Rebecca A. Rowland

Quantitative short-wave infrared multispectral imaging of in vivo tissue optical properties

Extending the wavelength range of spatial frequency domain imaging (SFDI) into the short-wave infrared (SWIR) has the potential to provide enhanced sensitivity to chromophores such as water and lipids that have prominent absorption features in the SWIR region. Here, we present, for the first time, a method combining SFDI with unstructured (zero spatial frequency) illumination to extract tissue absorption and scattering properties over a wavelength range (850 to 1800 nm) largely unexplored by previous tissue optics techniques. To obtain images over this wavelength range, we employ a SWIR camera in conjunction with an SFDI system. We use SFDI to obtain in vivo tissue reduced scattering coefficients at the wavelengths from 850 to 1050 nm, and then use unstructured wide-field illumination and an extrapolated power-law fit to this scattering spectrum to extract the absorption spectrum from 850 to 1800 nm. Our proof-of-principle experiment in a rat burn model illustrates that the combination of multispectral SWIR imaging, SFDI, and unstructured illumination can characterize in vivo changes in skin optical properties over a greatly expanded wavelength range. In the rat burn experiment, these changes (relative to normal, unburned skin) included increased absorption and increased scattering amplitude and slope, consistent with changes that we previously reported in the near-infrared using SFDI.

Quantitative long-term measurements of burns in a rat model using Spatial Frequency Domain Imaging (SFDI) and Laser Speckle Imaging (LSI): MEASUREMENTS OF BURNS IN A RAT MODEL

The current standard for diagnosis of burn severity and subsequent wound healing is through clinical examination, which is highly subjective. Several new technologies are shifting focus to burn care in an attempt to help quantify not only burn depth but also the progress of healing. While accurate early assessment of partial thickness burns is critical for dictating the course of treatment, the ability to quantitatively monitor wound status over time is critical for understanding treatment efficacy. SFDI and LSI are both non‐invasive imaging modalities that have been shown to have great diagnostic value for burn severity, but have yet to be tested over the course of wound healing.

Low-cost tissue simulating phantoms with adjustable wavelength-dependent scattering properties in the visible and infrared ranges

We present a method for low-cost fabrication of polydimethylsiloxane (PDMS) tissue simulating phantoms with tunable scattering spectra, spanning visible, and near-infrared regimes. These phantoms use optical polishing agents (aluminum oxide powders) at various grit sizes to approximate in vivo tissue scattering particles across multiple size distributions (range: 17 to 3  μm). This class of tunable scattering phantoms is used to mimic distinct changes in wavelength-dependent scattering properties observed in tissue pathologies such as partial thickness burns. Described by a power-law dependence on wavelength, the scattering magnitude of these phantoms scale linearly with particle concentration over a physiologic range [μs′=(0.5 to 2.0  mm−1)] whereas the scattering spectra, specific to each particle size distribution, correlate to distinct exponential coefficients (range: 0.007 to 0.32). Aluminum oxide powders used in this investigation did not detectably contribute to the absorption properties of these phantoms. The optical properties of these phantoms are verified through inverse adding-doubling methods and the tolerances of this fabrication method are discussed.

Assessing the predictive capability of optical imaging techniques, Spatial Frequency Domain Imaging (SFDI) and Laser Speckle Imaging (LSI), to the gold standard of clinical assessment in a controlled animal model

The current standard for assessment of burn severity and subsequent wound healing is through clinical examination, which is highly subjective. Accurate early assessment of burn severity is critical for dictating the course of wound management. Complicating matters is the fact that burn wounds are often large and can have multiple regions that vary in severity. In order to manage the treatment more effectively, a tool that can provide spatially resolved information related to mapping burn severity could aid clinicians when making decisions. Several new technologies focus on burn care in an attempt to help clinicians objectively determine burn severity. By quantifying perfusion, laser speckle imaging (LSI) has had success in categorizing burn wound severity at earlier time points than clinical assessment alone. Additionally, spatial frequency domain imaging (SFDI) is a new technique that can quantify the tissue structural damage associated with burns to achieve earlier categorization of burn severity. Here we compared the performance of a commercial LSI device (PeriCam PSI, Perimed Inc.), a SFDI device (Reflect RSTM, Modulated Imaging Inc.) and conventional clinical assessment in a controlled (porcine) model of graded burn wound severity over the course of 28 days. Specifically we focused on the ability of each system to predict the spatial heterogeneity of the healed wound at 28 days, based on the images at an early time point. Spatial heterogeneity was defined by clinical assessment of distinct regions of healing on day 28. Across six pigs, 96 burn wounds (3 cm diameter) were created. Clinical assessment at day 28 indicated that 39 had appeared to heal in a heterogeneous manner. Clinical observation at day 1 found 35 / 39 (90%) to be spatially heterogeneous in terms of burn severity. The LSI system was able to detect spatial heterogeneity of burn severity in 14 / 39 (36%) cases on day 1 and 23 / 39 cases (59%) on day 7. By contrast the SFDI system was able to detect spatial heterogeneity of burn severity in 39 / 39 (100%) cases on day 1. Here we have demonstrated that for the purposes of predicting heterogeneity in wound healing, SFDI generated scattering properties were a significantly more effective tool than perfusion images measured using LSI. This indicates that SFDI may be better suited to help clinicians categorize different burns earlier, ultimately informing treatment strategy to improve patient outcomes.

Spatial frequency domain imaging tracks healing following split-thickness skin grafts of burn wounds (Conference Presentation)

The ability to predict success or failure of wound healing strategies in burns has the potential to enable customized treatments tailored for the individual patient that would ultimately shorten recovery times, reduce the need for repeated grafting, and aid in achieving full rehabilitation. To this end, we are investigating the potential for spatial frequency domain imaging (SFDI) to non-invasively assess wound severity and healing status. SFDI is a wide-field diffuse optical imaging technique that enables non-invasive quantitative determination of in vivo tissue optical properties associated with physiologic structure and function. We have employed SFDI in a longitudinal study of wound healing using a controlled porcine burn model. Regions of wound repair using split thickness skin grafts were imaged using SFDI at multiple time points over a period of 60 days. The reduced scattering and absorption coefficients were determined at nine wavelengths spanning 470–970 nm, enabling determination of oxy- and deoxy-hemoglobin concentration, total hemoglobin concentration, oxygen saturation, and water fraction. These values obtained were compared to unburned control regions, undebrided burns, and debrided regions without treatment by grafting. Changes in the reduced scattering associated with structural changes in tissue correlate with histology as the wound heals. Compared to unburned tissue, the reduced scattering coefficient associated with repaired wounds is depressed and is spatially heterogeneous immediately following grafting. Over the course of healing, the scattering values increase and converge toward values of normal tissue and become more spatially homogeneous. Variations in chromophore concentrations are also characterized.

Characterisation of impaired wound healing in a preclinical model of induced diabetes using wide-field imaging and conventional immunohistochemistry assays

Major complications of diabetes lead to inflammation and oxidative stress, delayed wound healing, and persistent ulcers. The high morbidity, mortality rate, and associated costs of management suggest a need for non‐invasive methods that will enable the early detection of at‐risk tissue. We have compared the wound‐healing process that occurs in streptozotocin (STZ)‐treated diabetic rats with non‐diabetic controls using contrast changes in colour photography (ie, Weber Contrast) and the non‐invasive optical method Spatial Frequency Domain Imaging (SFDI). This technology can be used to quantify the structural and metabolic properties of in‐vivo tissue by measuring oxyhaemoglobin concentration (HbO2), deoxyhaemoglobin concentration (Hb), and oxygen saturation (StO2) within the visible boundaries of each wound. We also evaluated the changes in inducible nitric oxide synthase (iNOS) in the dermis using immunohistochemistry. Contrast changes in colour photographs showed that diabetic rats healed at a slower rate in comparison with non‐diabetic control, with the most significant change occurring at 7 days after the punch biopsy. We observed lower HbO2, StO2, and elevated Hb concentrations in the diabetic wounds. The iNOS level was higher in the dermis of the diabetic rats compared with the non‐diabetic rats. Our results showed that, in diabetes, there is higher level of iNOS that can lead to an observed reduction in HbO2 levels. iNOS is linked to increased inflammation, leading to prolonged wound healing. Our results suggest that SFDI has potential as a non‐invasive assessment of markers of wound‐healing impairment.

Bio-optic signatures for advanced glycation end products in the skin in streptozotocin (STZ) Induced Diabetes (Conference Presentation)

Type 1diabetes (T1D) is an autoimmune disorder that occurs due to the rapid destruction of insulin-producing beta cells, leading to insulin deficiency and the inability to regulate blood glucose levels and leads to destructive secondary complications. Advanced glycation end (AGEs) products, the result of the cross-linking of reducing sugars and proteins within the tissues, are one of the key causes of major complications associated with diabetes such as renal failure, blindness, nerve damage and vascular changes. Non-invasive techniques to detect AGEs are important for preventing the harmful effects of AGEs during diabetes mellitus. In this study, we utilized multiphoton microscopy to image biopsies taken from control rats and compared them to biopsies taken from streptozotocin (STZ) induced adult male diabetic rats. This was done at two and four weeks after the induction of hyperglycemia (>400 mg/dL) specifically to evaluate the effects of glycation on collagen. We chose to use an in-situ multiphoton microscopy method that combines multiphoton auto-florescence (AF) and second harmonic generation (SHG) to detect the microscopic influence of glycation. Initial results show high auto-florescence levels were present on the collagen, as a result of the accumulation of AGEs only two weeks after the STZ injection and considerably higher levels were present four weeks after the STZ injection. Future projects could involve evaluating advanced glycation end products in a clinical trial of diabetic patients.

Quantitative assessment of graded burn wounds using a commercial and research grade laser speckle imaging (LSI) system

Burn wounds are often characterized by injury depth, which then dictates wound management strategy. While most superficial burns and full thickness burns can be diagnosed through visual inspection, clinicians experience difficulty with accurate diagnosis of burns that fall between these extremes. Accurately diagnosing burn severity in a timely manner is critical for starting the appropriate treatment plan at the earliest time points to improve patient outcomes. To address this challenge, research groups have studied the use of commercial laser Doppler imaging (LDI) systems to provide objective characterization of burn-wound severity. Despite initial promising findings, LDI systems are not commonplace in part due to long acquisition times that can suffer from artifacts in moving patients. Commercial LDI systems are being phased out in favor of laser speckle imaging (LSI) systems that can provide similar information with faster acquisition speeds. To better understand the accuracy and usefulness of commercial LSI systems in burn-oriented research, we studied the performance of a commercial LSI system in three different sample systems and compared its results to a research-grade LSI system in the same environments. The first sample system involved laboratory measurements of intralipid (1%) flowing through a tissue simulating phantom, the second preclinical measurements in a controlled burn study in which wounds of graded severity were created on a Yorkshire pig, and the third clinical measurements involving a small sample of clinical patients. In addition to the commercial LSI system, a research grade LSI system that was designed and fabricated in our labs was used to quantitatively compare the performance of both systems and also to better understand the “Perfusion Unit” output of commercial systems.

Low-cost tissue simulating phantoms with tunable, wavelength-dependent scattering properties(Conference Presentation)

Tissue-simulating phantoms provide the opportunity to evaluate the performance of optical and spectroscopic instruments under controlled experimental conditions. Recent efforts have advanced phantom fabrication methods to provide more tissue realistic phantoms, both in terms of a) incorporating absorbing agents that more faithfully mimic in vivo tissue chromophores spanning visible and near infrared regimes and b) accounting for multi-layer tissue structures with distinct optical properties. The spectral scattering properties in these phantoms, however, are typically based only on a single scattering agent, thereby locking the spectral scattering properties to a single particle size distribution. However, in both healthy tissue as well as pathologic tissue, regions of distinct and differentiated scattering may be present. With differing mean size and distribution of scattering objects in these tissue regions, the relative wavelength-dependent scattering spectra may vary. For example, partial thickness burns exhibit significant cellular damage and collagen denaturation that will significantly alter the wavelength-dependent scattering properties resembling large Mie-like scatterer distributions in both visible and near infrared regimes. We present a low-cost method to fabricate silicone tissue-simulating phantoms with tunable scattering spectra properties that span visible and near infrared wavelengths. We use optical polishing agents (white aluminum oxides powders) at various grit sizes to approximate Mie scattering across multiple mean particle sizes. Mean particle sizes used in this study range from 17-3 micron. The optical properties of these phantoms are verified using an integrating sphere in combination with inverse adding-doubling methods. The tolerances of this fabrication method will be discussed.

Quantitative long term measurements of burns in a rat model using spatial frequency domain imaging and laser speckle imaging(Conference Presentation)

The ability to accurately assess burn wound severity in a timely manner is a critical component of wound management as it dictates the course of treatment. While full thickness and superficial burns can be easily diagnosed through visual inspection, burns that fall in between these categories are difficult to classify. Additionally, the ability to better quantify different stages of wound healing from a burn of any severity would be important for evaluating the efficacy of different treatment options. Here we present a longitudinal (28 day) study that employs spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) as non-invasive technologies to characterize in-vivo burn wounds and healing in a murine model. Burn wounds were created using an established technique of a brass comb heated to a given temperature and applied for a set amount of time. They were imaged immediately after the initial injury and then at 2, 4, 7, 14, 21, and 28 days following the injury. Biopsies were taken on the day of the injury in order to verify the extent of the burn damage as well as at different time points after the injury in order to visualize different stages of inflammation and healing. The results of this study suggest that the reduced scattering coefficient measured using SFDI and blood flow as measured using LSI have the potential to provide useful metrics for quantifying the severity of burn injuries as well as track the different stages associated with wound healing progression.