An Atlas of Optical Coherence Tomography (OCT): Elucidating In Vivo Differences of Scar Types Using OCT in Order to Guide Laser Treatment Parameters
Objective. When using laser therapy to effectively treat scars, the choice of treatment parameters depends on the knowledge accuracy of the underlying scar pathology, which is often difficult to judge by gross physical exam. As such, more quantitative measures are needed. In recent years, optical coherencetomography (OCT) has shown promise as a real-time imaging technology of skin microstructure. A key step in developing a methodology for utilizing OCT to develop a comprehensive ‘atlas’ of OCT characteristics of a wide variety of scar types. This atlas may then be used as a tool for selecting the optimal treatment modality and parameters for each scar type. Methods. One hundred and fifty scars of a wide range of anatomical locations were imaged using OCT, capturing both vascular and structural data. A variety of scar etiologies (e.g. burn, surgical, traumatic) and types (e.g. hypertrophic, keloidal, atrophic) were included. Comparator scans were also taken from normal, unscarred ski...
Michelson Diagnostics OCT points to reduced invasive biopsies
A clinical study published in The Lancet Oncology has evaluated the potential value of OCT technology in the treatment and care of basal cell carcinomas (BCC). The trial compared OCT-guided diagnosis of skin lesions with the standard punch biopsies in which small tissue samples are removed using a circular surgical instrument. The VivoSight OCT platform from Michelson Diagnostics was employed in the study, which involved 598 enrolled participants in the Netherlands. VivoSight is a multi-beam OCT platform employing light beams focused at different depths, designed to provide clinicians with continuous images of the epidermis and superficial dermis of the skin. The swept-source frequency-domain architecture operates at 1305 nanometers and achieves optical resolution of 7.5 microns in lateral and 5 microns in axial directions, according to the developers. The platform scans a 6 x 6 millimeter patch of skin and produces up to 500 cross-sectional slices per scan. The recent trial builds ...
66% of diagnostic biopsies for common skin cancer can be avoided using Michelson Diagnostics’ VivoSight OCT laser scanner
A major study published in leading cancer journal, The Lancet Oncology 1 have ground-breaking findings on Michelson Diagnostics, the UK based medical device company that use multi-beam Optical Coherence Tomography ('OCT') technology, which can transform patient's treatment and care of basal cell carcinomas (BCC). It was concluded that OCT-guided diagnosis, when compared to a standard punch biopsy could reduce the number of consultations and invasive procedures by a massive 66%. Professor Klara Mosterd performing an OCT scan on a patient’s lesion. Stitched skin biopsy wound Approximately 75% of skin cancers diagnosed in the UK are basal cell carcinomas 2 . It is the most common form of skin cancer that is rapidly increasing, with it affecting one in five people in the white population in their lifetime 3 . Annually, there are at least 150,000 cases in the UK and the number is growing, due to an aging population and sun exposure trends, creating a major burden on the NHS. OCT is an ad...
Examination of Subungual Hematomas and Subungual Melanocytic Lesions by Using Optical Coherence Tomography and Dermoscopy
Introduction: Examination of subungual pigmented lesions is sometimes a diagnostic challenge for clinicians. Objectives: The study was aimed to investigate characteristic patterns in optical coherence tomography (OCT) of subungual hematomas and determine distinctive features that can differentiate them from subungual melanocytic lesions. Methods: VivoSight® (Michelson Diagnostics, Maidstone, UK) was used to examine 71 subungual hematomas and 11 subungual melanocytic lesions in 69 patients (18 female and 51 male patients). Results: On OCT, bleeding was related to sharply defined black sickle-shaped ( p < 0.001) or globular regions (not significant [ns]) with a hyperreflective margin (0.002), a grey center (0.013), hyperreflective lines in the area (ns) or periphery ( p = 0.031), peripheral fading ( p = 0.029), and red dots in the area ( p = 0.001). In the 1 case of melanoma in situ examined, we found curved vessels with irregular sizes and distribution on the dermis of the nailbed...
Research Techniques Made Simple: Emerging Imaging Technologies for Noninvasive Optical Biopsy of Human Skin
Over the past few years, high-resolution optical imaging technologies such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM), and multiphoton microscopy (MPM) have advanced significantly as new methodologies for clinical research and for real-time detection, diagnosis, and therapy monitoring of skin diseases. Implementation of these technologies into clinical research and practice requires clinicians to have an understanding of their capabilities, benefits, and limitations. This concise review provides insights on the application of OCT, RCM, and MPM for clinical skin imaging through images acquired in vivo from the same lesions. The presented data are limited to pigmented lesions and basal cell carcinoma.
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OCT-guided hyperthermic treatment noninvasive option for superficial basal cell carcinoma
OCT-guided and temperature-controlled hyperthermic treatment could be a safe, noninvasive alternative to surgical tumor removal in superficial basal cell carcinoma , according to a presentation of preliminary data.“The purpose of this study is to optimize hyperthermic treatment of BCC with laser technology under the guidance of optical coherence tomography and near-infrared temperature monitoring,” Erica G. Baugh, BA, a medical student at University of California, Irvine, said at the American Society for Dermatology Surgery virtual meeting.Researchers plan to enroll 40 subjects in the study, of which six have already begin treatment with Controlled Hyperthermic and Mapped Protocol (CHAMP).Subjects with ...
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Optical-Coherence Tomography for the Non-invasive Diagnosis and Subtyping of Basal Cell Carcinoma
To date, the diagnosis and subtyping of basal cell carcinoma (BCC) is verified with histopathology which requires a biopsy. Because this technique is invasive, new non-invasive strategies have been developed, including Optical Coherence Tomography (OCT). This innovative technique enables microscopically detailed examination of lesions, which is useful for diagnosing and identification of various subtypes of BCC. The diagnostic value of the VIVOSIGHT OCT in daily clinical practice, has not been established to date.
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Vascular characteristics of port wine birthmarks as measured by dynamic optical coherence tomography
Background: Port wine birthmarks (PWB) are congenital capillary malformations. Vessel characteristics, such as diameter and depth, may impact presentation and outcomes. They can be imaged using dynamic optical coherence tomography (D-OCT), a high-resolution, non-invasive imaging method. Purpose: We conducted a cross-sectional observational study to measure in-vivo vascular characteristics as a function of PWB color. Methods: Patients undergoing treatment for PWB were recruited from three sites. PWB were classified by color, and D-OCT images with calculations were obtained. Results: 108 patients were enrolled. Mean age correlated with PWB color, with younger patients having lighter and older patients having darker birthmarks (p<0.01). Purple PWB had significantly shallower mean superficial plexus depth than pink PWB. Color was not associated with significant differences in mean superficial vessel density or diameter. Among pink PWB, each 10-year increase in age was associated with...
Blood Vessel Density Measured Using Dynamic Optical Coherence Tomography is a Tool for Wound Healers
Dynamic optical coherence tomography (D-OCT) is a relatively new technique that may be used to study the substructures in the retina, in the skin and its microcirculation. Furthermore, D-OCT is a validated method of imaging blood flow in skin microcirculation. The skin around venous and mixed arterio-venous ulcers was imaged and found to have tortuous vessels assumed to be angiogenic sprouts, and classified as dots, blobs, coils, clumps, lines, and curves. When these images were analyzed and measurements of vessel density were made, it was observed that the prevalence of coils and clumps in wound borders was significantly greater compared with those at wound centers. This reinforced the belief of inward growth of vessels from wound edge toward wound center which, in turn, reposed confidence in following the wound edge to study healing. D-OCT imaging permits the structure and the function of the microcirculation to be imaged, and vessel density measured. This offers a new vista of sk...
Assessing the Outcomes of Focused Heating of the Skin by a Long-Pulsed 1064 nm Laser with an Integrated Scanner, Infrared Thermal Guidance, and Optical Coherence Tomography
Background and Objective Long‐term benefits can be predicted by the incorporation of more intelligent systems in lasers and other devices. Such systems can produce more reliable zones of thermal injury when used in association with non‐invasive monitoring and precise laser energy delivery. The more classical endpoint of tumor destruction with radiofrequency or long‐pulsed (LP) 1064 nm laser is the non‐specific appearance of tissue graying and tissue contraction. Herein we discuss combining non‐invasive LP 1064 nm Nd:YAG treatment with the assistance of optical coherence tomography (OCT) and the forward‐looking infrared (FLIR) thermal camera while testing literature‐based formulae for thermal destruction. Study Design/Materials and Methods The skin on the forearm and back of two consenting volunteers was marked and anesthetized with lidocaine with epinephrine. The parameters of a scanner‐equipped LP 1064 nm Nd:YAG laser were adjusted to achieve an epidermal/superficial dermal heating...
Processing optical coherence tomography scans
A method of processing optical coherence tomography (OCT) scans through a subject's skin, the method comprising: receiving a plurality of scans through the subject's skin, the scans representing an OCT signal in slices through the user's skin at different times; comparing the scans to determine time-varying regions in the scans; determining a depth-distribution of the time varying regions.
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Compensating optical coherence tomography scans
A method of processing optical coherence tomography (OCT) scans, comprising: receiving OCT data comprising an OCT signal indicative of the level of scattering in a sample, the OCT data including the OCT signal for at least one scan through the sample, with the OCT signal having been measured at varying depth and position through the sample in each scan; processing the OCT data for each scan with depth to produce a indicative depth scan representative of the OCT signal at each depth through all of the scans; fitting a curve to the indicative depth scan, the curve comprising a first term which exponentially decays with respect to the depth and a second term which depends on the noise in the OCT signal; and calculating a compensated intensity for the OCT signal at each point through each scan, the compensated intensity comprising a ratio of a term comprising a logarithm of the OCT signal to a term comprising the logarithm of the fitted curve.
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Dynamic optical coherence tomography shows alterations of blood vessels characteristic for malignant melanoma
Background Dynamic optical coherence tomography (D‐OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumors. Vessel patterns in malignant melanoma may be associated with tumor stage. Objective The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. Methods 159 malignant melanomas were assessed in a multicenter study. Every tumor was imaged using D‐OCT prior to surgery and histologic evaluation. The tumor data like thickness and ulceration as well as the staging at primary diagnosis and a follow‐up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to pre‐defined categories, compared to healthy adjacent skin and correlated to stage. Results Melanomas contained more blood vessels in different patterns compared to healthy adjacent skin. In particular, irregular vascular shapes like blobs, coils, curves and serpiginous vessels were more common in melanomas....
Dynamic Optical Coherence Tomography of Cutaneous Blood Vessels in Melasma and Vessel Response to Oral Tranexamic Acid
Background and objectives: Melasma may be related to aberrant blood vessels, but there has been no report on the utility of dynamic optical coherence tomography (D-OCT) in studying vessel characteristics in melasma. We studied the characteristics of cutaneous blood vessels in melasma and the effects of oral tranexamic acid (TXA) with D-OCT. Study design/materials and methods: Six patients with moderate to severe melasma had a D-OCT scanning of the areas on the face affected by melasma and not affected by it. Three of them had scans within 3 months after starting oral TXA and at a follow-up visit. Blood flow at different depths of the skin and vessel diameter were compared between the melasma and normal skin. For those taking oral TXA, we compared the percent change of blood flow and diameter between the melasma and normal skin. Results: Dermal blood flow and vessel diameter were greater in the melasma skin than in the normal skin. Oral TXA reduced dermal blood flow in both the melas...
Optical Coherence Tomography Guided C&D
The purpose of the study is to identify the presence of residual superficial and nodular basal cell carcinoma (BCC) status-post curettage and desiccation (C&D) by using optical coherence tomography (OCT).
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