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Dong J, Grant C, Vuong B, Nishioka N, Gao AH, Beatty M, Baldwin G, Bailargeon A, Bablouzian A, Grahmann P, Bhat N, Ryan E, Barrios A, Giddings S, Ford T, Beaulieu-Ouellet E, Hosseiny SH, Lerman I, Trasischker W, Reddy R, Singh K, Gora M, Hyun D, Queneherve L, Wallace M, Wolfsen H, Sharma P, Wang KK, Leggett CL, Poneros J, Abrams JA, Lightdale C, Leeds S, Rosenberg M, Tearney G. Feasibility and Safety of Tethered Capsule Endomicroscopy in Patients With Barrett's Esophagus in a Multi-Center Study. Clin Gastroenterol Hepatol 2022; 20:756-765.e3. [PMID: 33549871 PMCID: PMC8715859 DOI: 10.1016/j.cgh.2021.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tethered capsule endomicroscopy (TCE) involves swallowing a small tethered pill that implements optical coherence tomography (OCT) imaging, procuring high resolution images of the whole esophagus. Here, we demonstrate and evaluate the feasibility and safety of TCE and a portable OCT imaging system in patients with Barrett's esophagus (BE) in a multi-center (5-site) clinical study. METHODS Untreated patients with BE as per endoscopic biopsy diagnosis were eligible to participate in the study. TCE procedures were performed in unsedated patients by either doctors or nurses. After the capsule was swallowed, the device continuously obtained 10-μm-resolution cross-sectional images as it traversed the esophagus. Following imaging, the device was withdrawn through mouth, and disinfected for subsequent reuse. BE lengths were compared to endoscopy findings when available. OCT-TCE images were compared to volumetric laser endomicroscopy (VLE) images from a patient who had undergone VLE on the same day as TCE. RESULTS 147 patients with BE were enrolled across all sites. 116 swallowed the capsule (79%), 95/114 (83.3%) men and 21/33 (63.6%) women (P = .01). High-quality OCT images were obtained in 104/111 swallowers (93.7%) who completed the procedure. The average imaging duration was 5.55 ± 1.92 minutes. The mean length of esophagus imaged per patient was 21.69 ± 5.90 cm. A blinded comparison of maximum extent of BE measured by OCT-TCE and EGD showed a strong correlation (r = 0.77-0.79). OCT-TCE images were of similar quality to those obtained by OCT-VLE. CONCLUSIONS The capabilities of TCE to be used across multiple sites, be administered to unsedated patients by either physicians or nurses who are not expert in OCT-TCE, and to rapidly and safely evaluate the microscopic structure of the esophagus make it an emerging tool for screening and surveillance of BE patients. Clinical trial registry website and trial number: NCT02994693 and NCT03459339.
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Affiliation(s)
- Jing Dong
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Catriona Grant
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Barry Vuong
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Norman Nishioka
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Anna Huizi Gao
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Matthew Beatty
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Grace Baldwin
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Aaron Bailargeon
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Ara Bablouzian
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Patricia Grahmann
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Nitasha Bhat
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Emily Ryan
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Amilcar Barrios
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Sarah Giddings
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Timothy Ford
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | | | | | - Irene Lerman
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Wolfgang Trasischker
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Rohith Reddy
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Kanwarpal Singh
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Michalina Gora
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA,ICube Laboratory, CNRS, Strasbourg University, France
| | - Daryl Hyun
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Lucille Queneherve
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Michael Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL
| | - Herbert Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City Veterans Administration and University of Kansas School of Medicine, MO
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology,, Mayo Clinic Rochester, MN
| | - Cadman L. Leggett
- Division of Gastroenterology and Hepatology,, Mayo Clinic Rochester, MN
| | | | | | | | | | - Mireille Rosenberg
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Guillermo Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA,Department of Pathology, Massachusetts General Hospital, MA,Harvard-MIT Division of Health Science and Technology (HST)
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Haindl R, Trasischker W, Wartak A, Baumann B, Pircher M, Hitzenberger CK. Total retinal blood flow measurement by three beam Doppler optical coherence tomography. Biomed Opt Express 2016; 7:287-301. [PMID: 26977340 PMCID: PMC4771449 DOI: 10.1364/boe.7.000287] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 05/04/2023]
Abstract
We present measurements of total retinal blood flow in healthy volunteers using a three beam Doppler optical coherence tomography (D-OCT) technique. This technology has the advantage of a precise determination of the flow vector without the use of any a-priori information on the vessel geometry. Circular D-OCT scans around the optic disc were recorded and venous as well as arterial total blood flow was determined and compared for each subject. The reproducibility of the method was assessed in 6 subjects by repeated measurements. Only small deviations of around 6% between the measurements were found which indicates the high precision of the proposed method.
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Affiliation(s)
- Richard Haindl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria;
| | - Wolfgang Trasischker
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA
| | - Andreas Wartak
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
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Haindl R, Trasischker W, Baumann B, Pircher M, Hitzenberger C. Three-beam Doppler optical coherence tomography using a facet prism telescope and MEMS mirror for improved transversal resolution. J Mod Opt 2015; 62:1781-1788. [PMID: 26689672 PMCID: PMC4681122 DOI: 10.1080/09500340.2014.983569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/28/2014] [Indexed: 05/21/2023]
Abstract
An improved three-beam Doppler optical coherence tomography system was developed. It utilizes a custom-made three-facet prism telescope to improve the transversal resolution at the sample. Furthermore, a two-axis gimbal-less MEMS mirror is used to minimize off-pivot beam movement at the pupil of the eye, enabling circular scanning for in vivo retinal measurements. We demonstrate the system's abilities for in vitro circular scanning to measure absolute flow and to reconstruct the full velocity vector on a bifurcation flow phantom. Moreover, in vivo retinal measurements using circular scanning around vessel bifurcations of healthy human volunteers were performed. Measurements of the absolute mean flow and its orientation are in good agreement with the expected values for in vitro measurements. For in vivo measurements, the in- and outflow of blood for retinal vessel bifurcations show an excellent agreement, demonstrating the reliability of the technique.
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Affiliation(s)
- R. Haindl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Corresponding author.
| | - W. Trasischker
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - B. Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - M. Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - C.K. Hitzenberger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Trasischker W, Werkmeister RM, Zotter S, Baumann B, Torzicky T, Pircher M, Hitzenberger CK. In vitro and in vivo three-dimensional velocity vector measurement by three-beam spectral-domain Doppler optical coherence tomography. J Biomed Opt 2013; 18:116010. [PMID: 24247747 DOI: 10.1117/1.jbo.18.11.116010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/21/2013] [Indexed: 05/19/2023]
Abstract
We developed a three-beam Doppler optical coherence tomography (OCT) system that enables measurement of the velocity vector of moving particles in three-dimensions (3-D). The spatial orientation as well as the magnitude of motion can be determined without prior knowledge of the geometry of motion. The system combines three spectral-domain OCT interferometers whose sample beams are focused at the sample by a common focusing lens at three different angles. This provides three spatially independent velocity components simultaneously from which the velocity vector can be reconstructed. We demonstrate the system in a simple test object (rotating disc), a flow phantom, and for blood flow measurements in the retina of a healthy human subject. Measurements of blood flow at a venous bifurcation achieve a good agreement between in- and outflow and demonstrate the reliability of the method.
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Torzicky T, Marschall S, Pircher M, Baumann B, Bonesi M, Zotter S, Götzinger E, Trasischker W, Klein T, Wieser W, Biedermann B, Huber R, Andersen P, Hitzenberger CK. Retinal polarization-sensitive optical coherence tomography at 1060 nm with 350 kHz A-scan rate using an Fourier domain mode locked laser. J Biomed Opt 2013; 18:26008. [PMID: 23377007 DOI: 10.1117/1.jbo.18.2.026008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We present a novel, high-speed, polarization-sensitive, optical coherence tomography set-up for retinal imaging operating at a central wavelength of 1060 nm which was tested for in vivo imaging in healthy human volunteers. We use the system in combination with a Fourier domain mode locked laser with active spectral shaping which enables the use of forward and backward sweep in order to double the imaging speed without a buffering stage. With this approach and with a custom designed data acquisition system, we show polarization-sensitive imaging with an A-scan rate of 350 kHz. The acquired three-dimensional data sets of healthy human volunteers show different polarization characteristics in the eye, such as depolarization in the retinal pigment epithelium and birefringence in retinal nerve fiber layer and sclera. The increased speed allows imaging of large volumes with reduced motion artifacts. Moreover, averaging several two-dimensional frames allows the generation of high-definition B-scans without the use of an eye-tracking system. The increased penetration depth of the system, which is caused by the longer probing beam wavelength, is beneficial for imaging choroidal and scleral structures and allows automated segmentation of these layers based on their polarization characteristics.
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Affiliation(s)
- Teresa Torzicky
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Austria.
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Zotter S, Pircher M, Torzicky T, Baumann B, Yoshida H, Hirose F, Roberts P, Ritter M, Schütze C, Götzinger E, Trasischker W, Vass C, Schmidt-Erfurth U, Hitzenberger CK. Large-field high-speed polarization sensitive spectral domain OCT and its applications in ophthalmology. Biomed Opt Express 2012; 3:2720-32. [PMID: 23162711 PMCID: PMC3493234 DOI: 10.1364/boe.3.002720] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/24/2012] [Accepted: 10/01/2012] [Indexed: 05/19/2023]
Abstract
We present a novel spectral domain polarization sensitive OCT system (PS-OCT) that operates at an A-scan rate of 70 kHz and supports scan angles of up to 40° × 40°. The high-speed imaging allows the acquisition of up to 1024 × 250 A-scans per 3D scan, which, together with the large field of view, considerably increases the informative value of the images. To demonstrate the excellent performance of the new PS-OCT system, we imaged several healthy volunteers and patients with various diseases such as glaucoma, AMD, Stargardt's disease, and albinism. The results are compared with clinically established methods such as scanning laser polarimetry and autofluorescence.
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Affiliation(s)
- Stefan Zotter
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
| | - Teresa Torzicky
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
| | | | | | - Philipp Roberts
- Department of Ophthalmology and Optometry, Medical University of
Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Markus Ritter
- Department of Ophthalmology and Optometry, Medical University of
Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Christopher Schütze
- Department of Ophthalmology and Optometry, Medical University of
Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Erich Götzinger
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
| | - Wolfgang Trasischker
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
| | | | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of
Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Christoph K. Hitzenberger
- Center for Medical Physics and Biomedical Engineering, Medical
University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna,
Austria
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