Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping

Mondal, Suman B.; Gao, Shengkui; Zhu, Nan; Sudlow, Gail; Liang, Kexian; Som, Avik; Akers, Walter J.; Fields, Ryan C.; Margenthaler, Julie A.; Liang, Rongguang; Gruev, Viktor; Achilefu, Samuel

doi:10.1038/srep12117

Cited by 54 publications

(57 citation statements)

References 41 publications

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“…Thirty-three of the 45 articles (73%) describing the use of HMDs were primary research articles, 19 of which were exploratory studies carried out in clinical settings 47 49 51 52 55–58 65 66 69 71 80 81 83–87. Device design and methodology varied significantly across these studies, but the results overall demonstrated the feasibility of HMDs in the various specified clinical environments.…”

Section: Resultsmentioning

confidence: 99%

Wearable technology in the operating room: a systematic review

et al. 2016

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Wearable technology is an emerging manifestation of consumer electronics that has the potential to revolutionise healthcare. The novel hands-free design and clinically relevant functionalities of various wearable devices hold significant promise for surgery, but the breadth and quality of evidence supporting clinical implementation in the operating room remains unclear. The objective of this article is to provide an objective overview of the available literature regarding the use of wearable technology in surgery, both in clinical and simulated experimental settings. A systematic review examining the use of wearable technology in surgery was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using the MEDLINE and Web of Science databases from inception through 15 January 2016. Three authors independently screened the titles and abstracts of the retrieved articles and those that satisfied the defined inclusion criteria were selected for a full-text review. A total of 87 publications were included in this review. These articles predominantly described the use of Google Glass, GoPro or customised head-mounted displays (HMDs) in a wide range of intraoperative clinical settings. The included articles were categorised based on the highlighted areas of clinical impact, with the majority (56) discussing various applications for enhancing intraoperative safety and efficiency. Almost all articles cited technological limitations and privacy concerns as serious barriers to the implementation of wearable technology in the operating room. Evidence in the available literature regarding the use of wearable technology in the operating room shows promise, but high-quality clinical trials are needed to fully understand their clinical impact. Further, it will be essential to address existing technological limitations, develop healthcare-specific applications, and integrate privacy-protecting safeguards before it may be feasible for wearable devices to seamlessly integrate into the operative environment.

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Section: Resultsmentioning

confidence: 99%

Wearable technology in the operating room: a systematic review

et al. 2016

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“…3). Using the tumor-specific NIRF marker LS301 (a cypate-based contrast agent that typically accumulates in the periphery of tumors [28]), we obtained high target-to-background contrast images due to the tissue’s low auto-fluorescence, low scattering, and absorption in the 700 to 950 nm spectral bands. The images in Figs.…”

Section: Resultsmentioning

confidence: 99%

Bio-inspired imager improves sensitivity in near-infrared fluorescence image-guided surgery

Garcia

Edmiston

York

et al. 2018

Optica

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Image-guided surgery can enhance cancer treatment by decreasing, and ideally eliminating, positive tumor margins and iatrogenic damage to healthy tissue. Current state-of-the-art near-infrared fluorescence imaging systems are bulky and costly, lack sensitivity under surgical illumination, and lack co-registration accuracy between multimodal images. As a result, an overwhelming majority of physicians still rely on their unaided eyes and palpation as the primary sensing modalities for distinguishing cancerous from healthy tissue. Here we introduce an innovative design, comprising an artificial multispectral sensor inspired by the Morpho butterfly’s compound eye, which can significantly improve image-guided surgery. By monolithically integrating spectral tapetal filters with photodetectors, we have realized a single-chip multispectral imager with 1000 × higher sensitivity and 7 × better spatial co-registration accuracy compared to clinical imaging systems in current use. Preclinical and clinical data demonstrate that this technology seamlessly integrates into the surgical workflow while providing surgeons with real-time information on the location of cancerous tissue and sentinel lymph nodes. Due to its low manufacturing cost, our bio-inspired sensor will provide resource-limited hospitals with much-needed technology to enable more accurate value-based health care.

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“…Additionally, the strict regulatory hurdles prevent the use of radioisotopes in some surgical centers. Although blue dyes can overcome some of these limitations, tissue autofluorescence and shallow penetration of visible light in tissue preclude visualizing deep-seated lymph nodes 8 . These dyes also pose the risk of anaphylactic reactions in 1–3% of patients 9 .…”

mentioning

confidence: 99%

“…We previously developed a goggle augmented imaging and navigation system (GAINS) 8 for real-time NIR FGS that allowed accurate tumor resection in mouse models of cancer and enabled SLN visualization in human breast cancer and melanoma patients with high sensitivity. GAINS detects both anatomic color reflectance and NIR fluorescence from contrast agents, displaying accurately aligned superimposed color-NIR images via a head-mounted display (HMD) worn by the surgeon 8 .…”

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confidence: 99%

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Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided Oncologic Surgery

et al. 2017

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Background The inability to directly visualize the patient and surgical site limits the use of current near infrared fluorescence-guided surgery systems for real-time sentinel lymph node biopsy and tumor margin assessment. Methods We evaluated an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared fluorescence-guided surgery. Tumor-bearing mice injected with a near infrared cancer-targeting agent underwent fluorescence-guided tumor resection. Female Yorkshire pigs received hind leg intradermal indocyanine green injection and underwent fluorescence-guided popliteal lymph node resection. Four breast cancer patients received 99mTc-sulfur colloid and indocyanine green retroareolarly, before undergoing sentinel lymph node biopsy using radioactive tracking and fluorescence imaging. Three other breast cancer patients received indocyanine green retroareolarly before undergoing standard-of-care partial mastectomy, followed by fluorescence imaging of resected tumor and tumor cavity for margin assessment. Results Using near-infrared fluorescence from the dyes, the optical see-through GAINS accurately identified all mouse tumors, pig lymphatics, and 4 pig popliteal lymph nodes with high signal-to-background ratio. In 4 human breast cancer patients, 11 sentinel lymph nodes were identified with a detection sensitivity of 86.67± 0.27% for radioactive tracking and 100% for GAINS. Tumor margin status was accurately predicted by GAINS in all three patients, including clear margins in patients 1 and 2 and positive margins in patient 3 as confirmed by paraffin embedded section histopathology. Conclusions The optical see-through GAINS prototype enhances near infrared fluorescence-guided surgery for sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting the surgical workflow in the operating room.

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Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping

Cited by 54 publications

References 41 publications

Wearable technology in the operating room: a systematic review

Wearable technology in the operating room: a systematic review

Bio-inspired imager improves sensitivity in near-infrared fluorescence image-guided surgery

Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided Oncologic Surgery

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