KEYWORDS: Oxygen, Photodynamic therapy, Dosimetry, Signal detection, Picosecond phenomena, Tissues, Luminescence, In vivo imaging, In vitro testing, Algorithm development
This study presents our implementation of a multi-channel device for continuous singlet oxygen luminescent dosimetry (CSOLD) signal acquisition using multiple InGaAs detectors connected to individual narrow band filters (1200 nm, 1240 nm, 1250 nm, 1270 nm, and 1300 nm) during PDT. An algorithm is developed to extrapolate various components from the raw multi-channel data.
The application of Photodynamic (PDT) for malignant pleural mesothelioma (MSM) is complex due to post-surgery alteration. To address this issue of calculating dose for complex anatomical geometries, our study utilized advanced digital technologies to construct and analyze 3D models of the human lung pleural cavity. This study aims to support a translational model that will eventually enhance PDT dose delivery while minimizing effects on surrounding healthy tissues. The pleural cavity geometries were digitally extracted from medical CT scans, transformed into stereolithography (STL) files, and 3D-printed using acrylic resins. Three volumes corresponding to small, medium, and large patient sizes were prepared. Each model was asymmetrically coated with non-reflective adhesive paper to mimic realistic conditions. Data capture utilized a single handheld scanning device operating at distances to accommodate generalized and refined detail capture. This approach enabled the precise capture of internalized cavity shapes and critical asymmetries. Medical CT validated all 3D printed models. The results confirmed the precise generation and capture of multiple asymmetric 3D human cavity models in actual size. The proposed workflow shows potential for clinicians to accurately map post-surgical pleural cavity changes, thereby improving PDT light dose delivery. This could enhance treatment efficacy and patient outcomes, underlining the potential of digital technology in advancing precision oncology and integration into future clinical practice.
Intraoperative photodynamic therapy (PDT) has proven effective in treating malignant pleural mesothelioma. Achieving uniform light dose delivery is vital for its efficiency. Currently, eight light detectors are placed inside the pleural cavity to monitor light distribution. To enhance this process, an updated navigation system, combined with a novel scanning system, has been developed to provide real-time guidance to physicians during pleural PDT, thereby improving light delivery. The scanning system incorporates two handheld three-dimensional (3D) scanners, enabling rapid and precise capture of the pleural cavity's surface topography before PDT. This allows for identification of the target surface for real-time calculation of light fluence distribution during treatment. An algorithm has been devised to further process the scanned volume, facilitating continuous tracking of the light source position within the pleural cavity throughout the treatment process. During PDT, real-time 3D and 2D visualizations of the light source position, scanned pleural cavity, and light fluence distribution across the entire cavity's surface are displayed, providing physicians with invaluable guidance to enhance overall treatment efficiency. To validate the system, phantom studies were conducted using three newly 3D-printed lung phantoms of varying volumes based on individual CT scans. A set of liquid tissue-simulating phantoms with different combinations of optical properties (μa, μs') was utilized for improved clinical simulation. These lung phantoms, designed to mimic surgical conditions, feature side openings similar to the actual surgery and are treated with eight isotropic detectors fixed on the inner surface at positions predetermined by the physician.
Photodynamic therapy (PDT) is employed following surgical resection to address microscopic residual malignant pleural mesothelioma. The generation of singlet oxygen during PDT induces the death of cancer cells. Precise dosimetry plays a pivotal role in ensuring treatment efficacy. This study sought to model the distribution of reacted singlet oxygen ([1O2]rx) on the surface of the pleural cavity using patient-specific data acquired in a clinical setting for Photofrin-mediated PDT. Cavity geometry was obtained using an infrared camera-based navigation system during surgery, and Photofrin concentration was measured using a multi-fiber contact probe. Light fluence was calculated based on the cavity geometry and the position of the treatment wand. The COMSOL Multiphysics software simulated the distribution of [1O2]rx using the measured geometry, Photofrin concentration, and light fluence data. Models comparing homogeneous and heterogeneous Photofrin uptake were examined, revealing that [1O2]rx increased proportionally to the Photofrin concentration in both scenarios. The aim of this research is to account for heterogeneity and optimize treatment outcomes by incorporating real patient data into the model. Monitoring under- and over-exposed regions could potentially enhance treatment efficacy. The findings demonstrate the feasibility of employing explicit dosimetry for pleural PDT. Future investigations will concentrate on real-time modeling through the integration of patient data obtained during treatment. Explicit dosimetry holds the potential to provide accurate dosing, thereby maximizing treatment effectiveness and improving patient outcomes. This patient-specific modeling approach could be extended to PDT in other anatomical locations where a reconstructed treated cavity is available.
Direct detection of singlet-state oxygen ([1O2]) is a crucial objective in type II photodynamic therapy (PDT), achievable through the implementation of multispectral singlet oxygen dosimetry (MSOLD). To accurately assess the amount of reactive singlet oxygen, the Singlet Oxygen Explicit Dosimetry (SOED) model was developed, incorporating parameters such as light fluence rate, photosensitizer concentration, and ground-state oxygen concentration. This study focuses on comparing the results obtained from MSOLD and SOED by measuring the singlet oxygen signal via a commercial InGaAs spectrometer and subsequently calculating reactive singlet oxygen based on the SOED theory. A continuous-wave laser emitting at 630nm is employed to excite Protoporphyrin IX (PPIX) in methanol, varying the concentration from 10mg/kg to 100mg/kg. Utilizing the Singular Value Decomposition (SVD) algorithm, the measured singlet oxygen spectrum is fitted to extract the singlet oxygen signal. To simulate clinical PDT scenarios, real-time singlet oxygen spectra are collected over 1200 seconds, employing a 1.5mm diameter optic fiber for signal collection. Ground-state oxygen concentration is measured using a commercial oxygen probe while the laser is inactive, and photosensitizer concentration is assessed via a custom-made contact probe. Additionally, the fluence rate of the laser is measured using an isotropic detector. The Reactive Singlet Oxygen is then calculated using the SOED model, incorporating the photosensitizer concentration, oxygen concentration, and photon fluence rate. Detailed comparisons between MSOLD and SOED results are presented, offering valuable insights into the accuracy and reliability of both methods in quantifying singlet-state oxygen during PDT.
KEYWORDS: Oxygen, Monte Carlo methods, Optical properties, Signal detection, Absorption, Photodynamic therapy, Luminescence, Singular value decomposition
Photodynamic therapy (PDT) is a promising cancer treatment modality that involves the administration of a photosensitizing agent followed by light activation at a specific wavelength. Upon activation, the photosensitizer generates reactive oxygen species, including singlet-state oxygen ([1O2]), which causes cellular damage leading to cancer cell death. Direct detection of singlet-state oxygen constitutes the holy grail dosimetric method for type II PDT, a goal that can be quantified using multispectral singlet oxygen dosimetry (MSOLD). The optical properties of tissues, specifically their scattering and absorption coefficients, play a crucial role in determining how light interacts within a medium. Variations in these optical properties can significantly impact various aspects, including the distribution of treatment laser, the generation of singlet oxygen, and the detection of singlet oxygen signals using the MSOLD device. In this study, we have investigated the influence of optical properties variation on the spatial distribution of treatment laser energy in tissue simulated phantom and the distribution of generated singlet oxygen signals using Monte Carlo simulations (MC). Additionally, we conducted a comparative analysis by examining singlet oxygen signals generated by Photofrin in MeOH, as detected by an InGaAs spectrometer in vitro, and compared these results to our Monte Carlo simulations. The experimental findings validate the accuracy of our Monte Carlo simulations, further affirming the robustness of our research. Our research advanced the comprehension of singlet oxygen generation and enhanced the accuracy of singlet oxygen detection using the MSOLD device, especially when optical properties undergo changes.
SignificancePhotodynamic therapy (PDT) is an established cancer treatment utilizing light-activated photosensitizers (PS). Effective treatment hinges on the PDT dose-dependent on PS concentration and light fluence-delivered over time. We introduce an innovative eight-channel PDT dose dosimetry system capable of concurrently measuring light fluence and PS concentration during treatment.AimWe aim to develop and evaluate an eight-channel PDT dose dosimetry system for simultaneous measurement of light fluence and PS concentration. By addressing uncertainties due to tissue variations, the system enhances accurate PDT dosimetry for improved treatment outcomes.ApproachThe study positions eight isotropic detectors strategically within the pleural cavity before PDT. These detectors are linked to bifurcated fibers, distributing signals to both a photodiode and a spectrometer. Calibration techniques are applied to counter tissue-related variations and improve measurement accuracy. The fluorescence signal is normalized using the measured light fluence, compensating for variations in tissue properties. Measurements were taken in 78 sites in the pleural cavities of 20 patients.ResultsObservations reveal minimal Photofrin concentration variation during PDT at each site, juxtaposed with significant intra- and inter-patient heterogeneities. Across 78 treated sites in 20 patients, the average Photofrin concentration for all 78 sites is 4.98 μM, with a median concentration of 4.47 μM. The average PDT dose for all 78 sites is 493.17 μMJ/cm2, with a median dose of 442.79 μMJ/cm2. A significant variation in PDT doses is observed, with a maximum difference of 3.1 times among all sites within one patient and a maximum difference of 9.8 times across all patients.ConclusionsThe introduced eight-channel PDT dose dosimetry system serves as a valuable real-time monitoring tool for light fluence and PS concentration during PDT. Its ability to mitigate uncertainties arising from tissue properties enhances dosimetry accuracy, thus optimizing treatment outcomes and bolstering the effectiveness of PDT in cancer therapy.
We have developed a novel scanning protocol for a life-sized human phantom model using handheld threedimensional (3D) surface acquisition devices. This technology will be utilized to develop light fluence modeling of the internal pleural cavity space during Photodynamic Therapy (PDT) of malignant mesothelioma. The external aspect of the chest cavity phantom was prefabricated of a hardened synthetic polymer resembling ordinary human anatomy (pleural cavity space) and the internal aspect remained hollow without any characterizations. Both surfaces were layered with non-reflective adhesive paper to create non-uniformed surface topographies. These surface characteristics were established in randomized X-Y-Z coordinates ranging in dimensions from 1-15mm. This protocol utilized the handheld Occipital Scanner and the MEDIT i700. The Occipital device required a minimum scanner-to-surface distance of 24cm and the MEDIT device 1cm respectively. The external and internal aspects of the phantom model were successfully scanned acquiring digital measurements in actual value and converted into a digital image file. The initial surface rendering was acquired by the Occipital device and applied with proprietary software to guide the MEDIT device to fill voided areas. This protocol is accompanied by a visualization tool that allows for real-time inspection of surface acquisition in 2D and 3D. This scanning protocol can be utilized to scan the pleural cavity for real-time guidance for light fluence modeling during PDT, which will be expanded to ongoing clinical trials.
Direct detection of singlet-state oxygen ([1O2]) constitutes the holy grail dosimetric method for type II PDT, a goal that can be quantified using multispectral singlet oxygen dosimetry (MSOLD). However, the short lifetime and extremely weak nature of the singlet oxygen signal produced has given rise to a need to improve MSOLD signal-to-noise ratio. This study examines methods for optimizing MSOLD signal acquisition, specifically employing an orthogonal arrangement between detection and PDT treatment light, consisting of two fiber optics - connected to a 632-nm laser and an InGaAs detector respectively. Light collected by the InGaAs detector is then passed through a filter wheel, where spectral emission measurements are taken at 1200 nm, 1240 nm, 1250 nm, 1270 nm, and 1300 nm. The data, after fitting to the fluorescence background and a gaussian-fit for the singlet oxygen peak, is established for the background-subtracted singlet oxygen emission signal. The MSOLD signal is then compared with the singlet oxygen explicit dosimetry (SOED) results, based on direct measurements of in-vivo light fluence (rate), in-vivo Photofrin concentration, and tissue oxygenation concentration. This study focuses on validating the sensitivity and minimum detectability of MSOLD signal in various in-vitro conditions. Finally, the MSOLD device will be tested in Photofrin-mediated PDT for mice bearing Radiation- Induced Fibrosarcoma (RIF) tumors.
Photodynamic therapy (PDT) has been used intraoperatively to treat patients with malignant pleural mesothelioma. For the efficiency of PDT, it is crucial to deliver light doses uniformly. The current procedure utilizes eight light detectors placed inside the pleural cavity to monitor the light. An updated navigation system, combined with a novel scanning system, is developed to provide real-time guidance for physicians during pleural PDT to improve light delivery. The scanning system consists of two handheld three-dimensional (3D) scanners to capture the pleural cavity's surface topographies quickly and precisely before PDT so that the target surface can be identified for real-time light fluence distribution calculation during PDT. An algorithm is developed to further process the scanned volume to denoise for accurate light fluence calculation and rotate the local coordinate system into any desired direction for a clear visualization during the real-time guidance. The navigation coordinate system is registered to the patient coordinate system utilizing at least three markers to track the light source point position within the pleural cavity throughout the treatment. During PDT, the light source position, the scanned pleural cavity, and the light fluence distribution for the cavity's surface will be displayed in 3D and 2D, respectively. For validation, this novel system is tested using phantom studies with a large chest phantom and 3D-printed lung phantoms of different volumes based on a personal CT scan, immersed in a liquid tissue-simulating phantom with different optical properties, and treated with eight isotropic detectors and the navigation system.
Photodynamic therapy (PDT) is an established modality for cancer treatment, and reactive oxygen species explicit dosimetry (ROSED), based on direct measurements of in-vivo light fluence (rate), in-vivo photofrin concentration, and tissue oxygenation concentration, has been proved to provide the best dosimetric quantity which can be used to predict non-fractionated PDT outcome. This study performed ROSED for Photofrin-mediated PDT for mice bearing radiation-induced fibrosacorma (RIF) tumor. As demonstrated by our previous study, fractionated PDT with a 2-hour time interval can significantly improve the long-term cure rate (from 15% to 65% at 90 days), and it tends to increase as the light dose for the first light fraction gets larger. This study focused on further improving the long-term cure rate without introducing apparent toxicity using combinations of different first light fraction lengths and total light fluences. Photofrin was injected through the mouse tail vein at a concentration of 5 mg/kg. After 18~24 hours, treatment was delivered with a collimated laser beam of 1 cm diameter at 630 nm. Mice were treated using two fractions of light fluences with a 2-hour dark interval. Different dose metrics were quantified, including light fluence, PDT dose, and [ROS]rx. In addition, the total reacted [ROS]rx and treatment outcomes were evaluated and compared to identify the optimal light fraction length and total light fluence.
We developed a simulation method for modeling the light fluence delivery in intracavity Photodynamic Therapy (icav-PDT) for pleural lung cancer using a moving light source. Due to the large surface area of the pleural lung cavity, the light source needs to be moved to deliver a uniform dose around the entire cavity. While multiple fixed detectors are used for dosimetry at a few locations, an accurate simulation of light fluence and fluence rate is still needed for the rest of the cavity. We extended an existing Monte Carlo (MC) based light propagation solver to support moving light sources by densely sampling the continuous light source trajectory and assigning the proper number of photon packages launched along the way. The performance of Simphotek GPU CUDA-based implementation of the method – PEDSy-MC – has been demonstrated on a life-size lung-shaped phantom, custom printed for testing icav-PDT navigation system at the Perlman School of Medicine (PSM) – calculations completed under a minute (for some cases) and within minutes have been achieved. We demonstrate results within a 5% error of the analytic solution for multiple detectors in the phantom. PEDSy-MC is accompanied by a dose-cavity visualization tool that allows real-time inspection of dose values of the treated cavity in 2D and 3D, which will be expanded to ongoing clinical trials at PSM. PSM has developed a technology to measure 8-detectors in a pleural cavity phantom using Photofrin-mediated PDT that has been used during validation.
Photodynamic therapy (PDT) is an established modality for cancer treatment and reactive oxygen species explicit dosimetry (ROSED), based on direct measurements of in-vivo light fluence (rate), in-vivo photofrin concentration, and tissue oxygenation concentration, has been proved to be an effective dosimetric quantity which can be used to predict PDT outcome. In this study, ROSED was performed for photofrin-mediated PDT for mice bearing radiation-induced fibrosacorma (RIF) tumor. PDT treatments were performed using single or fractionated illumination to a same total fluence of 135 Jcm-2. The effects of light fractionation on the total reacted [ROS]rx and treatment outcomes were evaluated.
Accurate dosimetry is crucial for the ongoing development and clinical study of photodynamic therapy (PDT). Current dosimetry standards range from less accurate methods involving measurement of only light fluence and photosensitizer concentration during treatment, to significantly improved methods such as singlet oxygen explicit dosimetry (SOED), a macroscopic model that includes an additional important parameter in its dosimetric calculations: ground-state oxygen concentration ([3O2]). However, neither of these models is a method of direct dosimetry. Multispectral singlet oxygen luminescence dosimetry (MSOLD) shows promise in this regard but requires significant improvement in signal quality and remains to be validated in a clinical setting. In this study, we validate a linearly increasing MSOLD signal with an InGaAs photodiode detector for increasing concentration (0 mg/kg to 200 mg/kg) in tissue-simulating phantoms containing photofrin, calculating a calibration curve based on 1270 nm peak-intensity signal and area under the curve for backgroundsubtracted singlet oxygen emission. Additionally, we validate MSOLD against the current clinical dosimetry standard, SOED, through simultaneous measurement of SOED parameters and MSOLD signal for varying concentrations (50 μM – 500 μM). Finally, we investigate the effects of using very high gain amplification on InGaAs photodiode detectors to amplify the MSOLD signal for use in clinical models. We show that a calibration curve relating photosensitizer concentration (PS) and MSOLD signal can be established. Additionally, we demonstrate good correlation between MSOLD signal and SOED-calculated [1O2]rx. However, we show that when using high amplification on InGaAs photodiodes for long illumination times, the inherent instability in these detectors becomes apparent.
PDT dose is the product of the photosensitizer concentration and the light fluence in the target tissue. For improved dosimetry during plural photodynamic therapy (PDT), an eight-channel PDT dose dosimeter was developed to measure both the light fluence and the photosensitizer concentration simultaneously from eight different sites in the pleural cavity during PDT. An isotropic detector with bifurcated fibers was used for each channel to ensure detected light was split equally to the photodiode and spectrometer. The light fluence rate distribution is monitored using an IR navigation system. The navigation system allows 2D light fluence mapping throughout the whole pleural cavity rather than just the selected points. The fluorescence signal is normalized by the light fluence measured at treatment wavelength. We have shown that the absolute photosensitizer concentration can be obtained by applying optical properties correction and linear spectral fitting to the measured fluorescence data. The detection limit and the optical property correction factor of each channel were determined and validated using tissue-simulating phantoms with known varying concentration of Photofrin. Tissue optical properties are determined using an absorption spectroscopy probe immediately before PDT at the same sites. The combination of 8-channel PDT dosimeter system and IR navigation system, which can calculate light fluence rate in the pleural cavity in real-time, providing a mean to determine the distribution of PDT dose on the entire pleural cavity to investigate the heterogeneity of PDT dose on the pleural cavity.
Total Skin Electron Therapy (TSET) utilizes high-energy electrons to treat cancers on the entire body surface. The otherwise invisible radiation beam can be observed via the optical Cherenkov photons emitted from interaction between the high-energy electron beam and tissue. Cherenkov emission can be used to evaluate the dose uniformity on the surface of the patient in real-time using a time-gated intensified camera system. Each patient was monitored during TSET by in-vivo detectors (IVD) as well as Scintillators. Patients undergoing TSET in various conditions (whole body and half body) were imaged and analyzed. A rigorous methodology for converting Cherenkov intensity to surface dose as products of correction factors, including camera vignette correction factor, incident radiation correction factor, and tissue optical properties correction factor. A comprehensive study has been carried out by inspecting various positions on the patients such as vertex, chest, perineum, shins, and foot relative to the umbilicus point (the prescription point).
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