Optimization of fluorescent imaging in the operating room through pulsed acquisition and gating to ambient background cycling

Sexton, Kristian J.; Zhao, Yan; Davis, Scott C.; Jiang, Shudong; Pogue, Brian W.

doi:10.1364/boe.8.002635

Cited by 17 publications

(16 citation statements)

References 22 publications

(27 reference statements)

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“…To obtain quantifiable imaging information, a controlled environment using a closed-field fluorescence imaging device is needed, which requires an ex vivo setting (20). Currently, some open-field systems are able to suppress a significant amount of ambient light by synchronizing the acquisition to the 120 Hz of room light with pulsed LED excitation (25). Furthermore, to be widely applicable, software adaptations have to allow the camera to accommodate in a wide range of signal intensities and distances.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer

et al. 2019

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Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that realtime fluorescence imaging can enhance intraoperative decision making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision making. Methods: Head and neck cancer patients (n 5 14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision making in 3 cases (21.4%): identification of a close margin (n 5 1) and unanticipated regions of primary disease (n 5 2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision making during resection of primary tumors.

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Section: Discussionmentioning

confidence: 99%

The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer

et al. 2019

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“…Our results suggest that TCSPC acquisitions at 50 Hz are possible and virtually background‐free, while providing sufficient photons to accurately characterize the fluorescence intensity decay. We opted to realize acquisitions at 50 Hz for two reasons: (a) this frequency is sufficiently high to avoid the stroboscopic effect of a blinking source and thus the sample will appear to be under continuous and constant illumination to the naked eye; (b) 50 Hz is the alternating current frequency in most countries and an alternative strategy to the bright LED‐based illumination could comprise using a photodiode to detect periodic variations in room light intensity and trigger the TCSPC acquisition when the intensity is found below a pre‐defined threshold . This strategy will require only minor modifications in our setup and thus its feasibility and viability will be subject of future investigations.…”

Section: Discussionmentioning

confidence: 99%

Real‐time fiber‐based fluorescence lifetime imaging with synchronous external illumination: A new path for clinical translation

Lagarto

Shcheslavskiy

Pavone

et al. 2019

Journal of Biophotonics

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Time‐correlated single photon counting is the “gold‐standard” method for fluorescence lifetime measurements and has demonstrated potential for clinical deployment. However, the translation of the technology into clinic is hindered by the use of ultrasensitive detectors, which make the fluorescence acquisition impractical with bright lighting conditions such as in clinical settings. We address this limitation by interleaving periodic fluorescence detection with synchronous out‐of‐phase externally modulated light source, thus guaranteeing specimen illumination and a fluorescence signal free from bright background light upon temporal separation. Fluorescence lifetime maps are generated in real‐time from single‐point measurements by tracking a reference beam and using the phasor approach. We demonstrate the feasibility and practicality of this technique in a number of biological specimens, including real‐time mapping of degraded articular cartilage. This method is compatible and can be integrated with existing clinical microscopic, endoscopic and robotic modalities, thus offering a new pathway towards label‐free diagnostics and surgical guidance in a number of clinical applications.

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“…2c–f ). These decreases in speckle contrast are to be expected since room/OR lights have a broad frequency spectrum 26 and therefore do not produce a speckle pattern. The uniform lighting fills in dark spots in the speckle pattern generated by the laser, thereby reducing the contrast.…”

Section: Resultsmentioning

confidence: 86%

Intraoperative Assessment of Parathyroid Viability using Laser Speckle Contrast Imaging

Mannoh

Thomas

Solórzano

et al. 2017

Sci Rep

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Post-surgical hypoparathyroidism and hypocalcemia are known to occur after nearly 50% of all thyroid surgeries as a result of accidental disruption of blood supply to healthy parathyroid glands, which are responsible for regulating calcium. However, there are currently no clinical methods for accurately identifying compromised glands and the surgeon relies on visual assessment alone to determine if any gland(s) should be excised and auto-transplanted. Here, we present Laser Speckle Contrast Imaging (LSCI) for real-time assessment of parathyroid viability. Taking an experienced surgeon’s visual assessment as the gold standard, LSCI can be used to distinguish between well vascularized (n = 32) and compromised (n = 27) parathyroid glands during thyroid surgery with an accuracy of 91.5%. Ability to detect vascular compromise with LSCI was validated in parathyroidectomies. Results showed that this technique is able to detect parathyroid gland devascularization before it is visually apparent to the surgeon. Measurements can be performed in real-time and without the need to turn off operating room lights. LSCI shows promise as a real-time, contrast-free, objective method for helping reduce hypoparathyroidism after thyroid surgery.

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Optimization of fluorescent imaging in the operating room through pulsed acquisition and gating to ambient background cycling

Cited by 17 publications

References 22 publications

The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer

The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer

Real‐time fiber‐based fluorescence lifetime imaging with synchronous external illumination: A new path for clinical translation

Intraoperative Assessment of Parathyroid Viability using Laser Speckle Contrast Imaging

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