Bioterrorism is no longer a hypothetical construct but a reality. Nevertheless, disease detection and intervention currently remain largely reliant on clinical assessment. Technology providing early detection of disease could impact the care of individual patients and the evolution of epidemic spread. Hyperspectral Imaging (HSI) is a remote sensing technology developed originally by the Department of Defense that combines high-resolution imaging with chemical spectroscopy. In other medical applications HSI is emerging as a new means of early or more sensitive detection of changes in tissue that can be used to define pathology, predict clinical outcomes and adapt therapy. As a small, robust, camera based, non-invasive device, HSI may be well suited to aid in defense against biological warfare or epidemic disease by providing early detection or confirmation of disease and by monitoring the efficacy of vaccination or therapy. Crossover applications exist in the evaluation and treatment of emerging diseases. HSI is well suited to be a screening tool to provide earlier or more accurate detection of disease in an at risk population to better treat and contain disease.
Hyperspectral (HS) imaging has been useful in the monitoring of several medical conditions, which to date have generally involved changes in skin oxygenation in isolated regions of interest such as skin flaps or small burns. Here, by contrast, we present a study in which HSI was used to assess the cutaneous manifestations of significant systemic events. HS imaging of the ventral surface of the lower jaw was used to monitor changes in skin oxygenation during hypovolemic shock induced by pulmonary contusion and hemorrhage in a porcine model, and to monitor the subsequent recovery of oxygenation following resuscitation. Changes are seen both quantitatively, in the level of skin oxygenation as determined by the fitting of reference hemoglobin and deoxyhemoglobin spectra to sample spectra, and qualitatively, in the observed spatial distribution or pattern of oxygenation-related changes in the skin. Linear regression was used to correlate these changes with invasively obtained parameters to include mixed venous oxygen saturation and systemic arterial blood pressure. Historically, the assessment of skin color and mottling has been an important, albeit inexact, component of resuscitation algorithms. Now, it is possible to analyze these variables during shock and resuscitation in an objective manner. The clinical utility of these advances needs to be determined.
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