Department of Radiology, Washington University, St. Louis, MO; Department of Biomedical Engineering, Washington University, St. Louis, MO.
Surgery. 2011 May;149(5):689-98. doi: 10.1016/j.surg.2011.02.007.
Current cancer management faces several challenges, including the occurrence of a residual tumor after resection, the use of radioactive materials or high concentrations of blue dyes for sentinel lymph node biopsy, and the use of bulky systems in surgical suites for image guidance. To overcome these limitations, we developed a real-time, intraoperative imaging device that, when combined with near infrared fluorescent molecular probes, can aid in the identification of tumor margins, guide surgical resections, map sentinel lymph nodes, and transfer acquired data wirelessly for remote analysis.
We developed a new compact, wireless, wearable, and battery-operated device that allows for hands-free operation by surgeons. A charge-coupled device-based, consumer-grade night vision viewer was used to develop the detector portion of the device, and the light source portion was developed from a compact headlamp. This piece was retrofitted to provide both near infrared excitation and white light illumination simultaneously. Wireless communication was enabled by integrating a battery-operated, miniature, radio-frequency video transmitter into the system. We applied the device in several types of oncologic surgical procedures in murine models, including sentinel lymph node mapping, fluorescence-guided tumor resection, and surgery under remote expert guidance.
Unlike conventional imaging instruments, the device displays fluorescence information directly on its eyepiece. When employed in sentinel lymph node mapping, the locations of sentinel lymph nodes were visualized clearly, even with tracer level dosing of a near infrared fluorescent dye (indocyanine green). When used in tumor resection, tumor margins and small nodules invisible to the naked eye were visualized readily. In a simulated, point-of-care setting, tumors were located successfully and removed under remote guidance using the wireless feature of the device. Importantly, the total cost of this prototype system ($1200) is substantially less than existing imaging instruments.
Our results demonstrate the feasibility of using the new device to aid surgical resection of tumors, map sentinel lymph nodes, and facilitate telemedicine.
当前的癌症治疗面临着多种挑战，包括切除后残余肿瘤的发生、放射性材料或高浓度蓝色染料在示踪淋巴结活检中的应用，以及手术室内笨重系统在图像引导中的应用。为了克服这些局限性，我们开发了一种实时、术中成像设备，当与近红外荧光分子探针结合使用时，可以帮助识别肿瘤边缘、指导手术切除、定位前哨淋巴结，并将获得的数据无线传输以供远程分析。
我们开发了一种新的紧凑、无线、可穿戴和电池供电的设备，使外科医生能够实现免提操作。基于电荷耦合器件的消费级夜视仪被用于开发设备的探测器部分，光源部分则由紧凑型头灯开发而成。这部分被改装为同时提供近红外激发和白光照明。通过将一个电池供电的微型射频视频发射器集成到系统中，实现了无线通信。我们在几种类型的肿瘤手术模型中应用了该设备，包括前哨淋巴结定位、荧光引导肿瘤切除以及远程专家指导下的手术。
与传统成像仪器不同，该设备直接在目镜上显示荧光信息。在进行前哨淋巴结定位时，即使使用近红外荧光染料（吲哚菁绿）的示踪剂剂量，也能清晰地显示前哨淋巴结的位置。在肿瘤切除中，能够轻易地看到肉眼看不见的肿瘤边缘和小结节。在模拟的即时护理环境中，成功地使用设备的无线功能定位和切除了肿瘤。重要的是，该原型系统的总成本（1200 美元）远低于现有成像仪器。
我们的结果表明，使用新设备辅助肿瘤切除、定位前哨淋巴结和促进远程医疗是可行的。
