Collection of biopsies from the most pathologically advanced region is critical for histopathological assessment of potentially cancerous sites in the lung. However, current applications are limited in their ability to simultaneously image and collect samples in subsegmental airways. We demonstrate a suction-snare device guided with optical coherence tomography and autofluorescence imaging (OCT-AFI) to improve diagnostic yield in these airways. Biopsies collected in healthy ex-vivo porcine airways are shown to retain structural and functional information. Feasibility is demonstrated in an ex-vivo porcine model to assess tissue abnormality prior to biopsy collection.
Current cervical screening techniques are fairly effective at assessing the ectocervical surface, but they are limited in their capacity to assess the endocervical canal. There is a need for tools that examine the endocervical canal for cancerous or pre-cancerous lesions. This pilot study explores whether an endoscopic imaging approach combining structural and functional imaging techniques (optical coherence tomography (OCT) and autofluorescence imaging (AFI) respectively) can visualize cancerous or pre-cancerous changes in the endocervical canal. We present findings from an on-going in vivo imaging study including sample cases demonstrating precancers and cancers and preliminary features of interest.
Multimodal optical coherence tomography (OCT) can be implemented using double-clad fiber (DCF). A consequence of using DCF is the introduction of multipath artifacts which deteriorate the quality of OCT imaging. We demonstrate that a w-type DCF, characterized by a depressed cladding layer between the core and the multimode cladding, can eliminate OCT multipath artifacts. The modal contents of the fiber are determined from simulation and verified experimentally. A w-type fiber-based endoscope is used to generate co-registered OCT and autofluorescence imaging (AFI) with reduced artifacts. Results are compared with a DCF-based catheter.
The most prevalent ovarian cancers, high-grade serous carcinomas (HGSCs), begin as lesions in the fallopian tubes. There is a need for tools that examine the fallopian tubes for early-stage ovarian cancers. We hypothesize an endoscopic imaging approach combining structural and functional imaging techniques (optical coherence tomography (OCT) and autofluorescence imaging (AFI) respectively) will be able to visualize cancerous or pre-cancerous changes in the fallopian tubes for early ovarian cancer detection. We present findings from an on-going ex vivo imaging study of fallopian tubes including sample cases demonstrating various cancers and preliminary features of interest.
Significance: Chronic lung allograft dysfunction (CLAD) is the leading cause of death in transplant patients who survive past the first year post-transplant. Current diagnosis is based on sustained decline in lung function; there is a need for tools that can identify CLAD onset.
Aim: Endoscopic optical coherence tomography (OCT) can visualize structural changes in the small airways, which are of interest in CLAD progression. We aim to identify OCT features in the small airways of lung allografts that correlate with CLAD status.
Approach: Imaging was conducted with an endoscopic rotary pullback OCT catheter during routine bronchoscopy procedures (n = 54), collecting volumetric scans of three segmental airways per patient. Six features of interest were identified, and four blinded raters scored the dataset on the presence and intensity of each feature.
Results: Airway dilation (AD) was the only feature found to significantly (p < 0.003) correlate with CLAD diagnosis (R = 0.40 to 0.61). AD could also be fairly consistently scored between raters (κinter-rater = 0.48, κintra-rater = 0.64). There is a stronger relationship between AD and the combined obstructive and restrictive (BOS + RAS) phenotypes than the obstructive-only (BOS) phenotype for two raters (R = 0.92 , 0.94).
Conclusions: OCT examination of small AD shows potential as a diagnostic indicator for CLAD and CLAD phenotype and merits further exploration.
KEYWORDS: Biopsy, Optical coherence tomography, Tissues, Lung, In vivo imaging, Auto-fluorescence imaging, Diagnostics, Yield improvement, Visualization, Real time imaging
Significance: Diagnosis of suspicious lung nodules requires precise collection of relevant biopsies for histopathological analysis. Using optical coherence tomography and autofluorescence imaging (OCT-AFI) to improve diagnostic yield in parts of the lung inaccessible to larger imaging methods may allow for reducing complications related to the alternative of computed tomography-guided biopsy.
Aim: Feasibility of OCT-AFI combined with a commercially available lung biopsy needle was demonstrated for visualization of needle puncture sites in airways with diameters as small as 1.9 mm.
Approach: A miniaturized OCT-AFI imaging stylet was developed to be inserted through an 18G biopsy needle. We present design considerations and procedure development for image-guided biopsy. Ex vivo and in vivo porcine studies were performed to demonstrate the feasibility of the procedure and the device.
Results: OCT-AFI scans were obtained ex vivo and in vivo. Discrimination of pullback site is clear.
Conclusions: Use of the device is shown to be feasible in vivo. Images obtained show the stylet is effective at providing structural information at the puncture site that can be used to assess the diagnostic potential of the sample prior to collection.
Multipath artifacts in double clad fiber (DCF) based endoscopic optical coherence tomography (OCT) imaging systems are investigated and a novel mechanism for artifact generation is proposed. We present evidence that the characteristic image artifacts found in DCF OCT images are partially due to the existence of an index dip within the core of double clad optical fibers. This core dip is shown to affect the modal quality of the light propagating through the core of the DCF, causing additional peaks or ghost images to be generated within the point spread function of the OCT system. Through these investigations we hope to gain a better understanding of how modal artifacts degrade OCT image quality, allowing for the design of more ideal optical fibers which can restore the quality of the OCT imaging domain.
Ovarian cancer is one of the most lethal gynecological conditions in the developed world. Current screening methods have only made marginal differences in overall survival over the past 30 years. The deficit of early-stage detection methods is a critical factor in the mortality associated with this disease. Recent evidence has shown that the fallopian tubes are a critical site in carcinogenesis of ovarian cancers. We present the first endoscopic co-registered OCT-AFI imaging of ex vivo fallopian tubes. This work aims to evaluate the potential of OCT-AFI to identify pre-cancerous lesions in the fallopian tubes. The BC Cancer Research Centre’s Optical Imaging Lab has developed a multimodal imaging system and catheter which enables both optical coherence tomography (OCT) and autofluorescence imaging (AFI). The imaging probe consists of a dual-clad fiber optical core inside a 0.9mm diameter sterile sheath. This system allows for resolutions of 20-30μm and imaging depths of up to 1.5mm. Samples are collected from patients consented through the OVCARE Gynecological Cancer Tissue Bank banking protocol. Volumetric OCT-AFI images are acquired for the entire catheterizable length of the sample at pullback speeds of 1mm/s. After imaging, histology is conducted according to the “sectioning and extensively examining the fimbriated end” protocol to serve as a gold standard. We present methods for obtaining scans of the ex vivo fallopian tubes, sample cases correlated with histology, and our preliminary results. As of January 2020, we have imaged 21 patients and 27 fallopian tubes including 6 cancerous specimens.
KEYWORDS: Reflectivity, Imaging systems, RGB color model, Optical coherence tomography, Endoscopes, Fiber optics, Endoscopy, Signal to noise ratio, Tongue, In vivo imaging
A fiber-based endoscopic imaging system combining narrowband red-green-blue (RGB) reflectance with optical coherence tomography (OCT) and autofluorescence imaging (AFI) has been developed. The system uses a submillimeter diameter rotary-pullback double-clad fiber imaging catheter for sample illumination and detection. The imaging capabilities of each modality are presented and demonstrated with images of a multicolored card, fingerprints, and tongue mucosa. Broadband imaging, which was done to compare with narrowband sources, revealed better contrast but worse color consistency compared with narrowband RGB reflectance. The measured resolution of the endoscopic system is 25 μm in both the rotary direction and the pullback direction. OCT can be performed simultaneously with either narrowband RGB reflectance imaging or AFI.
This study explores endobronchial optical coherence tomography (OCT) imaging of lung transplant patients with chronic lung allograft dysfunction (CLAD). Optical coherence tomography (OCT), the optical analog of ultrasonography with superior resolution (10μm) but shallow (2mm) penetration, allows for the visualization of the early structural changes in the small airways, which is of interest in CLAD progression. Imaging was conducted with a catheter-based rotary OCT probe during routine bronchoscopy procedures, resulting in three-dimension pullbacks of three subsegmental airways per patient (n=9). A scoring rubric for visualized features of interest was used to quantify characteristics of the image set: loss of alveolar visualization, emphysema-like alveolar enlargement, alveolar hyperinflation, airway dilation, excessive mucous, excessive duct-like structures, and an unidentified structure. Four raters, blinded to clinical status, scored the set. Statistical analysis including Pearson correlation coefficients (R), Fleiss’ Kappa (κ) were used on this score set to assess preliminary potential of these features. 3/9 patients met the diagnostic criteria for both obstructive (BOS) and restrictive (RAS) phenotypes of CLAD and 6/9 for solely the obstructive phenotype. The airway dilation feature was found to be significantly associated (p<0.05) with the BOS+RAS diagnosis for three raters (R=0.72-0.94), with fairly consistent rater reliability (κinterrater = 0.25, κintrarater = 0.59). No OCT features were significantly correlated with infection status. Small airway dilation, as measured through catheterized OCT imaging, shows potential for use in detection of CLAD and distinguishing between CLAD phenotypes.
KEYWORDS: Endoscopes, RGB color model, In vivo imaging, Fiber optics, Cancer, Signal to noise ratio, Oncology, Imaging systems, Prototyping, Image resolution
The early detection of cancer brings increased success in the treatment of cancer patients. A prototype sub-millimeter diameter high resolution fibre endoscope for the in-vivo imaging in oral, lung, cervix, ovarian and pancreas sites for the early detection and delineation of cancers is currently in its early stages of development. The endoscope is to utilize a combination of rotary and pullback motion to allow a wide field-of-view while capturing high-resolution (10 to 20 um) RGB images. In this system an RGB laser module uses the core of a dual-clad fibre for illumination and the inner cladding for detection to achieve real time in-vivo reflectance imaging .
Signal detection for each laser (RGB) has been tested using a white card printed with black lines of varying widths. The contrast between the white and black portions of the card and the Signal to Noise Ratio (SNR) for the pullback mechanism of the system were determined. The card contrast values for red, green and blue light were calculated to be 25.0, 15.6 and 8.3 respectively, while the SNR values were 180, 155, and 154 respectively. These values suggest that the performance of the system is wavelength dependent. The imaging performance characteristics of the endoscope with rotary and pullback motion combined will be further quantified, and results and images will be presented.
High resolution optical imaging modalities such as optical coherence tomography (OCT), confocal and multiphoton microscopy continue to show promise for diagnostic imaging. These imaging modalities commonly employ 2D scanning mechanisms that scan the sample in regular, pre-defined patterns. However, these scanners can often have limited in field-of-view and can be susceptible to artefacts due to patient or clinician motion. We have recently demonstrated a new imaging paradigm called dual-beam manually-actuated distortion-corrected imaging (DMDI) that overcomes these limitations. DMDI exploits the predictable path and spatial separation of two beams to calculate and correct the scanning distortion caused by manual actuation of the probe or the sample. DMDI was first implemented using a dual-beam micromotor catheter (DBMC) which could be useful for in vivo imaging of internal vessels, air ways, or tubular organs. Here, we present a new implementation of DMDI using a single axis galvanometer scanner.
OCT imaging is used to demonstrate this implementation of DMDI. A single 1310nm swept source laser is split into two independent OCT interferometers. The two samples arms of the interferometers are aligned at different angles onto a single-axis galvo-mirror which is driven synchronously by the swept source. After passing through a scan lens, the scan pattern traced by the two beams is a pair of roughly parallel lines. A one-time calibration procedure is performed by imaging a phantom to precisely determine the beam separation and scanning pattern.
Samples were scanned by manually moving them approximately perpendicular to the scan lines, acquiring two images. Using common, unique features in both of the images, the recorded time difference between the imaging of the features, and the calibrated relationship between the two beams, the image distortion caused by manually actuating the sample can be discerned, and the distortion-corrected images can be produced.
To validate the galvanometer implementation of DMDI, we first imaged a phantom with a defined flat pattern. Image restoration was performed on the en face OCT images and showed distortion correction was feasible both perpendicular and parallel to the scan beam axis over a range of speeds. We also demonstrate correction for en face OCT images of a biological sample.
DMDI is demonstrated as a versatile imaging modality as it can be adapted for different implementations. Although a bench top galvanometer scanner setup was used in this study this implementation could be adapted for imaging body sites such as the oral cavity or skin. Furthermore, OCT was chosen due to its availability in our lab, however in principle any point-scanning modality could be used for DMDI.
KEYWORDS: Motion models, Modeling and simulation, Nonuniformity corrections, Optical coherence tomography, In vivo imaging, Endoscopy, 3D image processing, Image registration, Imaging systems, Data acquisition
A model for motion artifacts for 3D/2D rotational catheter data and a motion correction method called azimuthal en face image registration is presented. Qualitative and quantitative evaluations of the method are analysed on optical coherence tomography (OCT) and AFI images.
Chronic Lung Allograft Dysfunction (CLAD) remains a significant cause of morbidity and mortality following lung transplantation. Bronchiolitis obliterans Syndrome (BOS) is a predominant phenotype of CLAD primarily affecting the small and subsequently the large airways leading eventually to graft failure. In addition, the allograft airways are also involved in other types of CLAD such as Restrictive Allograft Syndrome (RAS). Freedom from BOS at five years post-transplant is only approximately 50 % among lung transplant recipients.
The diagnosis of CLAD is primarily based on pulmonary function testing and radiographic findings on CT scan. Transbronchial biopsies have a low diagnostic yield due to the multifocal nature of CLAD and the frequent lack of bronchioles in the biopsy specimen. Thus, CLAD is often diagnosed after significant disease progression.
We performed endoscopic OCT as a minimally invasive method to identify early CLAD biomarkers. During 65 routine surveillance and event-initiated bronchoscopies of lung transplant recipients at Vancouver General Hospital, OCT imaging was performed prior to acquiring biopsy samples, with multiple 3D volumetric scans taken at locations as close as possible to those biopsied. OCT has the potential to be advantageous over biopsy because multiple airways in the lung can be quickly surveyed. As a first step towards clinical utility we present our methods for quantifying observable biomarkers including luminal size and alveolar density. Ranges of values are established and correlated with airway generation, time since transplant, and infection status.
We present a method for the correction of motion artifacts present in two- and three-dimensional in vivo endoscopic images produced by rotary-pullback catheters. This method can correct for cardiac/breathing-based motion artifacts and catheter-based motion artifacts such as nonuniform rotational distortion (NURD). This method assumes that en face tissue imaging contains slowly varying structures that are roughly parallel to the pullback axis. The method reduces motion artifacts using a dynamic time warping solution through a cost matrix that measures similarities between adjacent frames in en face images. We optimize and demonstrate the suitability of this method using a real and simulated NURD phantom and in vivo endoscopic pulmonary optical coherence tomography and autofluorescence images. Qualitative and quantitative evaluations of the method show an enhancement of the image quality.
Peripheral lung nodules found by CT-scans are difficult to localize and biopsy bronchoscopically particularly for those ≤ 2 cm in diameter. In this work, we present the results of endoscopic co-registered optical coherence tomography and autofluorescence imaging (OCT-AFI) of normal and abnormal peripheral airways from 40 patients using 0.9 mm diameter fiber optic rotary pullback catheter. Optical coherence tomography (OCT) can visualize detailed airway morphology endoscopically in the lung periphery. Autofluorescence imaging (AFI) can visualize fluorescing tissue components such as collagen and elastin, enabling the detection of airway lesions with high sensitivity. Results indicate that AFI of abnormal airways is different from that of normal airways, suggesting that AFI can provide a sensitive visual presentation for rapidly identifying possible sites of pulmonary nodules. AFI can also rapidly visualize in vivo vascular networks using fast scanning parameters resulting in vascular-sensitive imaging with less breathing/cardiac motion artifacts compared to Doppler OCT imaging. It is known that tumor vasculature is structurally and functionally different from normal vessels. Thus, AFI can be potentially used for differentiating normal and abnormal lung vasculature for studying vascular remodeling.
In this work, we present multimodal imaging of peripheral airways in vivo using an endoscopic imaging system capable of co-registered optical coherence tomography and autofluorescence imaging (OCT-AFI). This system employs a 0.9 mm diameter double-clad fiber optic-based catheter for endoscopic imaging of small peripheral airways. Optical coherence tomography (OCT) can visualize detailed airway morphology in the lung periphery and autofluorescence imaging (AFI) can visualize fluorescent tissue components such as collagen and elastin, improving the detection of airway lesions. Results from in vivo imaging of 40 patients indicate that OCT and AFI offer complementary information that may increase the ability to identify pulmonary nodules in the lung periphery and improve the safety of biopsy collection by identifying large blood vessels. AFI can rapidly visualize in vivo vascular networks using fast scanning parameters resulting in vascular-sensitive imaging with less breathing/cardiac motion artifacts compared to Doppler OCT imaging. By providing complementary information about structure and function of tissue, OCT-AFI may improve site selection during biopsy collection in the lung periphery.
Endoscopic catheter-based imaging systems that employ a 2-dimensional rotary or 3-dimensional rotary-pullback scanning mechanism require constant angular velocity at the distal tip to ensure correct angular registration of the collected signal. Non-uniform rotational distortion (NURD) – often present due to a variety of mechanical issues – can result in inconsistent position and velocity profiles at the tip, limiting the accuracy of any measurements. Since artifacts like NURD are difficult to identify and characterize during tissue imaging, phantoms with well-defined patterns have been used to quantify position and/or velocity error. In this work we present a fast, versatile, and cost-effective method for making fused deposition modeling 3D printed phantoms for identifying and quantifying NURD errors along an arbitrary user-defined pullback path. Eight evenly-spaced features are present at the same orientation at all points on the path such that deviations from expected geometry can be quantified for the imaging catheter. The features are printed vertically and then folded together around the path to avoid issues with printer head resolution. This method can be adapted for probes of various diameters and for complex imaging paths with multiple bends. We demonstrate imaging using the 3D printed phantoms with a 1mm diameter rotary-pullback OCT catheter and system as a means of objectively evaluating the mechanical performance of similarly constructed probes.
Diagnosis of peripheral lung nodules is challenging because they are rarely visualized endobronchially. Imaging
techniques such as endobronchial ultrasound (EBUS) are employed to improve tumor localization. The current EBUS
probe provides limited nodule characterization and has an outer diameter of 1.4 mm that restricts access to small
peripheral airways. We report a novel co-registered autofluoresence Doppler optical coherence tomography (AF/DOCT)
system with a 0.9 mm diameter probe to characterize peripheral lung nodules prior to biopsy in vivo.
Method: Patients referred for evaluation of peripheral lung nodules underwent bronchoscopy with examination of
standard EBUS and the novel AF/DOCT system. The lesion of interest was first identified with EBUS and then imaged
with the AF/DOCT system. The abnormal area was biopsied. AF/DOCT images of pathology proved lung malignancies
were reviewed by a panel of a pathologist, respirologists, and AF/DOCT experts.
Results: Eleven patients with biopsy proven lung cancer underwent examination with AF/DOCT. The majority of the
cancers were adenocarcinoma. AF/DOCT images were obtained in all patients. There were no complications to the
procedures. Lung abnormalities visualized in AF/ OCT images were observed in 11 cases. In one case large blood
vessels were identified and biopsy was avoided.
Conclusion: In this pilot study, AF/DOCT obtained high quality images of peripheral pulmonary nodules. The present
study supports the safety and feasibility of AF/DOCT for the evaluation of lung cancer. The addition of Doppler
information may improve biopsy site selection and reduce hemorrhage.
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