Experimental Evaluation of an Axillary Microwave Imaging System to Aid Breast Cancer Staging

The number of metastasised Axillary Lymph Nodes (ALNs) is a key indicator for breast cancer staging. Its correct assessment affects subsequent therapeutic decisions. Common ALN screening modalities lack high enough sensitivity and specificity. Level I ALNs produce detectable backscattering of microwaves, opening the way for Microwave Imaging (MWI) as a complementary screening modality. Radar-based MWI is a low-cost, noninvasive technique, widely studied for breast cancer and brain stroke detection. However, new specific challenges arise for ALN detection, which deter a simple extension of existing MWI methods. The geometry of the axillary region is more complex, limiting the antenna travel range required for maximum resolution. Additionally, unlike breast MWI setups, it is impractical to use liquid immersion to enhance energy coupling to the body; therefore, higher skin reflection masks ALNs response. We present a complete study that proposes dedicated imaging algorithms to detect ALNs dealing with the above constraints, and evaluate their effectiveness experimentally. We describe the developed setup based on a 3D-printed anthropomorphic phantom, and the antenna-positioning configuration. To the authors’ knowledge, this is the first ALN-MWI study involving a fully functional anatomically compliant setup. A Vivaldi antenna, operating in a monostatic radar mode at 2-5 GHz, scans the axillary region. Pre-clinical assessment in different representative scenarios shows Signal-to-ClutterRatio higher than 2.8 dB and Location Error lower than 15mm, which is smaller than considered ALN dimensions. Our study shows promising level I ALN detection results despite the new challenges, confirming MWI potential to aid breast cancer staging.info:eu-repo/semantics/publishedVersio

Feasibility study of focal lens for multistatic microwave breast imaging

Microwave Imaging is an emerging technique to aid breast cancer diagnosis. Current multistatic setups involve complex and heavy signal processing techniques, such as to remove the energy coupling between adjacent sensors, which masks the response from inner tissues. We investigate a novel approach using a dielectric lens in order to reduce the coupling effects between antennas, thus reducing the signal processing burden, while preserving all the advantages of multistatic setups. In this paper, we show that we can successfully detect simulated breast targets on reconstructed images using a setup with a dielectric lens.info:eu-repo/semantics/publishedVersio

Optimisation of Artefact Removal Algorithm for Microwave Imaging of the Axillary Region Using Experimental Prototype Signals

Microwave Imaging (MWI) has the potential to aid breast cancer staging through the detection of Axillary Lymph Nodes (ALNs). This type of system can present some challenges, mainly due to the irregular axillary surface. The optimisation of the artefact removal algorithm to successfully remove the surface reflections is of great importance. In this paper, we propose using Singular Value Decomposition (SVD) as an artefact removal algorithm and study the effect of choosing different subsets of antenna positions for artefact removal on imaging results using experimental signals. We show that different subsets of antenna positions affect the results and in some cases prevent the targets detection. Our analysis allowed us to find an optimal combination of parameters which results in Signal-to-Clutter Ratio higher than 2.77 dB and Location Error lower than 14.9 mm for three different experimental tests. These results are relevant for the development of dedicated algorithms for ALN-MWI application.info:eu-repo/semantics/publishedVersio

Study of the Refraction Effects in Microwave Breast Imaging Using a Dry Setup

Medical Microwave Imaging (MWI) has been studied as a technique to aid breast cancer diagnosis. Several different prototypes have been proposed but most of them require the use of a coupling medium between the antennas and the breast, in order to reduce skin backscattering and avoid refraction effects. The use of dry setups has been addressed and recent publications show promising results. In this paper, we assess the importance of considering refraction effects in the image reconstruction algorithms. To this end, we consider a simplified homogeneous spherical model of the breast and analytically compute the propagating rays through the air-body interface. The comparison of results considering only direct ray propagation or refracted rays shows negligible impact on the accuracy of the images for moderately high permittivity media. Thus, we may avoid the computational burden of calculating the refracted rays in complex shapes.info:eu-repo/semantics/publishedVersio

Target Selection in Multistatic Microwave Breast Imaging Setup Using Dielectric Lens

Microwave Imaging (MWI) has been studied to aid early breast cancer detection. Current prototypes in more advanced stages of development include both monostatic or multistatic setups. However, multistatic configurations usually include a high number of antennas which consequently require complex and computationally-intensive signal processing algorithms to ensure a good target detection. We previously presented a novel approach using a dielectric lens which reduces the signal processing burden of multistatic setups, while ensuring good spatial resolution. In this paper, we evaluate this novel setup using an anatomically realistic breast phantom and its capability of selecting targets inside the breast. We show a successful detection of the targets using an artefact removal algorithm based on singular value decomposition when the Bessel beam is centered at the target location.info:eu-repo/semantics/publishedVersio

Evaluation of Refraction Effects in Dry Medical Microwave Imaging Setups

Dry microwave imaging (MWI) systems are more practical, hygienic, and fast to operate since they do not require immersion liquid. However, the dielectric contrast between air and the part of the body under examination is larger, causing larger refraction effects. Including refraction in the image reconstruction algorithm significantly increases the computational effort, especially when imaging nonuniform shapes. Hence, our systematic study aims to evaluate the impact of neglecting refraction effects on MWI by using quantitative metrics and define objective guidelines that are lacking in the literature. We perform comparative studies with a spherical numerical phantom (which is typically used to represent simplified breast or head phantoms) by varying the phantom relative permittivity values between 4 and 40, metallic targets diameter between 5 and 15 mm, and the number of probing antennas. Additionally, the refraction effects are evaluated with anthropomorphic body phantoms representing a breast and the axillary region. We numerically and experimentally show that refraction tends to have a greater impact on imaging results when phantom relative permittivity values exceed 8, while it has a minor effect in the remaining tested cases. This favors potential fast real-time image reconstruction. This letter provides useful criteria to decide whether refraction should be considered or not for imaging reconstruction when developing new dry medical MWI setups.info:eu-repo/semantics/publishedVersio

Study of Freezing and Defrosting Effects on Complex Permittivity of Biological Tissues

In this letter we study the effect of freezing and defrosting on the dielectric properties of biological tissues. The electromagnetic characterization of tissues at microwave frequencies is crucial for the development of microwave-based biomedical devices. These measurements are often not practical, as tissue degradation restricts the time available between tissue excision and dielectric measurements. For this reason, measurement of tissues that underwent freezing and defrosting may provide researchers with more flexibility in setting measurement campaigns, thus speeding up the development of microwave-based biomedical devices. To this end, this letter presents dielectric measurement on frozen and defrosted tissue, which translates into the following objectives: first, investigate if the dielectric properties of defrosted tissues depend on frozen storage time; second, determine if defrosted tissue dielectric properties differ from those of fresh tissues. As a result, we measure the dielectric properties of ten samples of chicken muscle, bovine liver, and bovine fat, each before and after freezing (up to 14 days) and defrosting. The measurements are performed with the open-ended coaxial probe method at the frequency band of 0.5–8.5 GHz. We observe a slight increase—less than 10%—in complex permittivity of high-water-content tissues (muscle and liver) after defrosting, and negligible effect on fat tissues.info:eu-repo/semantics/acceptedVersio

Effect of Varying Prior Information in Axillary 2D Microwave Tomography

We numerically assess the potential of microwave tomography (MWT) for the detection and dielectric properties estimation of axillary lymph nodes (ALNs), and we study the robustness of our system using prior information with varying levels of accuracy. We adopt a 2-dimensional MWT system with 8 antennas (0.5-2.5 GHz) placed around the axillary region. The reconstruction algorithm implements the distorted Born iterative method. We show that: (i) when accurate prior knowledge of the axillary tissues (fat and muscle) is available, our system successfully detects an ALN; (ii) ±30% error in the prior estimation of fat and muscle dielectric properties does not affect image quality; (iii) ±7mm error in muscle position causes slight artifacts, while ± 14mm error in muscle position affects ALN detection. To the best of our knowledge, this is the first paper in the literature to study the impact of prior information accuracy on detecting an ALN using MWT.info:eu-repo/semantics/publishedVersio

Extracting Dielectric Properties for MRI-based Phantoms for Axillary Microwave Imaging Device

Microwave Imaging (MWI) is an emerging medical imaging technique, which has been studied to aid breast cancer diagnosis in the frequency range from 0.5 to 30 GHz. The information about the dielectric properties of each tissue is essential to assess the viability of this type of systems. However, accurate measurements of heterogeneous tissues can be very challenging, and the current available information is still very limited. In this paper, we present a methodology for extracting dielectric properties to create anatomical models of the axillary region. These models will be used in a MWI device to aid breast cancer diagnosis through the detection of metastasised axillary lymph nodes. We apply segmentation tools to Magnetic Resonance Images (MRI) of the breast and assign dielectric properties to each tissue, extracting preliminary information about the properties of axillary lymph nodes. This study may open a way to more quickly extract dielectric properties of tissues and/or validate measurements, accelerating the development of microwave-based medical devices.The authors would like to acknowledge the study with ref. CES/44/2019/ME in Hospital da Luz Lisboa (19/09/2019).info:eu-repo/semantics/publishedVersio

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc