Perspectives on interstitial photodynamic therapy for malignant tumors

SIGNIFICANCE

Despite remarkable advances in the core modalities used in combating cancer, malignant diseases remain the second largest cause of death globally. Interstitial photodynamic therapy (IPDT) has emerged as an alternative approach for the treatment of solid tumors.

AIM

The aim of our study is to outline the advancements in IPDT in recent years and provide our vision for the inclusion of IPDT in standard-of-care (SoC) treatment guidelines of specific malignant diseases.

APPROACH

First, the SoC treatment for solid tumors is described, and the attractive properties of IPDT are presented. Second, the application of IPDT for selected types of tumors is discussed. Finally, future opportunities are considered.

RESULTS

Strong research efforts in academic, clinical, and industrial settings have led to significant improvements in the current implementation of IPDT, and these studies have demonstrated the unique advantages of this modality for the treatment of solid tumors. It is envisioned that further randomized prospective clinical trials and treatment optimization will enable a wide acceptance of IPDT in the clinical community and inclusion in SoC guidelines for well-defined clinical indications.

CONCLUSIONS

The minimally invasive nature of this treatment modality combined with the relatively mild side effects makes IPDT a compelling alternative option for treatment in a number of clinical applications. The adaptability of this technique provides many opportunities to both optimize and personalize the treatment.

Gas Monitoring in Human Frontal Sinuses-Stability Considerations and Gas Exchange Studies

Acute rhinosinusitis is a common infectious disease, which, in more than 90% of cases, is caused by viruses rather than by bacteria. Even so, antibiotics are often unnecessarily prescribed, and in the long run this contributes to the alarming level of antibiotics resistance. The reason is that there are no good guiding tools for defining the background reason of the infection. One main factor for the clearance of the infection is if there is non-obstructed ventilation from the sinus to the nasal cavity. Gas in Scattering Media Absorption Spectroscopy (GASMAS) has potential for diagnosing this. We have performed a study of frontal sinuses of volunteers with a focus on signal stability and reproducibility over time, accurate oxygen concentration determination, and assessment of gas transport through passages, naturally and after decongestant spray administration. Different from earlier studies on frontal sinuses, water vapor, serving the purpose of oxygen signal normalization, was measured at 818 nm rather than earlier at 937 nm, now closer to the 760 nm oxygen absorption band and thus resulting in more reliable results. In addition, the action of decongestants was objectively demonstrated for the first time. Evaluated oxygen concentration values for left- and right-hand side sinus cavities were found to agree within 0.3%, and a left-right geometrical asymmetry parameter related to anatomical differences was stable within 10%.

Ripening of avocado fruits studied by spectroscopic techniques

Avocados are considered very healthy due to the high content mono-unsaturated lipid, essential vitamins and minerals, minimal sugar and no cholesterol and are therefore sometimes referred to as "the perfect fruits". Avocados, mainly grown in Latin-America, are harvested unripe and sent overseas. However, the ripening process is very difficult to assess visually and tactilely. A tool for precise noninvasive judgment of the status would be valuable as the fruit is too expensive to be cut open unripe or overdue. A white-light source and a light-emitting diode unit with four excitation wavelengths (365, 385, 395, and 405 nm) were used for reflectance and fluorescence spectroscopy in a fiber-coupled set-up for noninvasive monitoring. Twelve non-ripe avocados, with approximately the same size and appearance, were studied and divided into three groups and kept at three different storage conditions; at room temperature, in a refrigerator and a combination of the two. We showed that fluorescence was useful for following the ripening process. A method, which compensates for the spatial variations in spectral properties around a fruit, is described. Remote fluorescence monitoring, intended for orchard use, was also demonstrated. A low-cost device based on fluorescence for avocado ripeness assessment is proposed.

Photodynamic therapy dosimetry using multiexcitation multiemission wavelength: toward real-time prediction of treatment outcome

Evaluating the optical properties of biological tissues is needed to achieve accurate dosimetry during photodynamic therapy (PDT). Currently, accurate assessment of the photosensitizer (PS) concentration by fluorescence measurements during PDT is typically hindered by the lack of information about tissue optical properties. In the present work, a hand-held fiber-optic probe instrument monitoring fluorescence and reflectance is used for assessing blood volume, reduced scattering coefficient, and PS concentration facilitating accurate dosimetry for PDT. System validation was carried out on tissue phantoms using nonlinear least squares support machine regression analysis. It showed a high correlation coefficient (>0.99) in the prediction of the PS concentration upon a large variety of phantom optical properties. In vivo measurements were conducted in a PDT chlorine e6 dose escalating trial involving 36 male Swiss mice with Ehrlich solid tumors in which fluences of 5, 15, and 40  J cm  -  2 were delivered at two fluence rates (100 and 40  mW cm  -  2). Remarkably, quantitative measurement of fluorophore concentration was achieved in the in vivo experiment. Diffuse reflectance spectroscopy (DRS) system was also used to independently measure the physiological properties of the target tissues for result comparisons. Then, blood volume and scattering coefficient measured by the fiber-optic probe system were compared with the corresponding result measured by DRS and showed agreement. Additionally, tumor hemoglobin oxygen saturation was measured using the DRS system. Overall, the system is capable of assessing the implicit photodynamic dose to predict the PDT outcome.

Towards an optical diagnostic system for otitis media using a combination of otoscopy and spectroscopy

An improved method, where conventional otoscope investigation of human suspicious otitis media is combined with diffuse reflectance spectroscopy and gas in scattering media absorption spectroscopy (GASMAS) is being developed. Otitis media is one of the most common infectious diseases in children, whose Eustachian tube connecting the middle ear with the nasal cavity is more horizontal than for adults, which leads to impaired fluid drainage. At present, the use of an otoscope to visually observe possible changes in the tympanic membrane appearance is the main diagnostics method for otitis media. Inaccurate diagnosis related to similar symptoms, and the difficulty for small children to describe the condition experienced, frequently leads to over-prescription of antibiotics and alarming increase in bacterial resistance development. More accurate diagnostic methods are highly desirable. Diffuse reflectance spectroscopy is a non-invasive quantitative spectroscopic technique that enables to objectively quantify changes in the hemoglobin content of the tympanic membrane related to inflammation. If an infection is present, the ventilatory function of the Eustachian tube is frequently impaired and the middle-ear cavity will be filled with fluid. GASMAS, a non-invasive detection method, can non-invasively determine if gas is replaced by fluid in the middle-ear cavity.

Laser-based gas absorption spectroscopy in decaying hip bone: water vapor as a predictor of osteonecrosis

Affluent blood flow through a complicated net of vessels supplies skeletal bone tissue with oxygen and nutrients. Due to accidental events or physiological processes, the blood supply might be deficient or even disrupted, and the healthy bone decays in a process that, for the hip location, is denoted as osteonecrosis of the femoral head (ONFH) or avascular femoral head necrosis. Early diagnosis is important for the prognosis. X-ray-based imaging, such as CT or MRI, is not of much value for the early detection. As the decay theoretically is associated with the development of gas-filled pores, gas analysis should have diagnostic value. We have introduced gas in scattering media absorption spectroscopy, as a complementary modality. Eighteen extracted femoral joint heads, diseased as well as normal, were investigated. Diseased samples are associated with clear signals due to water vapor, whereas the normal ones largely lack such features. The results suggest that free water vapor could serve as an early indicator of pore development and thus as a promising predictor of ONFH pathological changes, once the technique has been fully refined.

Non-intrusive studies of gas contents and gas diffusion in hen eggs

A detailed study of the condition of eggs was performed using tunable diode lasers to monitor free gas in hen eggs. We detected oxygen and water vapor signals from 13 unfertilized eggs and studied the growth of the egg air cell over a time period of 3 weeks. We also studied the gas exchange through the egg shell, which is of particular interest for fertilized eggs. Four fertilized and five unfertilized eggs were followed over 3 weeks, the hatching period for hen eggs, and significant variations were found both in time and for the two types of eggs. Our results indicate that the techniques could be developed for automatic control of egg freshness, as well as for monitoring the hatching progress of fertilized eggs.

Insect remote sensing using a polarization sensitive cw lidar system in chinese rice fields

A joint Chinese-Swedish field campaign of Scheimpflug continuous-wave lidar monitoring of rice-field flying pest insects was pursued in very hot July weather conditions close to Guangzhou, China. The occurrence of insects, birds and bats with almost 200 hours of round-the-clock polarization-sensitive recordings was studied. Wing-beat frequency recordings and depolarization properties were used for target classification. Influence of weather conditions on the flying fauna was also investigated.

The bat-bird-bug battle: daily flight activity of insects and their predators over a rice field revealed by high-resolution Scheimpflug Lidar

We present the results of, to our knowledge, the first Lidar study applied to continuous and simultaneous monitoring of aerial insects, bats and birds. It illustrates how common patterns of flight activity, e.g. insect swarming around twilight, depend on predation risk and other constraints acting on the faunal components. Flight activity was monitored over a rice field in China during one week in July 2016, using a high-resolution Scheimpflug Lidar system. The monitored Lidar transect was about 520 m long and covered approximately 2.5 m³. The observed biomass spectrum was bimodal, and targets were separated into insects and vertebrates in a categorization supported by visual observations. Peak flight activity occurred at dusk and dawn, with a 37 min time difference between the bat and insect peaks. Hence, bats started to feed in declining insect activity after dusk and stopped before the rise in activity before dawn. A similar time difference between insects and birds may have occurred, but it was not obvious, perhaps because birds were relatively scarce. Our observations are consistent with the hypothesis that flight activity of bats is constrained by predation in bright light, and that crepuscular insects exploit this constraint by swarming near to sunset/sunrise to minimize predation from bats.

Detection of free oxygen and water vapor in fertilized and unfertilized eggs by diode laser spectroscopy-Exploration of diagnostics possibilities

Nonintrusive methods for characterizing food products are of increasing interest related to the greater awareness of food safety issues. Hen eggs are an important part in food consumption in most parts of the world. We have investigated an optical method utilizing tunable diode lasers for monitoring free gas in eggs. We show that oxygen signals, recorded around 760 nm, increase steadily as eggs become older. Further, we investigated fertilized eggs, which show a quite different temporal behavior during the hatching time. The oxygen signal decreases here with time, while water vapor, recorded around 937 nm, shows a steady increase. Conclusions regarding the size of the air cell and the oxygen availability in fertilized eggs are drawn. The technique might be developed for automatic control of egg freshness, as well as for assessing if eggs are fertilized or not.

Diagnostics of femoral head status in humans using laser spectroscopy - In vitro studies

Osteonecrosis of the femoral head (ONFH), a recalcitrant and disabling disease, is caused by inadequate or fully disrupted blood supply to the affected segment of the subchondral bone. Theoretically, there will develop gas-filled pores during the bone decay process due to lacking blood supply. Unfortunately, the relationship between the gas-filled pores and ONFH is still unclear. Here, we have introduced diode laser absorption spectroscopy to detect oxygen and water vapor signals in the femoral heads from hip replacement in 19 patients. Five samples are affected by osteoarthritis (OA) and the others are related to ONFH. Oxygen and water vapor signals could be obtained, demonstrating the presence of gas-filled pores in both the OA and ONFH groups while the measurement results showed no significant difference. A study of gas exchange was also performed on one excised bone sample to study how these gas pores communicate with the ambient air. The results suggested that the obtained oxygen signals inside the bone samples originate from the invasion of ambient air, which is not expected in vivo. In conclusion, the ability to detect the gas signal of laser absorption spectroscopy shows the potential for the medical application of assessing the human femoral head in vivo.

Application of Tunable Diode Laser Spectroscopy for the Assessment of Food Quality

Adequate food packaging is important to ensure food quality and prolong the shelf life of food. Frequently, the method of modified atmosphere packaging (MAP) is used. We used a tunable diode laser spectroscopy technique to detect the oxygen content in food packages, e.g., in packaged milk and bread. Different detection geometries were adopted to be able to collect scattering light that had passed through the gas volume in the packages, and to avoid the disturbance of ambient air. Furthermore, studies of the bread-baking process have been performed by measuring the water vapor signals in a fermenting dough. The results demonstrate that the technique has a great potential for nonintrusive assessment of food quality and the bread-baking process.

Gas exchange in fruits related to skin condition and fruit ripening studied with diode laser spectroscopy

The concentration of the biologically active molecular oxygen gas is of crucial importance for fruits in the metabolic respiration, maturation, and ripening processes. In our study, oxygen content and oxygen transport in fruits, exemplified by apples and guavas, were studied noninvasively by gas in scattering media absorption spectroscopy. The technique is based on the fact that free gases typically have 10,000 times narrower absorption features than the bulk material. The technique was demonstrated in studies of the influence of the fruit skin in regulating the internal oxygen balance, by observing the signal response of the internal oxygen gas to a transient change in the ambient gas concentration on peeled and unpeeled fruits. In addition, the gas exchange rate at different ripening stages was also studied in intact guavas.

Diode laser spectroscopy for noninvasive monitoring of oxygen in the lungs of newborn infants

BACKGROUND

Newborn infants may have pulmonary disorders with abnormal gas distribution, e.g., respiratory distress syndrome. Pulmonary radiography is the clinical routine for diagnosis. Our aim was to investigate a novel noninvasive optical technique for rapid nonradiographic bedside detection of oxygen gas in the lungs of full-term newborn infants.

METHODS

Laser spectroscopy was used to measure contents of oxygen gas (at 760 nm) and of water vapor (at 937 nm) in the lungs of 29 healthy newborn full-term infants (birth weight 2,900-3,900 g). The skin above the lungs was illuminated using two low-power diode lasers and diffusely emerging light was detected with a photodiode.

RESULTS

Of the total 390 lung measurements performed, clear detection of oxygen gas was recorded in 60%, defined by a signal-to-noise ratio of >3. In all the 29 infants, oxygen was detected. Probe and detector positions for optimal pulmonary gas detection were determined. There were no differences in signal quality with respect to gender, body side or body weight.

CONCLUSION

The ability to measure pulmonary oxygen content in healthy full-term neonates with this technique suggests that with further development, the method might be implemented in clinical practice for lung monitoring in neonatal intensive care.

Laser spectroscopy applied to environmental, ecological, food safety, and biomedical research

Laser spectroscopy provides many possibilities for multi-disciplinary applications in environmental monitoring, in the ecological field, for food safety investigations, and in biomedicine. The paper gives several examples of the power of multi-disciplinary applications of laser spectroscopy as pursued in our research group. The studies utilize mostly similar and widely applicable spectroscopic approaches. Air pollution and vegetation monitoring by lidar techniques, as well as agricultural pest insect monitoring and classification by elastic scattering and fluorescence spectroscopy are described. Biomedical aspects include food safety applications and medical diagnostics of sinusitis and otitis, with strong connection to the abatement of antibiotics resistance development.

Assessment of human sinus cavity air volume using tunable diode laser spectroscopy, with application to sinusitis diagnostics

Sinusitis is a very common disease and improved diagnostic tools are desirable also in view of reducing over-prescription of antibiotics. A non-intrusive optical technique called GASMAS (GAs in Scattering Media Absorption Spectroscopy), which has a true potential of being developed into an important complement to other means of detection, was utilized in this work. Water vapor in the frontal sinuses, related to the free gas volume, was studied at around 937 nm in healthy volunteers. The results show a good stability of the GASMAS signals over extended times for the frontal sinuses for all volunteers, showing promising applicability to detect anomalies due to sinusitis. Measurements were also performed following the application of a decongestion spray. No noticeable signal change was observed, which is consistent with the fact that the water vapor concentration is given by the temperature only, and is not influenced by changes in cavity ventilation. Evaluated GASMAS data recorded on 6 consecutive days show signal stability for the left and right frontal sinus in one of the test volunteers.

Optical detection of middle ear infection using spectroscopic techniques: phantom experiments

A noninvasive optical technique, which is based on a combination of reflectance spectroscopy and gas in scattering media absorption spectroscopy, is demonstrated. It has the potential to improve diagnostics of middle ear infections. An ear phantom prepared with a tissue cavity, which was covered with scattering material, was used for spectroscopic measurements. Diffuse reflectance spectra of the phantom eardrum were measured with a reflectance probe. The presence of oxygen and water vapor as well as gas exchange in the phantom cavity were studied with a specially designed fiber-optic probe for backscattering detection geometry. The results suggest that this method can be developed for improved clinical detection of middle ear infection.

Pharmacokinetic and biodistribution study following systemic administration of Fospeg®--a Pegylated liposomal mTHPC formulation in a murine model

Fospeg® is a newly developed photosensitizer formulation based on meso-tetra(hydroxyphenyl)chlorin (mTHPC), with hydrophilic liposomes to carry the hydrophobic photosensitizer to the target tissue. In this study the pharmacokinetics and biodistribution of Fospeg® were investigated by high performance liquid chromatography at various times (0.5-18 hours) following systemic i.v. administration. As a model an experimental HT29 colon tumor in NMRI nu/nu mice was employed. Our study indicates a higher plasma peak concentration, a longer circulation time and a better tumor-to-skin ratio than those of Foslip®, another liposomal mTHPC formulation. Data from ex vivo tissue fluorescence and reflectance imaging exhibit good correlation with chemical extraction. Our results have shown that optical imaging provides the potential for fluorophore quantification in biological tissues.

Studies of tropical fruit ripening using three different spectroscopic techniques

We present a noninvasive method to study fruit ripening. The method is based on the combination of reflectance and fluorescence spectroscopies, as well as gas in scattering media absorption spectroscopy (GASMAS). Chlorophyll and oxygen are two of the most important constituents in the fruit ripening process. Reflectance and fluorescence spectroscopies were used to quantify the changes of chlorophyll and other chromophores. GASMAS, based on tunable diode laser absorption spectroscopy, was used to measure free molecular oxygen in the fruit tissue at 760 nm, based on the fact that the free gases have much narrower spectral imprints than those of solid materials. The fruit maturation and ripening processes can be followed by studying the changes of chlorophyll and oxygen contents with these three techniques.

Noninvasive monitoring of gas in the lungs and intestines of newborn infants using diode lasers: feasibility study

Preterm newborn infants have a high morbidity rate. The most frequently affected organs where free gas is involved are the lungs and intestines. In respiratory distress syndrome, both hyperexpanded and atelectatic (collapsed) areas occur, and in necrotizing enterocolitis, intramural gas may appear in the intestine. Today, these conditions are diagnosed with x-ray radiography. A bed-side, rapid, nonintrusive, and gas-specific technique for in vivo gas sensing would improve diagnosis. We report the use of noninvasive laser spectroscopy, for the first time, to assess gas content in the lungs and intestines of three full-term infants. Water vapor and oxygen were studied with two low-power diode lasers, illuminating the skin and detecting light a few centimeters away. Water vapor was easily detected in the intestines and was also observed in the lungs. The relatively thick chest walls of the infants prevented detection of the weaker oxygen signal in this study. However, results from a previous phantom study, together with scaling of the results presented here to the typical chest-wall thickness of preterm infants, suggest that oxygen also should be detectable in their lungs.

Non-invasive diagnostics of the maxillary and frontal sinuses based on diode laser gas spectroscopy

PROBLEM

Suspected, but objectively absent, rhinosinusitis constitutes a major cause of visits to the doctor, high health care costs, and the over-prescription of antibiotics, contributing to the serious problem of resistant bacteria. This situation is largely due to a lack of reliable and widely applicable diagnostic methods.

METHOD

A novel method for the diagnosis of rhinosinusitis based on non-intrusive diode laser gas spectroscopy is presented. The technique is based on light absorption by free gas (oxygen and water vapour) inside the sinuses, and has the potential to be a complementary diagnostic tool in primary health care. The method was evaluated on 40 patients with suspected sinus problems, referred to the diagnostic radiology clinic for low-dose computed tomography (CT), which was used as the reference technique.

MAIN RESULTS

The data obtained with the new laser-based method correlated well with the grading of opacification and ventilation using CT. The sensitivity and specificity were estimated to be 93% and 61%, respectively, for the maxillary sinuses, and 94% and 86%, respectively, for the frontal sinuses. Good reproducibility was shown.

PRINCIPAL CONCLUSION

The laser-based technique presents real-time clinical data that correlate well to CT findings, while being non-intrusive and avoiding the use of ionizing radiation.

Method for Studying Gas Composition in the Human Mastoid Cavity by Use of Laser Spectroscopy

Objectives:

We evaluated a method for gas monitoring in the mastoid cavity using tunable diode laser spectroscopy by comparing it to simultaneously obtained computed tomographic (CT) scans.

Methods:

The presented optical technique measures free gases, oxygen (O2), and water vapor (H2O) within human tissue by use of low-power diode lasers. Laser light was sent into the tip of the mastoid process, and the emerging light at the level of the antrum was captured with a detector placed on the skin. The absorption of H2O was used to monitor the probed gas volume of the mastoid cavity, and it was compared to the CT scan–measured volume. The ratio between O2 absorption and H2O absorption estimated the O2 content in the mastoid cavity and thus the ventilation. The parameters were compared to the grading of mastoid cavities based on the CT scans (n = 31). The reproducibility of the technique was investigated by measuring each mastoid cavity 4 times.

Results:

Both O2 and H2O were detected with good reproducibility. The H2O absorption and the CT volume correlated (r = 0.69). The average ratio between the normalized O2 absorption and the H2O absorption signals was 0.7, indicating a lower O2 content than in surrounding air (expected ratio, 1.0), which is consistent with previous findings made by invasive techniques. All mastoid cavities with radiologic signs of disease were detected.

Conclusions:

Laser spectroscopy monitoring appears to be a usable tool for noninvasive investigations of gas composition in the mastoid cavity, providing important clinical information regarding size and ventilation.

In vivo measurements of diffuse reflectance and time-resolved autofluorescence emission spectra of basal cell carcinomas

We present a clinical investigation of diffuse reflectance and time-resolved autofluorescence spectra of skin cancer with an emphasis on basal cell carcinoma. A total of 25 patients were measured using a compact steady-state diffuse reflectance/fluorescence spectrometer and a fibre-optic-coupled multispectral time-resolved spectrofluorometer. Measurements were performed in vivo prior to surgical excision of the investigated region. Singular value decomposition was used to reduce the dimensionality of steady state diffuse reflectance and fluorescence spectra. Linear discriminant analysis was then applied to the measurements of basal cell carcinomas (BCCs) and used to predict the tissue disease state with a leave-one-out methodology. This approach was able to correctly diagnose 87% of the BCCs. With 445 nm excitation a decrease in the spectrally averaged fluorescence lifetime was observed between normal tissue and BCC lesions with a mean value of 886 ps. Furthermore, the fluorescence lifetime for BCCs was lower than that of the surrounding healthy tissue in all cases and statistical analysis of the data revealed that this decrease was significant (p = 0.002).

Nonintrusive gas monitoring in neonatal lungs using diode laser spectroscopy: feasibility study

A feasibility study on noninvasive, real-time monitoring of gases in lungs of preterm infants is reported, where a laser-spectroscopic technique using diode lasers tuned to oxygen and water vapor absorption lines was employed on realistic tissue phantoms. Our work suggests that the technique could provide a new possibility for surveillance of the lung function of preterm infants, in particular the oxygenation, which is of prime importance in this patient group.

The future of medical diagnostics: review paper

While histopathology of excised tissue remains the gold standard for diagnosis, several new, non-invasive diagnostic techniques are being developed. They rely on physical and biochemical changes that precede and mirror malignant change within tissue. The basic principle involves simple optical techniques of tissue interrogation. Their accuracy, expressed as sensitivity and specificity, are reported in a number of studies suggests that they have a potential for cost effective, real-time, in situ diagnosis.

We review the Third Scientific Meeting of the Head and Neck Optical Diagnostics Society held in Congress Innsbruck, Innsbruck, Austria on the 11th May 2011. For the first time the HNODS Annual Scientific Meeting was held in association with the International Photodynamic Association (IPA) and the European Platform for Photodynamic Medicine (EPPM). The aim was to enhance the interdisciplinary aspects of optical diagnostics and other photodynamic applications. The meeting included 2 sections: oral communication sessions running in parallel to the IPA programme and poster presentation sessions combined with the IPA and EPPM posters sessions.

Drug quantification in turbid media by fluorescence imaging combined with light-absorption correction using white Monte Carlo simulations

Accurate quantification of photosensitizers is in many cases a critical issue in photodynamic therapy. As a noninvasive and sensitive tool, fluorescence imaging has attracted particular interest for quantification in pre-clinical research. However, due to the absorption of excitation and emission light by turbid media, such as biological tissue, the detected fluorescence signal does not have a simple and unique dependence on the fluorophore concentration for different tissues, but depends in a complex way on other parameters as well. For this reason, little has been done on drug quantification in vivo by the fluorescence imaging technique. In this paper we present a novel approach to compensate for the light absorption in homogeneous turbid media both for the excitation and emission light, utilizing time-resolved fluorescence white Monte Carlo simulations combined with the Beer-Lambert law. This method shows that the corrected fluorescence intensity is almost proportional to the absolute fluorophore concentration. The results on controllable tissue phantoms and murine tissues are presented and show good correlations between the evaluated fluorescence intensities after the light-absorption correction and absolute fluorophore concentrations. These results suggest that the technique potentially provides the means to quantify the fluorophore concentration from fluorescence images.

At the frontiers of surgery: review

The complete surgical removal of disease is a desirable outcome particularly in oncology. Unfortunately much disease is microscopic and difficult to detect causing a liability to recurrence and worsened overall prognosis with attendant costs in terms of morbidity and mortality. It is hoped that by advances in optical diagnostic technology we could better define our surgical margin and so increase the rate of truly negative margins on the one hand and on the other hand to take out only the necessary amount of tissue and leave more unaffected non-diseased areas so preserving function of vital structures. The task has not been easy but progress is being made as exemplified by the presentations at the 2nd Scientific Meeting of the Head and Neck Optical Diagnostics Society (HNODS) in San Francisco in January 2010. We review the salient advances in the field and propose further directions of investigation.

Multimodal imaging to study the morphochemistry of basal cell carcinoma

Basal cell carcinoma is the most abundant malignant neoplasm in humans, the pathology of which is characterized by an abnormal proliferation of basal cells. Basal cell carcinoma can show a variety of different morphologies, which are based on different cellular biology. Furthermore, the carcinoma often grows invisibly to the eye imbedded in the surrounding skin. Therefore, in some cases its clinical detection is challenging. Thus, our work aims at establishing an unsupervised tissue classification method based on multimodal imaging and the application of chemometrics to discriminate basal cell carcinoma from non-diseased tissue. A case study applying multimodal imaging to ex-vivo sections of basal cell carcinoma is presented. In doing so, we apply a combination of various linear and non-linear imaging modalities, i.e. fluorescence, Raman and second-harmonic generation microscopy, to study the morphochemistry of basal cell carcinoma. The joint information content obtained by such multimodal approach in studying various aspects of the malignant tissue alterations associated with basal cell carcinoma is discussed.

System for interstitial photodynamic therapy with online dosimetry: first clinical experiences of prostate cancer

The first results from a clinical study for Temoporfin-mediated photodynamic therapy (PDT) of low-grade (T1c) primary prostate cancer using online dosimetry are presented. Dosimetric feedback in real time was applied, for the first time to our knowledge, in interstitial photodynamic therapy. The dosimetry software IDOSE provided dose plans, including optical fiber positions and light doses based on 3-D tissue models generated from ultrasound images. Tissue optical property measurements were obtained using the same fibers used for light delivery. Measurements were taken before, during, and after the treatment session. On the basis of these real-time measured optical properties, the light-dose plan was recalculated. The aim of the treatment was to ablate the entire prostate while minimizing exposure to surrounding organs. The results indicate that online dosimetry based on real-time tissue optical property measurements enabled the light dose to be adapted and optimized. However, histopathological analysis of tissue biopsies taken six months post-PDT treatment showed there were still residual viable cancer cells present in the prostate tissue sections. The authors propose that the incomplete treatment of the prostate tissue could be due to a too low light threshold dose, which was set to 5 J∕cm2.

Photodynamic therapy: superficial and interstitial illumination

Photodynamic therapy (PDT) is reviewed using the treatment of skin tumors as an example of superficial lesions and prostate cancer as an example of deep-lying lesions requiring interstitial intervention. These two applications are among the most commonly studied in oncological PDT, and illustrate well the different challenges facing the two modalities of PDT-superficial and interstitial. They thus serve as good examples to illustrate the entire field of PDT in oncology. PDT is discussed based on the Lund University group's over 20 yr of experience in the field. In particular, the interplay between optical diagnostics and dosimetry and the delivery of the therapeutic light dose are highlighted. An interactive multiple-fiber interstitial procedure to deliver the required therapeutic dose based on the assessment of light fluence rate and sensitizer concentration and oxygen level throughout the tumor is presented.

Head & neck optical diagnostics: vision of the future of surgery

Review paper and Proceedings of the Inaugural Meeting of the Head and Neck Optical Diagnostics Society (HNODS) on March 14th 2009 at University College London. The aim of our research must be to provide breakthrough translational research which can be applied clinically in the immediate rather than the near future. We are fortunate that this is indeed a possibility and may fundamentally change current clinical and surgical practice to improve our patients' lives.

Clinical system for non-invasive in situ monitoring of gases in the human paranasal sinuses

We present a portable system for non-invasive, simultaneous sensing of molecular oxygen (O(2)) and water vapor (H(2)O) in the human paranasal cavities. The system is based on high-resolution tunable diode laser spectroscopy (TDLAS) and digital wavelength modulation spectroscopy (dWMS). Since optical interference and non-ideal tuning of the diode lasers render signal processing complex, we focus on Fourier analysis of dWMS signals and procedures for removal of background signals. Clinical data are presented, and exhibit a significant improvement in signal-to-noise with respect to earlier work. The in situ detection limit, in terms of absorption fraction, is about 5x10(-5) for oxygen and 5x10(-4) for water vapor, but varies between patients due to differences in light attenuation. In addition, we discuss the use of water vapor as a reference in quantification of in situ oxygen concentration in detail. In particular, light propagation aspects are investigated by employing photon time-of-flight spectroscopy.

Towards accurate in vivo spectroscopy of the human prostate

The recent interest in photodynamic therapy of human prostate cancer is accompanied by a need for techniques for in vivo monitoring of optical and physiological characteristics. We propose time-of-flight (TOF) spectroscopy in combination with Monte Carlo evaluation as a reliable optical technique for quantitative assessment of absorption, scattering, hemoglobin content and tissue oxygenation in the human prostate. For the first time, we demonstrate Monte Carlo-based evaluation of in vivo TOF photon migration data. We show that this approach is crucial in order to avoid the large errors associated with the use of time-resolved diffusion theory of light propagation in prostate-like tissues. This progress also allows us to present the first in vivo scattering spectroscopy of human prostate tissue. Furthermore, TOF spectroscopy, in contrast to the more common steady-state approach, is insensitive to bleedings, and has been found highly reliable (100% success rate).

Diagnostics of Human Body Cavities Using Diode Laser Gas Spectroscopy

We have developed a technique to measure gas non-intrusive in scattering media, such as human tissue. The technique was first demonstrated for test samples in 2001 by our group and utilizes diode laser absorption spectroscopy to monitor molecular oxygen and water vapor. The focus of medical application has been on sinuses, both maxillary and frontal sinuses and the potential of the technique has been shown on volunteers. A spin-off company named GasPorOx AB has been formed with the aim to develop a product used to improve the diagnosis of the sinus infections. A portable fiber-guided system has been developed and is used in an ongoing initial clinical trial in collaboration with the Ear, Nose and Throat Clinic, the Oncology and Diagnostic radiology clinics at the Lund University Hospital.

Simultaneous detection of molecular oxygen and water vapor in the tissue optical window using tunable diode laser spectroscopy

We report on a dual-diode laser spectroscopic system for simultaneous detection of two gases. The technique is demonstrated by performing gas measurements on absorbing samples such as an air distance, and on absorbing and scattering porous samples such as human tissue. In the latter it is possible to derive the concentration of one gas by normalizing to a second gas of known concentration. This is possible if the scattering and absorption of the bulk material is equal or similar for the two wavelengths used, resulting in a common effective pathlength. Two pigtailed diode lasers are operated in a wavelength modulation scheme to detect molecular oxygen ~760 nm and water vapor ~935 nm within the tissue optical window (600 nm to 1.3 mum). Different modulation frequencies are used to distinguish between the two wavelengths. No crosstalk can be observed between the gas contents measured in the two gas channels. The system is made compact by using a computer board and performing software-based lock-in detection. The noise floor obtained corresponds to an absorption fraction of approximately 6x10(-5) for both oxygen and water vapor, yielding a minimum detection limit of ~2 mm for both gases in ambient air. The power of the technique is illustrated by the preliminary results of a clinical trial, nonintrusively investigating gas in human sinuses.

Tumor selectivity at short times following systemic administration of a liposomal temoporfin formulation in a murine tumor model

Meso-tetra(hydroxyphenyl)chlorin (mTHPC) (INN: Temoporfin) is one of the most potent photodynamically active substances in clinical use. Treatment protocols for Temoporfin-mediated photodynamic therapy often rely on drug-light intervals of several days in order for the photosensitizer to accumulate within the target tissue, though tumor selectivity is limited. Here, the mTHPC localization was studied at 2-8 h following systemic administration of a liposomal Temoporfin formulation (0.15 mg kg(-1) b.w.) in HT29 human colon adenocarcinoma in NMRI nu/nu mice. Photosensitizer distribution within tumor and internal organs was investigated by means of high performance liquid chromatography following chemical extraction, as well as in situ fluorescence imaging and point-monitoring fluorescence spectroscopy. For tumor tissue, the Temoporfin concentrations at 4 h (0.16+/-0.024 ng mg(-1)) and 8 h (0.18+/-0.064 ng mg(-1)) were significantly higher than at 2 h (0.08+/-0.026 ng mg(-1)). The average tumor-to-muscle and the tumor-to-skin selectivity were 6.6 and 2, respectively, and did not vary significantly with time after photosensitizer injection. In plasma, the Temoporfin concentration was low (0.07+/-0.07 ng mg(-1)) and showed no significant variation with time. Our results indicate a rapid biodistribution and clearance from the bloodstream. Within the same type of organ, data from both fluorescence methods generally exhibited a significant correlation with the extraction results.

Fluorescence monitoring of a topically applied liposomal Temoporfin formulation and photodynamic therapy of nonpigmented skin malignancies

Meso-tetra(hydroxyphenyl)chlorin (mTHPC) (INN: Temoporfin) is a potent photodynamically active substance in clinical use today. Usually, the substance is given systemically and a known drawback with this administration route is a prolonged skin light sensitization. For the first time to our knowledge, a liposomal Temoporfin gel formulation for topical application was studied in connection with photodynamic therapy (PDT) of nonpigmented skin malignancies in humans. Intervals of 4 hr between drug administration and light irradiation were used. Sensitizer distribution within tumor and surrounding normal skin was investigated by means of point monitoring and imaging fluorescence spectroscopy before, during, and after PDT, showing high tumor selectivity. Furthermore, the bleaching of Temoporfin was studied during the PDT procedure by monitoring the fluorescence following excitation by using a therapeutic light. A 30-35% light-induced photometabolization was shown. No pain occurred during or after treatment. It was also observed that the treated area did not show any swollen tissue or reddening, as is often seen in PDT using topical delta-aminolevulinic acid. On controlling the patients one week after treatment, healing progress was observed in several patients and no complications were registered.

Gas monitoring in human sinuses using tunable diode laser spectroscopy

We demonstrate a novel nonintrusive technique based on tunable diode laser absorption spectroscopy to investigate human sinuses in vivo. The technique relies on the fact that free gases have spectral imprints that are about 10.000 times sharper than spectral structures of the surrounding tissue. Two gases are detected; molecular oxygen at 760 nm and water vapor at 935 nm. Light is launched fiber optically into the tissue in close proximity to the particular maxillary sinus under study. When investigating the frontal sinuses, the fiber is positioned onto the caudal part of the frontal bone. Multiply scattered light in both cases is detected externally by a handheld probe. Molecular oxygen is detected in the maxillary sinuses on 11 volunteers, of which one had constantly recurring sinus problems. Significant oxygen absorption imprint differences can be observed between different volunteers and also left-right asymmetries. Water vapor can also be detected, and by normalizing the oxygen signal on the water vapor signal, the sinus oxygen concentration can be assessed. Gas exchange between the sinuses and the nasal cavity is also successfully demonstrated by flushing nitrogen through the nostril. Advantages over current ventilation assessment methods using ionizing radiation are pointed out.

Fluorescence and absorption assessment of a lipid mTHPC formulation following topical application in a non-melanotic skin tumor model

Although the benefits of topical sensitizer administration have been confirmed for photodynamic therapy (PDT), ALA-induced protoporphyrin IX is the only sensitizer clinically used with this administration route. Unfortunately, ALA-PDT results in poor treatment response for thicker lesions. Here, selectivity and depth distribution of the highly potent sensitizer meso-tetra(hydroxyphenyl)chlorin (mTHPC), supplied in a novel liposome formulation was investigated following topical administration for 4 and 6 h in a murine skin tumor model. Extraction data indicated an average [+/- standard deviation (SD)] mTHPC concentration within lesions of 6.0(+/-3.1) ngmg tissue with no significant difference (p<0.05) between 4- and 6-h application times and undetectable levels of generalized photosensitivity. Absorption spectroscopy and chemical extraction both indicated a significant selectivity between lesion and normal surrounding skin at 4 and 6 h, whereas the more sensitive fluorescence imaging setup revealed significant selectivity only for the 4-h application time. Absorption data showed a significant correlation with extraction, whereas the results from the fluorescence imaging setup did not correlate with the other methods. Our results indicate that this sensitizer formulation and administration path could be interesting for topical mTHPC-PDT, decreasing the effects of extended skin photosensitivity associated with systemic mTHPC administration.

In vivo optical characterization of human prostate tissue using near-infrared time-resolved spectroscopy

The development of photodynamic therapy into a modality for treatment of prostate cancer calls for reliable optical dosimetry. We employ, for the first time, interstitial time-resolved spectroscopy to determine in vivo optical properties of human prostate tissue. Nine patients are included in the study, and measurements are conducted prior to primary brachytherapy treatment of prostate cancer. Intrasubject variability is examined by measuring across three tissue volumes within each prostate. The time-resolved instrumentation proves its usefulness by producing good signal levels in all measurements. We are able to present consistent values on reduced scattering coefficients (mu(s)'), absorption coefficients (mu(a)), and effective attenuation (mu(eff)) at the wavelengths 660, 786, and 916 nm. At 660 nm, mu(s)' is found to be 9+/-2 cm(-1), and mu(a) is 0.5+/-0.1 cm(-1). Derived values of mu(eff) are in the range of 3 to 4 cm(-1) at 660 nm, a result in good agreement with previously published steady state data. Total hemoglobin concentration (THC) and oxygen saturation are spectroscopically determined using derived absorption coefficients. Derived THC values are fairly variable (215+/-65 microM), while derived values of oxygen saturation are gathered around 75% (76+/-4%). Intrasubject variations in derived parameters correlate (qualitatively) with the heterogeneity exhibited in acquired ultrasound images.