Diabetic foot ulceration is a major complication of diabetes and afflicts as many as 15 to 25% of type 1 and 2 diabetes patients during their lifetime. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Early identification of tissue at risk of ulcerating could enable proper preventive care, thereby reducing the incidence of foot ulceration. Furthermore, noninvasive assessment of tissue viability around already formed ulcers could inform the diabetes caregiver about the severity of the wound and help assess the need for amputation. This article reviews how hyperspectral imaging between 450 and 700 nm can be used to assess the risk of diabetic foot ulcer development and to predict the likelihood of healing noninvasively. Two methods are described to analyze the in vivo hyperspectral measurements. The first method is based on the modified Beer-Lambert law and produces a map of oxyhemoglobin and deoxyhemoglobin concentrations in the dermis of the foot. The second is based on a two-layer optical model of skin and can retrieve not only oxyhemoglobin and deoxyhemoglobin concentrations but also epidermal thickness and melanin concentration along with skin scattering properties. It can detect changes in the diabetic foot and help predict and understand ulceration mechanisms
Abstract. Foot ulceration remains a serious health concern for diabetic patients and has a major impact on the cost of diabetes treatment. Early detection and preventive care, such as offloading or improved hygiene, can greatly reduce the risk of further complications. We aim to assess the use of hyperspectral tissue oximetry in predicting the risk of diabetic foot ulcer formation. Tissue oximetry measurements are performed during several visits with hyperspectral imaging of the feet in type 1 and 2 diabetes mellitus subjects that are at risk for foot ulceration. The data are retrospectively analyzed at 21 sites that ulcerated during the course of our study and an ulceration prediction index is developed. Then, an image processing algorithm based on this index is implemented. This algorithm is able to predict tissue at risk of ulceration with a sensitivity and specificity of 95 and 80%, respectively, for images taken, on average, 58 days before tissue damage is apparent to the naked eye. Receiver operating characteristic analysis is also performed to give a range of sensitivity/specificity values resulting in a Q-value of 89%. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).
This paper presents computationally efficient and accurate semi-empirical models of light transfer for real-time diffuse reflectance spectroscopy. The models predict the diffuse reflectance of both (i) semi-infinite homogeneous and (ii) two-layer media exposed to normal and collimated light. The two-layer medium consisted of a plane-parallel slab of finite thickness over a semi-infinite layer with identical index of refraction but different absorption and scattering properties. The model accounted for absorption and anisotropic scattering as well as for internal reflection at the medium/air interface. All media were assumed to be non-emitting, strongly forward scattering, with index of refraction between 1.0 and 1.44 and transport single scattering albedo between 0.50 and 0.99. First, simple analytical expressions for the diffuse reflectance of the semi-infinite and two-layer media considered were derived using the two-flux approximation. Then, parameters appearing in the analytical expression previously derived were instead fitted to match results from more accurate Monte Carlo simulations. A single semi-empirical parameter was sufficient to relate the diffuse reflectance to the radiative properties and thickness of the semi-infinite and two-layer media. The present model can be used for a wide range of applications including non-invasive diagnosis of biological tissue.1
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