Enhanced medical diagnosis for dOCTors: a perspective of optical coherence tomography
| Autor: | Lisa Krainz, Richard Haindl, Angelika Unterhuber, Tilman Schmoll, Wolfgang Drexler, Fabian Placzek, Marco Andreana, Elisabet Rank, Qian Li, Mengyang Liu, Rainer A. Leitgeb |
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| Rok vydání: | 2021 |
| Předmět: |
Paper
medicine.medical_specialty genetic structures Computer science Biomedical Engineering 030209 endocrinology & metabolism 02 engineering and technology Biomaterials 03 medical and health sciences 0302 clinical medicine miniaturized OCT Optical coherence tomography Artificial Intelligence medicine Medical imaging Medical physics Medical diagnosis optical coherence elastography optical coherence tomography medicine.diagnostic_test functional OCT OCT angiography Magnetic resonance imaging Optical Biopsy multimodal OCT 021001 nanoscience & nanotechnology Atomic and Molecular Physics and Optics eye diseases 3. Good health Electronic Optical and Magnetic Materials Ophthalmology artificial intelligence enhanced OCT Positron emission tomography Imaging technology non-linear optical microscopy photoacoustic imaging sense organs multimodal OCT endoscopy contrast enhanced OCT 0210 nano-technology Tomography Optical Coherence Preclinical imaging Perspectives |
| Zdroj: | Journal of Biomedical Optics |
| ISSN: | 1083-3668 |
| DOI: | 10.1117/1.jbo.26.10.100601 |
| Popis: | Optical coherence tomography (OCT) is one of the most innovative and successfully translated imaging techniques with substantial clinical and economic impacts and acceptance.1,2 OCT is a non-invasive optical analog to ultrasound (US) with significantly higher resolution ( millions of A-scans/s) imaging with tissue penetration of up to 2 mm, closely matching that of conventional histopathology. The year 2021 marks not only the 30th birthday of OCT (assuming its initiation with the Science paper by Huang et al.3 in 1991) but also the 35th birthday of low-coherence interferometry and optical ranging in biological systems.4,5 In the last three decades, more than 75,000 OCT related papers have been published (about two thirds in ophthalmology) with continuous yearly increases of published articles.6 Breaking through the 1000 publications/year barrier was initiated in 2005/2006 with the introduction of spectral domain OCT (SD OCT). In 2020, the OCT-related scientific output was more than 7800 papers, resulting in nearly one paper every single hour on every single day of the year. Extrapolating this publishing performance, a saturation of yearly publication output at about 9500 can be expected around 2030. After 30 years, it is interesting and important to benchmark this performance with other medical imaging techniques:6 multiphoton microscopy (MPM) [including second harmonic generation (SHG) and third harmonic generation (THG)], developed about three decades before OCT,7,8 has about 50,000 publications so far; photoacoustic imaging (PAI), established in the 1970s,9,10 has about 15,000 papers; and confocal microscopy, developed in the 1940s,11,12 has about 145,000. Developed in the 1940s,13 US imaging has contributed to about 160,000 papers; positron emission tomography (PET), initiated in the 1970s,14,15 has about 175,000; computed tomography (CT), developed in the 1930s,16 has about 750,000; and magnetic resonance imaging (MRI), developed in the late 1940s,17 has close to 1,000,000 publications. This dominance in publications of radiology and nuclear medicine imaging technologies is also one of the reasons why medical imaging is, in general, associated with MRI, CT, PET, or US. It is important to note, though, that from a medical imaging market perspective, optical imaging technologies dominate with 66% versus 34% for radiology and nuclear medicine imaging technologies. In addition, in the United States alone, about 450,000 physicians use primarily optical imaging techniques; 60,000 use primarily radiologic imaging; and about 130,000 use both.18 In the last three decades, OCT has revolutionized ophthalmic diagnosis, therapy monitoring, and guidance. Every second, a human gets a retinal OCT scan; therefore it is the fastest adopted imaging technology in the history of ophthalmology. This is mainly due to the ease of optical accessibility of the human eye, OCT’s exquisite depth sectioning performance at the micrometer level, and a significantly better performance compared with the previous gold standard in this field, ultrasonography. Furthermore, it is also due to the fact that the human retina cannot be biopsied and finally to the continuous clinically relevant improvements of this technology, due to an exquisite ecosystem between industry and academia in terms of resolution, speed, wide-field imaging, and longer wavelength for choroidal imaging. Motion contrast-based angiography, cellular level retinal visualization, visible light OCT for oximetry and unprecedented retinal layer detection, functional and contrast enhanced extensions, and artificial intelligence (AI)-enhanced performance also contributed to this success. Most of these superb technological developments can be directly translated to the original motivation and idea of OCT: to enable optical biopsy, i.e., the in situ imaging of tissue microstructure with a resolution approaching that of histology but without the need for tissue excision and preparation, allowing for quasi-instantaneous diagnostic feedback for physicians, and thereby reducing healthcare costs. There is no doubt that outside ophthalmology, OCT faces significantly bigger challenges with extremely well performing, long-established diagnostic techniques. Hence, OCT has successfully penetrated into different medical fields outside of ophthalmology, but in the last 30 years, it has not been as successful as in ophthalmic diagnosis. Despite the unprecedented success of this imaging technique in ophthalmology so far, there are still numerous remaining challenges in this field to be addressed (e.g., 4D intrasurgical OCT, portable, handheld OCT, and OCT-based digital adaptive optics) but one of the biggest perspectives for OCT is to further push performance frontiers of all involved technologies to converge to the original motivation of OCT, which is to enable in situ optical biopsy, especially for early cancer diagnosis and for a better understanding of oncogenesis. Consequently, this perspective will focus on the following areas that will pave the way for enabling even further enhanced medical diagnosis using OCT in the future. Imaging speed is absolutely essential in medical diagnosis: on the one hand, to minimize the exam time for the patient, but foremost to enable motion artifact free, properly sampled data sets. The speed of today’s systems already supports three- and even four-dimensional imaging as well as wide fields of view and functional extensions of OCT, such as OCT angiography. In the future, different technologies will enable increased OCT imaging speed with one of the fundamental decisions being at which scanning speed single-beam raster scanning will be abandoned and scanning beam parallelization will be used. Further challenges of OCT’s unmatched axial and transverse resolution will also be discussed. Similar to combining different radiology and nuclear medicine imaging technologies in current clinical diagnosis, multimodal optical imaging not only enables the “best of both/all worlds” but also compensates for the deficits of OCT (metabolic, molecular sensitivity, penetration depth, and limited contrast). Multimodal imaging applications combining techniques complementary to OCT will more and more be transferred from significantly improved microscopy setups—acting as fast quasi-histological optical biopsies next to the operating room—to the miniaturized endoscopic level with OCT acting like a global positioning system (GPS) by prescreening the tissue at a wider field of view (FOV) with microscopic resolution. Aside from OCTA, no other functional or contrast enhancing OCT extension has accomplished comparable clinical impact in the last three decades. Some more recently developed ones that might accomplish this challenging task, including quantitative OCTA (especially in neuro-ophthalmology), optical coherence elastography (OCE), dynamic contrast OCT, oximetry using visible light OCT, optophysiology—also referred to optoretinography—and AI-enhanced OCT, will be covered in this perspective. In addition, OCT miniaturization for portable, compact, handheld OCT applications, as well as for home-OCT and self-OCT, will be discussed. Finally, industrial translation of OCT, including medical device regulatory challenges, will be reviewed. |
| Databáze: | OpenAIRE |
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