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Samkoe KS, Bates BD, Tselepidakis NN, DSouza AV, Gunn JR, Ramkumar DB, Paulsen KD, Pogue BW, Henderson ER. Development and evaluation of a connective tissue phantom model for subsurface visualization of cancers requiring wide local excision. J Biomed Opt 2017; 22:1-12. [PMID: 29274143 PMCID: PMC5741805 DOI: 10.1117/1.jbo.22.12.121613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/01/2017] [Indexed: 05/14/2023]
Abstract
Wide local excision (WLE) of tumors with negative margins remains a challenge because surgeons cannot directly visualize the mass. Fluorescence-guided surgery (FGS) may improve surgical accuracy; however, conventional methods with direct surface tumor visualization are not immediately applicable, and properties of tissues surrounding the cancer must be considered. We developed a phantom model for sarcoma resection with the near-infrared fluorophore IRDye 800CW and used it to iteratively define the properties of connective tissues that typically surround sarcoma tumors. We then tested the ability of a blinded surgeon to resect fluorescent tumor-simulating inclusions with ∼1-cm margins using predetermined target fluorescence intensities and a Solaris open-air fluorescence imaging system. In connective tissue-simulating phantoms, fluorescence intensity decreased with increasing blood concentration and increased with increasing intralipid concentrations. Fluorescent inclusions could be resolved at ≥1-cm depth in all inclusion concentrations and sizes tested. When inclusion depth was held constant, fluorescence intensity decreased with decreasing volume. Using targeted fluorescence intensities, a blinded surgeon was able to successfully excise inclusions with ∼1-cm margins from fat- and muscle-simulating phantoms with inclusion-to-background contrast ratios as low as 2∶1. Indirect, subsurface FGS is a promising tool for surgical resection of cancers requiring WLE.
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Affiliation(s)
- Kimberley S. Samkoe
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
- Address all correspondence to: Kimberley S. Samkoe, E-mail:
| | - Brent D. Bates
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
| | - Niki N. Tselepidakis
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Alisha V. DSouza
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Jason R. Gunn
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Dipak B. Ramkumar
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire, United States
| | - Keith D. Paulsen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Eric R. Henderson
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire, United States
- White River Junction VAMC, White River Junction, Vermont, United States
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DSouza AV, Marra K, Gunn JR, Samkoe KS, Pogue BW. Optical tracer size differences allow quantitation of active pumping rate versus Stokes-Einstein diffusion in lymphatic transport. J Biomed Opt 2016; 21:100501. [PMID: 27752703 PMCID: PMC5067306 DOI: 10.1117/1.jbo.21.10.100501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/20/2016] [Indexed: 06/06/2023]
Abstract
Lymphatic uptake of interstitially administered agents occurs by passive convective–diffusive inflow driven by interstitial concentration and pressure, while the downstream lymphatic transport is facilitated by active propulsive contractions of lymphatic vessel walls. Near-infrared fluorescence imaging in mice was used to measure these central components of lymphatic transport for the first time, using two different-sized molecules––methylene blue (MB) and fluorescence-labeled antibody immunoglobulin G (IgG)-IRDye 680RD. This work confirms the hypothesis that lymphatic passive inflow and active propulsion rates can be separated based upon the relative differences in Stokes–Einstein diffusion coefficient. This coefficient specifically affects the passive-diffusive uptake when the interstitial volume and pressure are constant. Parameters such as mean time-to-peak signal, overall fluorescence signal intensities, and number of active peristaltic pulses, were estimated from temporal imaging data. While the mean time to attain peak signal representative of diffusion-dominated flow in the lymph vessels was 0.6±0.2??min for MB and 8±6??min for IgG, showing a size dependence, the active propulsion rates were 3.4±0.8??pulses/min and 3.3±0.5??pulses/min, respectively, appearing size independent. The propulsion rates for both dyes decreased with clearance from the interstitial injection-site, indicating intrinsic control of the smooth muscles in response to interstitial pressure. This approach to size-comparative agent flow imaging of lymphatic function can enable noninvasive characterization of diseases related to uptake and flow in lymph networks.
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Affiliation(s)
- Alisha V. DSouza
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
| | - Kayla Marra
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
| | - Jason R. Gunn
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
| | - Kimberley S. Samkoe
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
- Geisel School of Medicine, Department of Surgery, 1 Rope Ferry Road, Hanover, New Hampshire 03755, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
- Geisel School of Medicine, Department of Surgery, 1 Rope Ferry Road, Hanover, New Hampshire 03755, United States
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DSouza AV, Lin H, Henderson ER, Samkoe KS, Pogue BW. Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging. J Biomed Opt 2016; 21:80901. [PMID: 27533438 PMCID: PMC4985715 DOI: 10.1117/1.jbo.21.8.080901] [Citation(s) in RCA: 257] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 05/04/2023]
Abstract
There is growing interest in using fluorescence imaging instruments to guide surgery, and the leading options for open-field imaging are reviewed here. While the clinical fluorescence-guided surgery (FGS) field has been focused predominantly on indocyanine green (ICG) imaging, there is accelerated development of more specific molecular tracers. These agents should help advance new indications for which FGS presents a paradigm shift in how molecular information is provided for resection decisions. There has been a steady growth in commercially marketed FGS systems, each with their own differentiated performance characteristics and specifications. A set of desirable criteria is presented to guide the evaluation of instruments, including: (i) real-time overlay of white-light and fluorescence images, (ii) operation within ambient room lighting, (iii) nanomolar-level sensitivity, (iv) quantitative capabilities, (v) simultaneous multiple fluorophore imaging, and (vi) ergonomic utility for open surgery. In this review, United States Food and Drug Administration 510(k) cleared commercial systems and some leading premarket FGS research systems were evaluated to illustrate the continual increase in this performance feature base. Generally, the systems designed for ICG-only imaging have sufficient sensitivity to ICG, but a fraction of the other desired features listed above, with both lower sensitivity and dynamic range. In comparison, the emerging research systems targeted for use with molecular agents have unique capabilities that will be essential for successful clinical imaging studies with low-concentration agents or where superior rejection of ambient light is needed. There is no perfect imaging system, but the feature differences among them are important differentiators in their utility, as outlined in the data and tables here.
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Affiliation(s)
- Alisha V. DSouza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Address all correspondence to: Alisha V. DSouza, E-mail: ; Brian W. Pogue, E-mail:
| | - Huiyun Lin
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Fujian Normal University, MOE Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fujian 350007, China
| | - Eric R. Henderson
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire 03756, United States
| | - Kimberley S. Samkoe
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Dartmouth College, Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire 03755, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Dartmouth College, Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire 03755, United States
- Address all correspondence to: Alisha V. DSouza, E-mail: ; Brian W. Pogue, E-mail:
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DSouza AV, Lin H, Gunn J, Pogue BW. Logarithmic intensity compression in fluorescence guided surgery applications. J Biomed Opt 2015; 20:80504. [PMID: 26305450 PMCID: PMC4874040 DOI: 10.1117/1.jbo.20.8.080504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/20/2015] [Indexed: 05/20/2023]
Abstract
The use of fluorescence video imaging to guide surgery is rapidly expanding, and improvements in camera readout dynamic range have not matched display capabilities. Logarithmic intensity compression is a fast, single-step mapping technique that can map the useable dynamic range of high-bit fluorescence images onto the typical 8-bit display and potentially be a variable dynamic contrast enhancement tool. We demonstrate a ∼4.6 times improvement in image quality quantified by image entropy and a dynamic range reduction by a factor of ∼380 by the use of log-compression tools in processing in vivo fluorescence images.
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Affiliation(s)
- Alisha V. DSouza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Address all correspondence to: Alisha V. DSouza, E-mail: ; Brian W. Pogue, E-mail:
| | - Huiyun Lin
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Fujian Normal University, MOE Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fujian 350007, China
| | - Jason Gunn
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Geisel School of Medicine at Dartmouth, Department of Surgery, Hanover, New Hampshire 03755, United States
- Address all correspondence to: Alisha V. DSouza, E-mail: ; Brian W. Pogue, E-mail:
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DSouza AV, Elliott JT, Gunn JR, Barth RJ, Samkoe KS, Tichauer KM, Pogue BW. Nodal lymph flow quantified with afferent vessel input function allows differentiation between normal and cancer-bearing nodes. Biomed Opt Express 2015; 6:1304-17. [PMID: 25909014 PMCID: PMC4399669 DOI: 10.1364/boe.6.001304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 05/27/2023]
Abstract
Morbidity and complexity involved in lymph node staging via surgical resection and biopsy could ideally be improved using node assay techniques that are non-invasive. While visible blue dyes are often used to locate the sentinel lymph nodes from draining lymphatic vessels near a tumor, they do not provide an in situ metric to evaluate presence of cancer. In this study, the transport kinetics of methylene blue were analyzed to determine the potential for better in situ information about metastatic involvement in the nodes. A rat model with cancer cells in the axillary lymph nodes was used, with methylene blue injection to image the fluorescence kinetics. The lymphatic flow from injection sites to nodes was imaged and the relative kinetics from feeding lymphatic ducts relative to lymph nodes was quantified. Large variability existed in raw fluorescence and transport patterns within each cohort resulting in no systematic difference between average nodal uptake in normal, sham control and cancer-bearing nodes. However, when the signal from the afferent lymph vessel fluorescence was used to normalize the signal of the lymph nodes, the high signal heterogeneity was reduced. Using a model, the lymph flow through the nodes [Formula: see text] was estimated to be 1.49 ± 0.64 ml/g/min in normal nodes, 1.53 ± 0.45 ml/g/min in sham control nodes, and reduced to 0.50 ± 0.24 ml/g/min in cancer-cell injected nodes. This summarizes the significant difference (p = 0.0002) between cancer-free and cancer-bearing nodes in normalized flow. This process of normalized flow imaging could be used as an in situ tool to detect metastatic involvement in nodes.
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Affiliation(s)
- Alisha V DSouza
- Thayer School of Engineering, Dartmouth College, Hanover NH 03755, USA ;
| | | | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover NH 03755, USA
| | - Richard J Barth
- Department of Medicine, Geisel School of Medicine, Hanover NH 03755, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover NH 03755, USA ; Department of Surgery, Geisel School of Medicine, Hanover NH 03755, USA
| | - Kenneth M Tichauer
- Biomedical Engineering, Illinois Institute of Technology, Chicago IL 60616, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover NH 03755, USA ; Department of Surgery, Geisel School of Medicine, Hanover NH 03755, USA ;
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Flynn BP, DSouza AV, Kanick SC, Davis SC, Pogue BW. White light-informed optical properties improve ultrasound-guided fluorescence tomography of photoactive protoporphyrin IX. J Biomed Opt 2013; 18:046008. [PMID: 23584445 PMCID: PMC3639786 DOI: 10.1117/1.jbo.18.4.046008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Subsurface fluorescence imaging is desirable for medical applications, including protoporphyrin-IX (PpIX)-based skin tumor diagnosis, surgical guidance, and dosimetry in photodynamic therapy. While tissue optical properties and heterogeneities make true subsurface fluorescence mapping an ill-posed problem, ultrasound-guided fluorescence-tomography (USFT) provides regional fluorescence mapping. Here USFT is implemented with spectroscopic decoupling of fluorescence signals (auto-fluorescence, PpIX, photoproducts), and white light spectroscopy-determined bulk optical properties. Segmented US images provide a priori spatial information for fluorescence reconstruction using region-based, diffuse FT. The method was tested in simulations, tissue homogeneous and inclusion phantoms, and an injected-inclusion animal model. Reconstructed fluorescence yield was linear with PpIX concentration, including the lowest concentration used, 0.025 μg/ml. White light spectroscopy informed optical properties, which improved fluorescence reconstruction accuracy compared to the use of fixed, literature-based optical properties, reduced reconstruction error and reconstructed fluorescence standard deviation by factors of 8.9 and 2.0, respectively. Recovered contrast-to-background error was 25% and 74% for inclusion phantoms without and with a 2-mm skin-like layer, respectively. Preliminary mouse-model imaging demonstrated system feasibility for subsurface fluorescence measurement in vivo. These data suggest that this implementation of USFT is capable of regional PpIX mapping in human skin tumors during photodynamic therapy, to be used in dosimetric evaluations.
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Affiliation(s)
- Brendan P. Flynn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Alisha V. DSouza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Stephen C. Kanick
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Scott C. Davis
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Address all correspondence to: Brian W. Pogue, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755. Tel: (603) 646-3861; E-mail:
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