Exploiting diffuse reflectance measurement uncertainty estimates in spatial frequency domain imaging

Spatial frequency domain imaging (SFDI) is a wide-field, noncontact diffuse optical imaging technique that has garnered significant interest for a variety of applications, including the monitoring of skin and breast lesions in clinical settings, and the progression of Alzheimer’s disease and drug delivery to the brain in mouse models. In most applications, diffuse reflectance measurements are used to quantify the optical absorption and reduced scattering coefficients of the turbid medium, and with these, chromophore concentrations of interest are extracted (e.g., hemoglobin in tissue). However, uncertainties in estimated absorption and reduced scattering values are rarely reported, and we know of no method capable of providing such uncertainties when look-up table-based inversion algorithms are used to recover the optical properties. Quantifying these uncertainties would have several important benefits. For example, they could be propagated forward to yield uncertainties in estimated chromophore concentrations, which could have profound implications for the interpretation of experimental results. They could also be employed to help guide the selection of spatial frequencies used for SFDI measurements, given the requirements of the specific application. In this work, we make two novel contributions. First, we show how knowledge of the accuracy of diffuse reflectance measurements from an SFDI instrument (i.e., diffuse reflectance uncertainty estimates) can be transformed to yield quantitative predictions of uncertainties for recovered absorption and reduced scattering values. Second, we use diffuse reflectance uncertainty estimates directly in a new algorithm for the recovery of optical properties. This algorithm performs equivalently to a standard look-up table-based approach but is up to ~200X faster (per pixel). To transform diffuse reflectance uncertainty estimates into uncertainty estimates for the absorption and reduced scattering coefficients, we employ the Cramer-Rao bound (CRB). The CRB is a lower bound that defines the best achievable precision (i.e., lowest variance) of any unbiased estimator for a given data model. It is often used in the statistical signal processing community, especially in the sonar and radar signal processing communities, to perform feasibility studies and system design. We calculate the CRBs for the absorption and reduced scattering coefficients and use them as our estimates of uncertainties for these parameters. We show that these estimates agree with results from Monte Carlo simulations to better than 0.1% for the common scenario where optical properties are computed with a look-up table using two spatial frequencies. We validate our simulations with tissue-mimicking phantom experiments and in vivo measurements on a human volunteer. This method of generating uncertainty estimates opens the door to several exciting possibilities. For example, the analytical form of the CRB calculation can be exploited to quickly generate “maps” of uncertainty estimates as a function of optical properties and spatial frequencies, thereby providing a tool that can be used to efficiently explore this trade space. The CRB-derived uncertainty estimates can also be propagated into chromophore uncertainty estimates. With knowledge of the spatial frequencies and wavelengths used for a given application, it is possible to pre-compute look-up tables of optical property and/or chromophore uncertainty estimates, which would be a significant advantage for applications requiring real-time performance. Diffuse reflectance uncertainty estimates can also be used to speed up optical property recovery with no performance penalty. We have developed a new algorithm to do this that in simulation performs equivalently to a standard look-up table-based approach employing linear interpolation but is up to ~200X faster (per pixel)

Diffuse optical spectroscopic imaging reveals distinct early breast tumor hemodynamic responses to metronomic and maximum tolerated dose regimens.

BACKGROUND:Breast cancer patients with early-stage disease are increasingly administered neoadjuvant chemotherapy (NAC) to downstage their tumors prior to surgery. In this setting, approximately 31% of patients fail to respond to therapy. This demonstrates the need for techniques capable of providing personalized feedback about treatment response at the earliest stages of therapy to identify patients likely to benefit from changing treatment. Diffuse optical spectroscopic imaging (DOSI) has emerged as a promising functional imaging technique for NAC monitoring. DOSI uses non-ionizing near-infrared light to provide non-invasive measures of absolute concentrations of tissue chromophores such as oxyhemoglobin. In 2011, we reported a new DOSI prognostic marker, oxyhemoglobin flare: a transient increase in oxyhemoglobin capable of discriminating NAC responders within the first day of treatment. In this follow-up study, DOSI was used to confirm the presence of the flare as well as to investigate whether DOSI markers of NAC response are regimen dependent. METHODS:This dual-center study examined 54 breast tumors receiving NAC measured with DOSI before therapy and the first week following chemotherapy administration. Patients were treated with either a standard of care maximum tolerated dose (MTD) regimen or an investigational metronomic (MET) regimen. Changes in tumor chromophores were tracked throughout the first week and compared to pathologic response and treatment regimen at specific days utilizing generalized estimating equations (GEE). RESULTS:Within patients receiving MTD therapy, the oxyhemoglobin flare was confirmed as a prognostic DOSI marker for response appearing as soon as day 1 with post hoc GEE analysis demonstrating a difference of 48.77% between responders and non-responders (p < 0.0001). Flare was not observed in patients receiving MET therapy. Within all responding patients, the specific treatment was a significant predictor of day 1 changes in oxyhemoglobin, showing a difference of 39.45% (p = 0.0010) between patients receiving MTD and MET regimens. CONCLUSIONS:DOSI optical biomarkers are differentially sensitive to MTD and MET regimens at early timepoints suggesting the specific treatment regimen should be considered in future DOSI studies. Additionally, DOSI may help to identify regimen-specific responses in a more personalized manner, potentially providing critical feedback necessary to implement adaptive changes to the treatment strategy

Feasibility of direct digital sampling for diffuse optical frequency domain spectroscopy in tissue

Frequency domain optical spectroscopy in the diffusive regime is currently being investigated for biomedical applications including tumor detection, therapy monitoring, exercise metabolism, and others. Analog homodyne or heterodyne detection of sinusoidally modulated signals have been the predominant method for measuring phase and amplitude of photon density waves that have traversed through tissue. Here we demonstrate the feasibility of utilizing direct digital sampling of modulated signals using a 3.6 Gigasample/second 12 bit Analog to Digital Converter. Digitally synthesized modulated signals between 50MHz and 400MHz were measured on tissue simulating phantoms at six near-infrared wavelengths. An amplitude and phase precision of 1% and 0.6 degrees were achieved during drift tests. Amplitude, phase, scattering and absorption values were compared with a well-characterized network analyzer based diffuse optical device. Measured optical properties measured with both systems were within 3.6% for absorption and 2.8% for scattering over a range of biologically relevant values. Direct digital sampling represents a viable method for frequency domain diffuse optical spectroscopy and has the potential to reduce system complexity, size, and cost

Educating educators for virtual schooling: Communicating roles and responsibilities

Abstract. New forms of electronic media have enabled the creation of virtual classrooms in K-12 schools across the U.S. The virtual schooling (VS) movement, in which courses are offered mostly or completely via distance technologies, is expanding rapidly, yet many educators who work in these environments receive little or no foundation for effectively communicating with students at a distance. This paper codifies our current thinking on communication demands for K-12 VS teachers, designers, and facilitators, and provides a conceptual framework to ground further research and development in this critical aspect of virtual schooling. Communication theories which have direct application to the design and implementation of VS can inform practice and enhance the experience of students and teachers who participate in this increasingly common educational option. In this paper we provide an overview of how communication theories can be applied as a lens to inform VS practice

High optode-density wearable diffuse optical probe for monitoring paced breathing hemodynamics in breast tissue

Significance: Diffuse optical imaging (DOI) provides in vivo quantification of tissue chromophores such as oxy- and deoxyhemoglobin ([Formula: see text] and HHb, respectively). These parameters have been shown to be useful for predicting neoadjuvant treatment response in breast cancer patients. However, most DOI devices designed for the breast are nonportable, making frequent longitudinal monitoring during treatment a challenge. Furthermore, hemodynamics related to the respiratory cycle are currently unexplored in the breast and may have prognostic value. Aim: To design, fabricate, and validate a high optode-density wearable continuous wave diffuse optical probe for the monitoring of breathing hemodynamics in breast tissue. Approach: The probe has a rigid-flex design with 16 dual-wavelength sources and 16 detectors. Performance was characterized on tissue-simulating phantoms, and validation was performed through flow phantom and cuff occlusion measurements. The breasts of [Formula: see text] healthy volunteers were measured while performing a breathing protocol. Results: The probe has 512 unique source–detector (S-D) pairs that span S-D separations of 10 to 54 mm. It exhibited good performance characteristics: [Formula: see text] drift of 0.34%/h, [Formula: see text] precision of 0.063%, and mean [Formula: see text] up to 41 mm S-D separation. Absorption contrast was detected in flow phantoms at depths exceeding 28 mm. A cuff occlusion measurement confirmed the ability of the probe to track expected hemodynamics in vivo. Breast measurements on healthy volunteers during paced breathing revealed median signal-to-motion artifact ratios ranging from 8.1 to 8.7 dB. Median [Formula: see text] and [Formula: see text] amplitudes ranged from 0.39 to [Formula: see text] and 0.08 to [Formula: see text] , respectively. Median oxygen saturations at the respiratory rate ranged from 82% to 87%. Conclusions: A wearable diffuse optical probe has been designed and fabricated for the measurement of breast tissue hemodynamics. This device is capable of quantifying breathing-related hemodynamics in healthy breast tissue

Tissue phantoms in multicenter clinical trials for diffuse optical technologies

Tissue simulating phantoms are an important part of instrumentation validation, standardization/training and clinical translation. Properly used, phantoms form the backbone of sound quality control procedures. We describe the development and testing of a series of optically turbid phantoms used in a multi-center American College of Radiology Imaging Network (ACRIN) clinical trial of Diffuse Optical Spectroscopic Imaging (DOSI). The ACRIN trial is designed to measure the response of breast tumors to neoadjuvant chemotherapy. Phantom measurements are used to determine absolute instrument response functions during each measurement session and assess both long and short-term operator and instrument reliability

Compressive remodeling alters fluid transport properties of collagen networks - implications for tumor growth

Biomechanical alterations to the tumor microenvironment include accumulation of solid stresses, extracellular matrix (ECM) stiffening and increased fluid pressure in both interstitial and peri-tumoral spaces. The relationship between interstitial fluid pressurization and ECM remodeling in vascularized tumors is well characterized, while earlier biomechanical changes occurring during avascular tumor growth within the peri-tumoral ECM remain poorly understood. Type I collagen, the primary fibrous ECM constituent, bears load in tension while it buckles under compression. We hypothesized that tumor-generated compressive forces cause collagen remodeling via densification which in turn creates a barrier to convective fluid transport and may play a role in tumor progression and malignancy. To better understand this process, we characterized the structure-function relationship of collagen networks under compression both experimentally and computationally. Here we show that growth of epithelial cancers induces compressive remodeling of the ECM, documented in the literature as a TACS-2 phenotype, which represents a localized densification and tangential alignment of peri-tumoral collagen. Such compressive remodeling is caused by the unique features of collagen network mechanics, such as fiber buckling and cross-link rupture, and reduces the overall hydraulic permeability of the matrix.R01 HL098028 - NHLBI NIH HHS; U01 CA202123 - NCI NIH HHSPublished versio

Tissue Oxygen Saturation Predicts Response to Breast Cancer Neoadjuvant Chemotherapy within 10 Days of Treatment

Ideally, neoadjuvant chemotherapy (NAC) assessment should predict pathologic complete response (pCR), a surrogate clinical endpoint for 5-year survival, as early as possible during typical 3- to 6-month breast cancer treatments. We introduce and demonstrate an approach for predicting pCR within 10 days of initiating NAC. The method uses a bedside diffuse optical spectroscopic imaging (DOSI) technology and logistic regression modeling. Tumor and normal tissue physiological properties were measured longitudinally throughout the course of NAC in 33 patients enrolled in the American College of Radiology Imaging Network multicenter breast cancer DOSI trial (ACRIN-6691). An image analysis scheme, employing z-score normalization to healthy tissue, produced models with robust predictions. Notably, logistic regression based on z-score normalization using only tissue oxygen saturation (StO2) measured within 10 days of the initial therapy dose was found to be a significant predictor of pCR (AUC  =  0.92; 95% CI: 0.82 to 1). This observation suggests that patients who show rapid convergence of tumor tissue StO2 to surrounding tissue StO2 are more likely to achieve pCR. This early predictor of pCR occurs prior to reductions in tumor size and could enable dynamic feedback for optimization of chemotherapy strategies in breast cancer

Multispectral optical imaging device for in vivo detection of oral neoplasia

A multispectral digital microscope (MDM) is designed and constructed as a tool to improve detection of oral neoplasia. The MDM acquires in vivo images of oral tissue in fluorescence, narrow-band (NB) reflectance, and orthogonal polarized reflectance (OPR) modes, to enable evaluation of lesions that may not exhibit high contrast under standard white light illumination. The device rapidly captures image sequences so that the diagnostic value of each modality can be qualitatively and quantitatively evaluated alone and in combination. As part of a pilot clinical trial, images are acquired from normal volunteers and patients with precancerous and cancerous lesions. In normal subjects, the visibility of vasculature can be enhanced by tuning the reflectance illumination wavelength and polarization. In patients with histologically confirmed neoplasia, we observe decreased blue/green autofluorescence and increased red autofluorescence in lesions, and increased visibility of vasculature using NB and OPR imaging. The perceived lesion borders change with imaging modality, suggesting that multimodal imaging has the potential to provide additional diagnostic information not available using standard white light illumination or by using a single imaging mode alone.NIH (R21 DE 16485; R01 CA 103830