SignificanceTreatment planning for light-based therapies including photodynamic therapy requires tissue optical property knowledge. This is recoverable with spatially resolved diffuse reflectance spectroscopy (DRS) but requires precise source–detector separation (SDS) determination and time-consuming simulations.AimAn artificial neural network (ANN) to map from DRS at multiple SDS to optical properties was created. This trained ANN was adapted to fiber-optic probes with varying SDS using transfer learning (TL).ApproachAn ANN mapping from measurements to Monte Carlo simulation to optical properties was created with one fiber-optic probe. A second probe with different SDS was used for TL algorithm creation. Data from a third were used to test this algorithm.ResultsThe initial ANN recovered absorber concentration with RMSE=0.29 μM (7.5% mean error) and μs′ at 665 nm (μs,665′) with RMSE=0.77 cm−1 (2.5% mean error). For probe 2, TL significantly improved absorber concentration (0.38 versus 1.67 μM RMSE, p=0.0005) and μ′s,665 (0.71 versus 1.8 cm−1 RMSE, p=0.0005) recovery. A third probe also showed improved absorber (0.7 versus 4.1 μM RMSE, p<0.0001) and μs,665′ (1.68 versus 2.08 cm−1 RMSE, p=0.2) recovery.ConclusionsTL-based probe-to-probe calibration can rapidly adapt an ANN created for one probe to similar target probes, enabling accurate optical property recovery with the target probe.
SignificanceEfficacious photodynamic therapy (PDT) of abscess cavities requires personalized treatment planning. This relies on knowledge of abscess wall optical properties, which we report for the first time in human subjects.AimThe objective was to extract optical properties and photosensitizer concentration from spatially resolved diffuse reflectance measurements of abscess cavities prior to methylene blue (MB) PDT, as part of a phase 1 clinical trial.ApproachDiffuse reflectance spectra were collected at the abscess wall of 13 human subjects using a custom fiber-optic probe and optical spectroscopy system, before and after MB administration. A Monte Carlo lookup table was used to extract optical properties.ResultsPre-MB abscess wall absorption coefficients at 665 nm were 0.15±0.1 cm−1 (0.03 to 0.36 cm−1) and 10.74±15.81 cm−1 (0.08 to 49.3 cm−1) post-MB. Reduced scattering coefficients at 665 nm were 8.45±2.37 cm−1 (4.8 to 13.2 cm−1) and 5.6±2.26 cm−1 (1.6 to 9.9 cm−1) for pre-MB and post-MB, respectively. Oxygen saturations were found to be 58.83%±35.78% (5.6% to 100%) pre-MB and 36.29%±25.1% (0.0001% to 76.4%) post-MB. Determined MB concentrations were 71.83±108.22 μM (0 to 311 μM).ConclusionsWe observed substantial inter-subject variation in both native wall optical properties and MB uptake. This underscores the importance of making these measurements for patient-specific treatment planning.
KEYWORDS: Photodynamic therapy, Breast cancer, Tumor growth modeling, Tumors, Surgery, Luminescence, In vivo imaging, Near infrared, Microscopy, Cancer
This conference presentation was prepared for the Optical Methods for Tumor Treatment and Detection: Mechanisms and Techniques in Photodynamic Therapy XXXI conference at SPIE BiOS 2023.
As part of our ongoing Phase 1 clinical trial to establish the safety and feasibility of methylene blue photodynamic therapy (MB-PDT) for human deep tissue abscess cavities, we have shown that determination of abscess wall optical properties is vital for the design of personalized treatment plans aiming to optimize light dose. To that end, we have developed and validated an optical spectroscopy system for the assessment of optical properties at the cavity wall, including a compact fiber-optic probe that can be inserted through the catheter used for the standard of care abscess drainage. Here we report preliminary findings from the first three human subjects to receive these optical spectroscopy measurements. We observed wide variability in concentrations of oxy- and deoxy-hemoglobin prior to MB administration, ranging from 7.3-213 μM and 0.1-47.2 μM, respectively. Reduced scattering coefficients also showed inter-patient variability, but recovered values were more similar between subjects (5.5-10.9 cm-1 at 665 nm). Further, methylene blue uptake was found to vary between subjects, and was associated with a reduction in oxygen saturation. These measured optical properties, along with preprocedure computed tomography (CT) images, will be used with our previously developed Monte Carlo simulation framework to generate personalized treatment plans for individual patients, which could significantly improve the efficacy of MB-PDT while ensuring safety.
Deep tissue abscesses are inflammatory, purulent lesions encased in a fibrin-rich pseudocapsule that include multiple bacterial and fungal species. We have initiated a Phase 1 clinical trial exploring the safety and feasibility of methylene blue photodynamic therapy (MB-PDT) at the time of abscess drainage. To optimize treatment parameters for future clinical applications, our goal is to generate physically accurate three-dimensional (3D) abscess models upon which bacteria can be grown. Here, we report results of MB-PDT against four representative bacterial species found in human abscesses in planktonic culture, as biofilms on silicone, and pilot results in 3D silicone molds derived from human abscess computed tomography (CT) images. In all cases, MB-PDT was performed with 665 nm light at a fluence rate of 4 mW/cm2 for 30 minutes, resulting in a fluence of 7.2 J/cm2. In planktonic cultures, MB-PDT was effective against Escherichia coli, Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus (MRSA) (4- to 7-fold log CFU reduction). For Klebsiella pneumoniae, increased fluence was required to achieve comparable efficacy. When bacteria were grown as biofilms on silicone, MB-PDT efficacy was reduced (1- to 2-fold CFU reduction). A 3D silicone model was generated based on pelvic abscess CT images, and MRSA was grown in this model for six days. Crystal violet staining showed abundant growth on the silicone, without penetration into the model. These results motivate exploration of both light and drug dose ranging for biofilm samples. Future experiments will additionally focus on MB-PDT of bacteria grown on 3D silicone surfaces.
In order to safely and effectively treat patients with methylene blue photodynamic therapy (MB-PDT) for sterilization of deep tissue abscesses, abscess optical properties must be determined. We demonstrate the ability of our compact optical probe along with a Monte Carlo-based lookup table to retrieve optical properties in tissue simulating phantoms containing Intralipid as a scatterer, and Methylene Blue (MB) and/or Mn(III) meso-Tetra (4-sulfonatophenyl) porphine (MnTPPS) as absorbers. Our results demonstrate the system’s ability to accurately recover optical properties in the presence of multiple absorbers. Future applications for this system will allow for patient specific treatment throughout ongoing clinical trials.
We are investigating use of methylene blue photodynamic therapy (MB-PDT) to treat deep tissue abscesses. Monte Carlo simulations incorporating patient-specific CT images (60 subjects) were utilized to examine the effect of optical properties on the generation of patient-specific treatment plans. We investigated the influence of varying abscess wall absorption and Intralipid-induced scattering within the cavity on threshold optical power and eligibility for MB-PDT. When Intralipid concentration and delivered optical power were optimized simultaneously for each patient, eligibility for MB-PDT increased greatly from 42% to 92%, though this was diminished by the presence of absorption within the cavity.
Significance: Antimicrobial photodynamic therapy (PDT) effectively kills bacterial strains found in deep tissue abscess cavities. PDT response hinges on multiple factors, including light dose, which depends on patient optical properties.
Aim: Computed tomography images for 60 abscess drainage subjects were segmented and used for Monte Carlo (MC) simulation. We evaluated effects of optical properties and abscess morphology on PDT eligibility and generated treatment plans.
Approach: A range of abscess wall absorptions (μa , wall) and intra-cavity Intralipid concentrations were simulated. At each combination, the threshold optical power and optimal Intralipid concentration were found for a fluence rate target, with subjects being eligible for PDT if the target was attainable with <2000 mW of source light. Further simulations were performed with absorption within the cavity (μa , cavity).
Results: Patient-specific treatment planning substantially increased the number of subjects expected to achieve an efficacious light dose for antimicrobial PDT, especially with Intralipid modification. The threshold optical power and optimal Intralipid concentration increased with increasing μa , wall (p < 0.001). PDT eligibility improved with patient-specific treatment planning (p < 0.0001). With μa , wall = 0.2 cm − 1, eligibility increased from 42% to 92%. Increasing μa , cavity reduced PDT eligibility (p < 0.0001); modifying the delivered optical power had the greatest impact in this case.
Conclusions: MC-based treatment planning greatly increases eligibility for PDT of abscess cavities.
KEYWORDS: Monte Carlo methods, Photodynamic therapy, Tissue optics, Optical properties, Tissues, Safety, Resistance, Optical spectroscopy, In vivo imaging, Device simulation
Despite advances in image-guided percutaneous drainage, deep tissue abscesses remain a serious cause of morbidity, mortality, and hospital stay. We initiated a Phase 1 clinical trial exploring safety and feasibility of methylene blue (MB) photodynamic therapy during drainage. Five subjects have been treated, with no study-related adverse events and high technical success.
Monte Carlo simulations were used to examine effects of optical properties on delivered light dose. We found that light dose is highly dependent upon MB uptake and Intralipid concentration. These results motivated construction of an optical spectroscopy system for determination of abscess wall optical properties in vivo.
Deep tissue abscesses remain a significant cause of morbidity, mortality, and hospital stay despite improved surgical techniques and use of perioperative antibiotics. Long-term antibiotics increase risk of acquired resistance and polymicrobial infection, limiting future treatment options. We have therefore undertaken a Phase 1 clinical trial to evaluate safety and feasibility of methylene blue mediated photodynamic therapy (MB-PDT) at the time of drainage to treat deep tissue abscesses. This trial uses a fixed photosensitizer dose (1 mg/mL) delivered directly to the abscess cavity, and escalates light dose using a 3+3 design. Three patients were treated at the lowest light dose (20 mW/cm2, 6 J/cm2), with no study-related adverse events. Based on the technical success of this group, recruitment will continue for higher light dose groups with relaxed inclusion criteria.
This trial restricts potential subjects to those with single abscesses less than 8 cm in diameter. To investigate MB-PDT feasibility in a wider population, we extracted CT images for patients receiving abscess drainage locally. Images were segmented and imported into a custom Monte Carlo simulation framework. Simulations were performed to determine whether 20 mW/cm2 could be delivered to 95% of the abscess wall, given the available 2 W of optical power at the treatment fiber output. Preliminary results show that this is achievable in 80% of abscesses examined, with volumes ranging from 30-250 mL. Optical power required ranged from 50-950 mW. Based on these initial results, it appears that a large number of abscesses drained may be candidates for MB-PDT.
We demonstrate recovery of optical properties using arrays of interstitial cylindrical diffusing fibers as sources and detectors. A single 1-cm diffuser delivered laser illumination at 665 nm, while seven 1- and 2-cm diffusers at 1-cm grid spacing acted as detectors. Extraction of optical properties from these measurements was based upon a diffusion model of emission and detection distributions for these diffuser fibers, informed by previous measurements of heterogeneous axial detection. Verification of the technique was performed in 15 liquid tissue-simulating phantoms consisting of deionized water, India ink as absorber, and Intralipid 20% as scatterer. For the range of optical properties tested, mean errors were 4.4% for effective attenuation coefficient, 12.6% for absorption coefficient, and 7.6% for reduced scattering coefficient. Error in recovery tended to increase with decreasing transport albedo. For therapeutic techniques involving the delivery of light to locations deep within the body, such as interstitial photodynamic and photothermal therapies, the methods described here would allow the treatment diffuser fibers also to be used as sources and detectors for recovery of optical properties. This would eliminate the need for separately inserted fibers for spectroscopy, reducing clinical complexity and improving the accuracy of treatment planning.
Intravenous administration of some photosensitizers, including the FDA-approved Photofrin, results in significant
systemic photosensitivity and a 2-3-day drug-light interval. Direct intratumor injection of photosensitizer could
potentially eliminate these negative aspects of photodynamic therapy (PDT), while requiring a lower photosensitizer
dose to achieve comparable drug concentration in the target tissue.
We performed PDT using intratumor injection of 3 photosensitizers, methylene blue (MB), Pc 4, and Photofrin, in
mouse tumor models. After a 0-15 minute drug-light interval, illumination was delivered by appropriate diode
lasers. For animals receiving MB or Pc 4, surface illumination was delivered using a microlens-terminated fiber. For
animals receiving Photofrin, interstitial illumination was delivered by a 1 cm diffuser.
In animals receiving MB or Pc 4, tumor dimensions were measured daily post-PDT, with a cure being defined as no
palpable tumor 90 days post-treatment. For Photofrin, animals were sacrificed 24 hours post-PDT and tumors were
excised, with samples HE stained to assess PDT-induced necrosis. 55% of tumors were cured with MB-PDT, and
significant tumor growth delay (p=0.002) was observed for Pc 4. For Photofrin PDT, the mean necrosis radius was
3.4±0.8 mm, compared to 2.9±1.3 mm for systemic administration, which was not a significant difference (p=0.58).
Intratumoral injection of the photosensitizers methylene blue, Pc 4, and Photofrin is feasible, and results in
appreciable tumor response. Further investigation is necessary to optimize treatment protocols and assess the
systemic photosensitivity induced by intratumor injection.
The axial emission and detection profiles of 1- and 2-cm cylindrical diffusing fibers based on concentration gradients of scatterers were measured. Based on these measurements, we describe a method for determination of the scatterer concentration gradient within the diffusers. Using a Monte Carlo model incorporating these concentrations, detection was simulated and found to agree with measurements. The measured and simulated detection profiles for these diffusers were found to be drastically different from those previously measured in an alternative diffuser design incorporating an end reflector. When using cylindrical diffusers as detection fibers, it is, therefore, important to understand the design of the fiber and characterize the detection behavior.
Interstitial photodynamic therapy (iPDT) describes the use of implanted optical fibers for delivery of treatment light to activate photosensitizer in regions that can be located deep within the body. Since sensitive healthy structures are often located nearby, this requires careful treatment planning that is dependent on tissue optical properties. Determination of these values usually involves the insertion of additional fibers into the volume, or the use of flat-cleaved optical fibers as both treatment sources and detectors. The insertion of additional fibers is undesirable, and cylindrical diffusers have been shown to offer superior treatment characteristics compared to flat-cleaved fibers. Using cylindrical diffusers as detectors for spectroscopic measurement is therefore attractive. We describe the determination of the detection profile for a particular cylindrical diffuser design and derive the scatterer concentration gradient within the diffuser core. This detection profile is compared to previously characterized diffusers, and is shown to be dependent on the diffuser design. For diffusers with a constant scatterer concentration and distal mirror, the detection profile is localized to the proximal end of the diffusing region. For diffusers with variable scattering concentration along their length and no distal mirror, the detection profile is shown to be more uniform along the diffusing region. We also present preliminary results showing the recovery of optical properties using arrays of cylindrical diffusing fibers as sources and detectors, with a mean error of 4.4% in the determination of μeff. The accuracy of these results is comparable to those obtained with other methods of optical property recovery.
Knowledge of optical properties is required to determine light dose in photodynamic therapy. We have designed an
interstitial optical probe, consisting of six helically arranged side-firing fibers enclosed in a 1.1 mm diameter
encapsulant, that can be used to determine these values. White light is delivered by one fiber and detected by the others.
Based on a Monte Carlo (MC) model of the probe, the absorption (μa) and reduced scattering (μs') coefficients of the
sample are determined. Recovery was verified in tissue-simulating phantoms containing MnTPPS or intact human
erythrocytes as absorbers and Intralipid as scatterer. Mean errors in recovery of μa and μs' were 9% and 19%,
respectively. In phantoms containing erythrocytes, hemoglobin oxygen saturation was recovered with mean error of
12%.
Using the MC model, we mapped the volumes sampled by particular spectroscopy fibers. For μa = 0.1 cm-1 and μs' = 20cm-1, 49% of photon packets detected at the fiber adjacent to the source sampled a radius further than 5 mm from the probe, while 24% of photon packets sampled further than 7.5 mm. When μs' was reduced to 10 cm-1, 54% of photon packets traversed a radius greater than 5 mm from the probe and 29% sampled further than 7.5 mm. Changing the value of μa to 0.2 cm-1 did not have an effect on the sampled volume.
We also provide a new probe design that aims to improve upon the accuracy of the current probe by incorporating a
wider range of source-detector separations.
We demonstrate interstitial recovery of absorption and scattering coefficients using a custom optical probe and a Monte Carlo (MC)–based recovery algorithm. The probe consists of six side-firing spectroscopy fibers contained in a 1.1-mm outer diameter cladding, with each fiber having a different axial and angular position on the probe. Broadband white light is delivered by one of the fibers and is detected steady-state by the remaining fibers. These spatially and spectrally resolved data are analyzed using a MC-based fitting algorithm in order to extract the local optical properties. The technique was verified in tissue-simulating phantoms consisting of Intralipid-20% as a scatterer and either manganese meso-tetra (4-sulfanatophenyl) porphine or intact human erythrocytes as an absorber. Absorption coefficients were recovered with a mean error of 9% and scattering coefficients were recovered with a mean error of 19%, whereas the hemoglobin oxygen saturation was recovered with a mean error of 12%. These results demonstrate the feasibility of optical property recovery for situations in which surface-contact spectroscopy is not a possibility, and where only a single probe can be inserted into the tissue.
We measured the optical properties of freshly excised kidneys with renal parenchymal tumors to assess the feasibility of photodynamic therapy (PDT) in these patients. Kidneys were collected from 16 patients during surgical nephrectomies. Spatially resolved, white light, steady-state diffuse reflectance measurements were performed on normal and neoplastic tissue identified by a pathologist. Reflectance data were fit using a radiative transport model to obtain absorption (μ a ) and transport scattering coefficients (μ ′ s ), which define a characteristic light propagation distance, δ . Monte Carlo (MC) simulations of light propagation from cylindrical diffusing fibers were run using the optical properties extracted from each of the kidneys. Interpretable spectra were obtained from 14 kidneys. Optical properties of human renal cancers exhibit significant inter-lesion heterogeneity. For all diagnoses, however, there is a trend toward increased light penetration at longer wavelengths. For renal cell carcinomas (RCC), mean values of δ increase from 1.28 to 2.78 mm as the PDT treatment wavelength is increased from 630 to 780 nm. MC simulations of light propagation from interstitial optical fibers show that fluence distribution in tumors is significantly improved at 780 versus 630 nm. Our results support the feasibility of PDT in selected renal cancer patients, especially with photosensitizers activated at longer wavelengths.
We present a new Monte Carlo model of cylindrical diffusing fibers that is implemented with a graphics processing unit. Unlike previously published models that approximate the diffuser as a linear array of point sources, this model is based on the construction of these fibers. This allows for accurate determination of fluence distributions and modeling of fluorescence generation and collection. We demonstrate that our model generates fluence profiles similar to a linear array of point sources, but reveals axially heterogeneous fluorescence detection. With axially homogeneous excitation fluence, approximately 90% of detected fluorescence is collected by the proximal third of the diffuser for μs'/μa = 8 in the tissue and 70 to 88% is collected in this region for μs'/μa = 80. Increased fluorescence detection by the distal end of the diffuser relative to the center section is also demonstrated. Validation of these results was performed by creating phantoms consisting of layered fluorescent regions. Diffusers were inserted into these layered phantoms and fluorescence spectra were collected. Fits to these spectra show quantitative agreement between simulated fluorescence collection sensitivities and experimental results. These results will be applicable to the use of diffusers as detectors for dosimetry in interstitial photodynamic therapy.
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