Development of a portable imager for intraoperative real-time localization of parathyroid glands

Oh, Eugene; Kim, Wan Wook; Nam, So‐Hyun; Cheon, Gyeong Woo; Ning, Bo; Cha, Jaepyeong

doi:10.1117/12.2546250

Cited by 3 publications

(8 citation statements)

References 9 publications

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“…For this qualitative study, we interpreted the color of the vasculature or PGs according to a color map with quantification of blue (0–64), yellow to green (65–128), and green to red (129–255); red and green colors were deemed as well‐perfused vasculature and tissue, respectively, and blue was deemed as poorly perfused or devascularized. In a previous study, 23 we validated the false colors in a preclinical ischemic kidney model by ligating renal artery and vein. Although a detection threshold was not established in this study involving four patients due to the assessment of relative flow rates, we hope to further calibrate the absolute flow rates with known microfluidic channel systems described in our previous paper 28 …”

Section: Discussionmentioning

confidence: 99%

“…As reported in our recent paper, 23 our in‐house portable hand‐held imager is equipped with two cameras for visible and NIR spectral ranges (Figure 1). The beam splitter/dichroic filter in the imager splits light into red–green–blue (RGB) and NIR images.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, the on‐board software processes the data and displays a dual image consisting of RGB and NIR components on a 4k Ultrahigh‐Definition Screen intraoperatively. Mode 1 in this system permits label‐free, noninvasive localization of PGs using NIRAF, and Mode 2 enables continuous visualization of the vasculature and viability assessment of PG tissue using real‐time dye‐free angiography using an 830 nm laser source 23 . Intraoperatively, an operator held the imager approximately 20–30 cm from the surgical field (FOV: 50 mm diameter, working distance: 30 cm) and imaging was performed with the surgical lights on.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, no standardized or practical equipment is accessible for surgeons to conveniently locate and assess the viability of PGs intraoperatively in real‐time. We recently developed and introduced a real‐time, portable hand‐held imager to localize and assess the viability of PGs intraoperatively, and proved its efficacy in preclinical studies 23 . The fundamental operation utilizes the same laser speckle contrast analysis method.…”

Section: Introductionmentioning

confidence: 99%

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A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand‐held imager

Lee

Kim

et al. 2021

Lasers Surg Med

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Objectives Intraoperative localization and preservation of parathyroid glands (PGs) are challenging during thyroid surgery. A new noninvasive technique of combined near‐infrared PG autofluorescence detection and dye‐free imaging angiography that allows intraoperative feedback has recently been introduced. The objective of this study was to evaluate this technique in real‐time. Materials and Methods A pilot feasibility study of a portable imaging device in four patients who underwent either thyroid lobectomy or total thyroidectomy is presented. PG autofluorescence and vascularity/tissue perfusion were monitored using a real‐time screen display during the surgical procedure. Results Three lobectomies and one total thyroidectomy were performed. Among the nine PGs identified by the operating surgeon, eight PGs were confirmed using the autofluorescence device. Each PG was successfully determined to be either well‐perfused or devascularized, and devascularized PGs were autotransplanted. Conclusions The preliminary results suggest that the combination of PG autofluorescence detection and dye‐free angiography can potentially be used to assess PG function. With further validation studies, the effectiveness of this technique in clinical practice can be further delineated.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand‐held imager

Lee

Kim

et al. 2021

Lasers Surg Med

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“…Nevertheless, LSCI is also highly promising because it can be performed simultaneously with NIRAF imaging and work is already underway to develop clinical devices utilizing both techniques (54)(55)(56). Specific points for consideration and discussion on discrepancies between LSCI and surgeon assessment can be found in the Supplementary Discussion section in the Supplementary Data.…”

Section: Parathyroid Assessment With Laser Speckle Imagingmentioning

confidence: 99%

Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes

Mannoh

Thomas

Baregamian

et al. 2021

Thyroid

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Background: Accurate assessment of parathyroid gland vascularity is important during thyroidectomy to preserve the function of parathyroid glands and to prevent postoperative hypocalcemia. Laser speckle contrast imaging (LSCI) has been shown to be accurate in detecting differences in parathyroid vascularity. In this surgeon-blinded prognostic study, we evaluate the relationship between intraoperative LSCI measurements and postoperative outcomes of total thyroidectomy patients. Methods: Seventy-two thyroidectomy patients were included in this study. After thyroid resection, an LSCI device was used to image all parathyroid glands identified, and a speckle contrast value was calculated for each. An average value was calculated for each patient, and the data were grouped according to whether the patient had normal (16-77 pg/mL) or low levels of parathyroid hormone (PTH) measured on postoperative day 1 (POD1). The aim of this study was to establish a speckle contrast threshold for classifying a parathyroid gland as adequately perfused and to determine how many such glands are required for normal postoperative parathyroid function. Results: A speckle contrast limit of 0.186 separated the normoparathyroid and hypoparathyroid groups with 87.5% sensitivity and 84.4% specificity: 7 of 8 patients with low PTH on POD1 had an average parathyroid speckle contrast above this limit, while 54 of 64 patients with normal postoperative PTH had an average parathyroid speckle contrast below this limit. Taking this value as the threshold for adequate parathyroid perfusion, it was determined that only one vascularized gland was needed for normal postoperative parathyroid function: 64 of 69 patients (92.8%) with at least one vascularized gland (determined by LSCI) had normal postoperative PTH, while all 3 patients (100%) with no vascularized glands had low postoperative PTH. Overall, the rates of temporary and permanent hypoparathyroidism in this study were 8.3% and 1.4%, respectively. Conclusions: LSCI is a promising technique for assessing parathyroid gland vascularity. It has the potential to help reduce the incidence of hypocalcemia after thyroidectomy by providing surgeons with additional information during surgery to aid in the preservation of parathyroid function.

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Smartphone-Based Rigid Endoscopy Device with Hemodynamic Response Imaging and Laser Speckle Contrast Imaging

Kim

Choi

et al. 2023

Biosensors

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Modern smartphones have been employed as key elements in point-of-care (POC) devices due to remarkable advances in their form factor, computing, and display performances. Recently, we reported a combination of the smartphone with a handheld endoscope using laser speckle contrast imaging (LSCI), suggesting potential for functional POC endoscopy. Here, we extended our work to develop a smartphone-combined multifunctional handheld endoscope using dual-wavelength LSCI. Dual-wavelength LSCI is used to monitor the changes in dynamic blood flow as well as changes in the concentration of oxygenated (HbO2), deoxygenated (Hbr), and total hemoglobin (HbT). The smartphone in the device performs fast acquisition and computation of the raw LSCI data to map the blood perfusion parameters. The flow imaging performance of the proposed device was tested with a tissue-like flow phantom, exhibiting a speckle flow index map representing the blood perfusion. Furthermore, the device was employed to assess the blood perfusion status from an exteriorized intestine model of rat in vivo during and after local ischemia, showing that blood flow and HbO2 gradually decreased in the ischemic region whereas hyperemia and excess increases in HbO2 were observed in the same region right after reperfusion. The results indicate that the combination of LSCI with smartphone endoscopy delivers a valuable platform for better understanding of the functional hemodynamic changes in the vasculatures of the internal organs, which may benefit POC testing for diagnosis and treatment of vascular diseases.

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Development of a portable imager for intraoperative real-time localization of parathyroid glands

Cited by 3 publications

References 9 publications

A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand‐held imager

A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand‐held imager

Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes

Smartphone-Based Rigid Endoscopy Device with Hemodynamic Response Imaging and Laser Speckle Contrast Imaging

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