging.

Cherenkov light emission in molecular radiation therapy of the thyroid and its application to dosimetry

Numerical experiments based on Monte Carlo simulations and clinical CT data are performed to investigate the spatial and spectral characteristics of Cherenkov light emission and the relationship between Cherenkov light intensity and deposited dose in molecular radiotherapy of hyperthyroidism and papillary thyroid carcinoma. It is found that Cherenkov light is emitted mostly in the treatment volume, the spatial distribution of Cherenkov light at the surface of the patient presents high-value regions at locations that depend on the symmetry and location of the treatment volume, and the surface light in the near-infrared spectral region originates from the treatment site. The effect of inter-patient variability in the tissue optical parameters and radioisotope uptake on the linear relationship between the dose absorbed by the treatment volume and Cherenkov light intensity at the surface of the patient is investigated, and measurements of surface light intensity for which this effect is minimal are identified. The use of Cherenkov light measurements at the patient surface for molecular radiation therapy dosimetry is also addressed.

Ultrasound segmentation-guided edge artifact reduction in diffuse optical tomography using connected component analysis

Ultrasound (US)-guided diffuse optical tomography (DOT) has demonstrated potential value for breast cancer diagnosis and treatment response assessment. However, in clinical use, the chest wall, poor probe-tissue contact, and tissue heterogeneity can all cause image artifacts. These image artifacts, appearing commonly as hot spots in the non-lesion regions (edge artifacts), can decrease the reconstruction accuracy and cause misinterpretation of lesion images. Here we introduce an iterative, connected component analysis-based image artifact reduction algorithm. A convolutional neural network (CNN) is used to segment co-registered US images to extract the lesion location and size to guide the artifact reduction. We demonstrate its performance using Monte Carlo simulations on VICTRE digital breast phantoms and breast patient images. In simulated tissue mismatch models, this algorithm successfully reduces edge artifacts without significantly changing the reconstructed target absorption coefficients. With clinical data it improves the optical contrast between malignant and benign groups, from 1.55 without artifact reduction to 1.91 with artifact reduction. The proposed algorithm has a broad range of applications in other modality-guided DOT imaging.

Recipes for diffuse correlation spectroscopy instrument design using commonly utilized hardware based on targets for signal-to-noise ratio and precision

Over the recent years, a typical implementation of diffuse correlation spectroscopy (DCS) instrumentation has been adapted widely. However, there are no detailed and accepted recipes for designing such instrumentation to meet pre-defined signal-to-noise ratio (SNR) and precision targets. These require specific attention due to the subtleties of the DCS signals. Here, DCS experiments have been performed using liquid tissue simulating phantoms to study the effect of the detected photon count-rate, the number of parallel detection channels and the measurement duration on the precision and SNR to suggest scaling relations to be utilized for device design.

The LUCA device: a multi-modal platform combining diffuse optics and ultrasound imaging for thyroid cancer screening

We present the LUCA device, a multi-modal platform combining eight-wavelength near infrared time resolved spectroscopy, sixteen-channel diffuse correlation spectroscopy and a clinical ultrasound in a single device. By simultaneously measuring the tissue hemodynamics and performing ultrasound imaging, this platform aims to tackle the low specificity and sensitivity of the current thyroid cancer diagnosis techniques, improving the screening of thyroid nodules. Here, we show a detailed description of the device, components and modules. Furthermore, we show the device tests performed through well established protocols for phantom validation, and the performance assessment for in vivo. The characterization tests demonstrate that LUCA device is capable of performing high quality measurements, with a precision in determining in vivo tissue optical and dynamic properties of better than 3%, and a reproducibility of better than 10% after ultrasound-guided probe repositioning, even with low photon count-rates, making it suitable for a wide variety of clinical applications.

The Use of Supercontinuum Laser Sources in Biomedical Diffuse Optics: Unlocking the Power of Multispectral Imaging

Optical techniques based on diffuse optics have been around for decades now and are making their way into the day-to-day medical applications. Even though the physics foundations of these techniques have been known for many years, practical implementation of these technique were hindered by technological limitations, mainly from the light sources and/or detection electronics. In the past 20 years, the developments of supercontinuum laser (SCL) enabled to unlock some of these limitations, enabling the development of system and methodologies relevant for medical use, notably in terms of spectral monitoring. In this review, we focus on the use of SCL in biomedical diffuse optics, from instrumentation and methods developments to their use for medical applications. A total of 95 publications were identified, from 1993 to 2021. We discuss the advantages of the SCL to cover a large spectral bandwidth with a high spectral power and fast switching against the disadvantages of cost, bulkiness, and long warm up times. Finally, we summarize the utility of using such light sources in the development and application of diffuse optics in biomedical sciences and clinical applications.

Imaging the Human Thyroid Using Three-Dimensional Diffuse Optical Tomography: A Preliminary Study

Thyroid cancer is usually diagnosed by ultrasound imaging and fine-needle aspiration biopsy. However, diagnosis of follicular thyroid carcinomas (FTC) is difficult because FTC lacks nuclear atypia and a consensus on histological interpretation. Diffuse optical tomography (DOT) offers the potential to diagnose FTC because it can measure tumor hypoxia, while image reconstruction of the thyroid is still challenging mainly due to the complex anatomical features of the neck. In this study, we attempted to solve this issue by creating a finite element model of the human neck excluding the trachea (a void region). By reconstruction of the absorption coefficients at three wavelengths, 3D tissue oxygen saturation maps of the human thyroid are obtained for the first time by DOT.

Instrument response function acquisition in reflectance geometry for time-resolved diffuse optical measurements

In time-domain diffuse optical spectroscopy, the simultaneous acquisition of the time-of-flight distribution (DTOF) of photons traveling in a diffusive medium and of the instrument response function (IRF) is necessary to perform quantitative measurements of optical properties (absorption and reduced scattering coefficients) while taking into account the non-idealities of a real system (e.g. temporal resolution and time delays). The IRF acquisition can be a non-trivial and time-consuming operation that requires directly facing the injection and collection fibers. Since this operation is not always possible, a new IRF measurement scheme is here proposed where the IRF is acquired in reflectance geometry from a corrugate reflective surface. Validation measurements on a set of reference homogenous phantoms have been performed, resulting in an error in the optical properties estimation lower than 10% with respect to the typical IRF configuration. Thus, the proposed method proved to be a reliable approach that after a preliminary calibration can be exploited in a laboratory and clinical set-ups, leading to faster and more accurate measurements and reducing the operator-dependent performance.

Improving Localization of Deep Inclusions in Time-Resolved Diffuse Optical Tomography

Time-resolved diffuse optical tomography is a technique used to recover the optical properties of an unknown diffusive medium by solving an ill-posed inverse problem. In time-domain, reconstructions based on datatypes are used for their computational efficiency. In practice, most used datatypes are temporal windows and Fourier transform. Nevertheless, neither theoretical nor numerical studies assessing different datatypes have been clearly expressed. In this paper, we propose an overview and a new process to compute efficiently a long set of temporal windows in order to perform diffuse optical tomography. We did a theoretical comparison of these large set of temporal windows. We also did simulations in a reflectance geometry with a spherical inclusion at different depths. The results are presented in terms of inclusion localization and its absorption coefficient recovery. We show that (1) the new windows computed with the developed method improve inclusion localization for inclusions at deep layers, (2) inclusion absorption quantification is improved at all depths and, (3) in some cases these windows can be equivalent to frequency based reconstruction at GHz order.

Broadband Time Domain Diffuse Optical Reflectance Spectroscopy: A Review of Systems, Methods, and Applications

This review presents recent developments and a wide overview of broadband time domain diffuse optical spectroscopy (TD-DOS). Various topics including physics of photon migration, advanced instrumentation, methods of analysis, applications covering multiple domains (tissue chromophore, in vivo studies, food, wood, pharmaceutical industry) are elaborated. The key role of standardization and recent studies in that direction are discussed. Towards the end, a brief outlook is presented on the current status and future trends in broadband TD-DOS.

Spatially-enhanced time-domain NIRS for accurate determination of tissue optical properties

A multivariate method integrating time and space resolved techniques of near-infrared spectroscopy is proposed for simultaneously retrieving the absolute quantities of optical absorption and scattering properties in tissues. The time-domain feature of photon migration is advantageously constrained and regularized by its spatially-resolved amplitude patterns in the inverse procedure. Measurements of tissue-mimicking phantoms with various optical properties are analyzed with Monte-Carlo simulations to validate the method performance. The uniqueness, stability, and uncertainty of the method are discussed.

Self-calibrating time-resolved near infrared spectroscopy

Time-resolved near infrared spectroscopy is considered to be a gold standard technique when measuring absolute values of tissue optical properties, as it provides separable and independent information about both tissue absorption and scattering. However, time-resolved instruments require an accurate characterization by measuring the instrument response function in order to decouple the contribution of the instrument itself from the measurement. In this work, a new approach to the methodology of analysing time-resolved data is presented where the influence of instrument response function is eliminated from the data and a self-calibrating analysis is proposed. The proposed methodology requires an instrument to provide at least two wavelengths and allows spectral parameters recovery (optical properties or constituents concentrations and reduced scatter amplitude and power). Phantom and in-vivo data from two different time-resolved systems are used to validate the accuracy of the proposed self-calibrating approach, demonstrating that parameters recovery compared to the conventional curve fitting approach is within 10% and benefits from introducing a spectral constraint to the reconstruction problem. It is shown that a multi-wavelength time-resolved data can be used for parameters recovery directly without prior calibration (instrument response function measurement).

Broadband (550-1350 nm) diffuse optical characterization of thyroid chromophores

Thyroid plays an important role in the endocrine system of the human body. Its characterization by diffuse optics can open new path ways in the non-invasive diagnosis of thyroid pathologies. Yet, the absorption spectra of tyrosine and thyroglobulin–key tissue constituents specific to the thyroid organ–in the visible to near infrared range are not fully available. Here, we present the optical characterization of tyrosine (powder), thyroglobulin (granular form) and iodine (aqueous solution) using a time domain broadband diffuse optical spectrometer in the 550–1350 nm range. Various systematic errors caused by physics of photo migration and sample inherent properties were effectively suppressed by means of advanced time domain diffuse optical methods. A brief comparison with various other known tissue constituents is presented, which reveals key spectral regions for the quantification of the thyroid absorbers in an in vivo scenario.

Liquid phantoms for near-infrared and diffuse correlation spectroscopies with tunable optical and dynamic properties

We present the recipe and characterization for preparing liquid phantoms that are suitable for both near-infrared spectroscopy and diffuse correlation spectroscopy. The phantoms have well-defined and tunable optical and dynamic properties, and consist of a solution of water and glycerol with fat emulsion as the scattering element. The recipe takes into account the effect of bulk refractive index changes due to the addition of glycerol, which is commonly used to alter the sample viscosity.

Time-resolved near infrared light propagation using frequency domain superposition

Time-resolved temporal point spread function (TPSF) measurement of near infrared spectroscopic (NIRS) data allows the estimation of absorption and reduced scattering properties of biological tissues. Such analysis requires an iterative calculation of the theoretical TPSF curve using mathematical and computational models of the domain being imaged which are computationally complex and expensive. In this work, an efficient methodology for representing the TPSF data using a superposition of cosines calculated in frequency domain is presented. The proposed method is outlined and tested on finite element realistic models of the human neck and head. Using an adult head model containing ~140k nodes, the TPSF calculation at each node for one source is accelerated from 3.11 s to 1.29 s within an error limit of ± 5% related to the time domain calculation method.

Pressure injury prediction using diffusely scattered light

Pressure injuries (PIs) originate beneath the surface of the skin at the interface between bone and soft tissue. We used diffuse correlation spectroscopy (DCS) and diffuse near-infrared spectroscopy (DNIRS) to predict the development of PIs by measuring dermal and subcutaneous red cell motion and optical absorption and scattering properties in 11 spinal cord injury subjects with only nonbleachable redness in the sacrococcygeal area in a rehabilitation hospital and 20 healthy volunteers. A custom optical probe was developed to obtain continuous DCS and DNIRS data from sacrococcygeal tissue while the subjects were placed in supine and lateral positions to apply pressure from body weight and to release pressure, respectively. Rehabilitation patients were measured up to four times over a two-week period. Three rehabilitation patients developed open PIs (POs) within four weeks and eight patients did not (PNOs). Temporal correlation functions in the area of redness were significantly different ( p < 0.01 ) during both baseline and applied pressure stages for POs and PNOs. The results show that our optical method may be used for the early prediction of ulcer progression.

Time-resolved single-photon detection module based on silicon photomultiplier: A novel building block for time-correlated measurement systems

We present the design and preliminary characterization of the first detection module based on Silicon Photomultiplier (SiPM) tailored for single-photon timing applications. The aim of this work is to demonstrate, thanks to the design of a suitable module, the possibility to easily exploit SiPM in many applications as an interesting detector featuring large active area, similarly to photomultipliers tubes, but keeping the advantages of solid state detectors (high quantum efficiency, low cost, compactness, robustness, low bias voltage, and insensitiveness to magnetic field). The module integrates a cooled SiPM with a total photosensitive area of 1 mm(2) together with the suitable avalanche signal read-out circuit, the signal conditioning, the biasing electronics, and a Peltier cooler driver for thermal stabilization. It is able to extract the single-photon timing information with resolution better than 100 ps full-width at half maximum. We verified the effective stabilization in response to external thermal perturbations, thus proving the complete insensitivity of the module to environment temperature variations, which represents a fundamental parameter to profitably use the instrument for real-field applications. We also characterized the single-photon timing resolution, the background noise due to both primary dark count generation and afterpulsing, the single-photon detection efficiency, and the instrument response function shape. The proposed module can become a reliable and cost-effective building block for time-correlated single-photon counting instruments in applications requiring high collection capability of isotropic light and detection efficiency (e.g., fluorescence decay measurements or time-domain diffuse optics systems).