Effective burn wound management is informed by accurate severity assessment. Superficial partial-thickness burns do not require surgical intervention, while deep partial-thickness and full-thickness burn wounds necessitate skin grafting to minimize infection, contraction, and hypertrophic scarring. Visual-tactile wound assessment is subjective and error-prone, especially for inexperienced practitioners. A field- and hospital-deployable device, capable of quantifying both extent and severity of burns, could enable rapid, objective burn severity measurement with commensurate improvement in patient outcomes. Our group has previously shown that spatial frequency domain imaging (SFDI), a non-invasive, wide-field optical imaging technique, can accurately assess burn wound in a porcine model of controlled, graded burn severity[1, 2]. The device employed (OxImager RS) eight modulated wavelengths and five spatial frequencies and the classification of severity relies heavily on reduced scattering coefficient (tissue microstructure)[3]. In the work that we present here, we demonstrate the burn severity prediction performance of a dramatically streamlined version of SFDI that employs a single modulated wavelength in addition to five unmodulated wavelengths. This device, known as Clarifi (Modulim, Irvine CA), is currently in refinement for ruggedization and usability for a variety of situations in which the environment is more demanding than hospital clinics. In addition, we have developed a machine learning model capable of categorizing burn severity in a porcine model of graded burns using a reduced dataset of unprocessed calibrated reflectance images generated by the device. Outputs of the model are designed to be easily interpretable and clinically actionable, exhibiting a pixelwise cross-validation accuracy of up to 99%.
Frequency domain (FD) diffuse optical spectroscopy (DOS) can be used to recover absolute optical properties of biological tissue, providing valuable clinical feedback, including in diagnosis and monitoring of breast tumours. In this study, tomographic (3D) and topographic (2D) techniques for spatially-varying optical parameter recovery are presented, based on a multi-distance, handheld DOS probe. Processing pipelines and reconstruction quality are discussed and quantitatively compared, demonstrating the trade-offs between depth sensitivity, optical contrast, and computational speed. Together, the two techniques provide both depth sensitive real-time feedback, and high-resolution 3D reconstruction from a single set of measurements, enabling faster and more accurate clinical feedback.
Significance: Noninvasive diffuse optical spectroscopy (DOS) is a promising adjunct diagnostic imaging technique for distinguishing benign and malignant breast lesions. Most DOS approaches require normalizing lesion biomarkers to healthy tissue since major tissue constituents exhibit large interpatient variations. However, absolute optical biomarkers are desirable as it avoids reference measurements which may be difficult or impractical to acquire.
Aim: Our goal is to determine whether absolute measurements of minor absorbers such as collagen and methemoglobin (metHb) can successfully distinguish lesions. We hypothesize that metHb would exhibit less interpatient variability and be more suitable as an absolute metric for malignancy. However, we would expect collagen to exhibit more variability, because unlike metHb, collagen is also present in the healthy tissue.
Approach: In this retrospective clinical study, 30 lesions with breast imaging reporting and database system score ( BIRADS ) > = 3 (12 benign and 18 malignant) measured with broadband quantitative DOS were analyzed for their oxyhemoglobin (HbO), deoxyhemoglobin (HHb), water, lipids, collagen, metHb concentrations, and optical scattering characteristics. Wilcoxon rank sum test was used to compare benign and malignant lesions for all variables in both normalized and absolute forms.
Results: Among all absolute DOS parameters considered, only absolute metHb was observed to be significant for lesion discrimination (0.43 ± 0.18 μM for benign versus 0.87 ± 0.32 μM for malignant, p = 0.0002). Absolute metHb concentration was also determined to be the best predictor of malignancy with an area under the curve of 0.89.
Conclusions: Our findings demonstrate that lesion metHb concentration measured by DOS can improve noninvasive optical diagnosis of breast malignancies. Since metHb concentration found in normal breast tissue is extremely low, metHb may be a more direct indicator of malignancy that does not depend on other biomarkers found in healthy tissue with significant variability. Furthermore, absolute parameters require reduced measurement time and can be utilized in cases where healthy reference tissue is not available.
Noninvasive diffuse optical spectroscopy (DOS) is promising as an adjunct diagnostic imaging technique for distinguishing benign and malignant breast lesions. However, most DOS approaches require normalizing lesion optical biomarkers to healthy values in reference tissue since major tissue constituents exhibit large inter-patient variations. Our goal is to determine whether absolute measurements of minor optical absorbers such as collagen and methemoglobin (metHb) can successfully distinguish benign and malignant breast lesions. In this retrospective clinical study, 30 lesions with BIRADS score >= 3 (12 benign and 18 malignant lesions from 28 subjects) measured with broadband quantitative DOS were analyzed for their oxy-, deoxy- hemoglobin, water, lipids, collagen, and metHb concentrations as well as their optical scattering characteristics. Amongst all absolute DOS parameters (i.e., without normalization to healthy tissue) considered, only absolute metHb was observed to be significant for lesion discrimination (0.43±0.18 μM for benign vs 0.87±0.32 μM for malignant, p = 0.0002). Our findings demonstrate that lesion metHb concentration measured by quantitative DOS can improve noninvasive optical diagnosis of breast malignancies.
Reflectance-based, handheld diffuse optical tomography (DOT) uses multi-spectral frequency-domain (FD) and/or continuous-wave (CW) discrete wavelength sources. During DOT reconstruction, spectral constraints are commonly applied assuming a limited number of chromophores in the tissue in order to more accurately recover chromophore concentrations and scattering parameters. However, there are cases where spectral recovery cannot be applied, such as for the quantification of unknown tissue absorbers, where the chromophore extinction spectra are not known a priori. Therefore, we have worked toward a hyperspectral, hybrid FD and CW-DOT approach that can accurately recover tissue absorption and scattering spectra without needing a spectral constraint. Our approach increases the number of recoverable chromophores continuously across a 650 - 1050 nm spectrum. We have implemented and evaluated this technique in a prototype handheld probe for reflectance-mode breast imaging. Currently, no handheld portable DOT probe has this broadband hyperspectral capability. We simulated the accuracy of optical property recovery, showing that hybrid DOT successfully recovers the absorption spectra with average of 10% error across 650 − 1000 nm spectrum. We have also validated this technique by successfully imaging an inhomogeneous physical phantom with optical properties mimicking breast tissue. The methodology for the probe design along with the results of simulations and phantom studies are presented.
Despite numerous advances, malaria continues to kill nearly half a million people globally every year. New analytical methods and diagnostics are critical to understanding how treatments under development affect the lifecycle of malaria parasites. A biomarker that has been gaining interest is the "malaria pigment" hemozoin. This byproduct of hemoglobin digestion by the parasite has a unique spectral signature but is difficult to differentiate from hemoglobin and other tissue chromophores. Hemozoin can be detected in blood samples, but only utilizing approaches that require specialized training and facilities.
Diffuse optical spectroscopy (DOS) is a noninvasive sensing technique that is sensitive to near-infrared absorption and scattering and capable of probing centimeter-deep volumes of tissue in vivo. DOS is relatively low-cost, does not require specialized training and thus potentially suitable for use in low-resource settings. In this work, we assess the potential of DOS to detect and quantify the presence of hemozoin noninvasively and at physiologically relevant levels. We suspended synthetic hemozoin in Intralipid-based tissue-simulating phantoms in order to mimic malaria infection in multiply-scattering tissue. Using a fiber probe that combines frequency-domain and continuous-wave broadband DOS (650-1000 nm), we detected hemozoin concentrations below 250 ng/ml, which corresponds to parasitemia sensitivities comparable to modern rapid diagnostic tests. We used the experimental variability to simulate and estimate the sensitivity of DOS to hemozoin in tissue that includes hemoglobin, water, and lipid under various tissue oxygen saturation levels. The results indicate that with increased precision, it may be possible to detect Hz noninvasively with DOS.
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