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Cerenkov luminescence imaging (CLI) for image-guided cancer surgery

View Article: PubMed Central - PubMed

ABSTRACT

Cerenkov luminescence imaging (CLI) is a novel molecular optical imaging technique based on the detection of optical Cerenkov photons emitted by positron emission tomography (PET) imaging agents. The ability to use clinically approved tumour-targeted tracers in combination with small-sized imaging equipment makes CLI a particularly interesting technique for image-guided cancer surgery. The past few years have witnessed a rapid increase in proof-of-concept preclinical studies in this field, and several clinical trials are currently underway. This article provides an overview of the basic principles of Cerenkov radiation and outlines the challenges of CLI-guided surgery for clinical use. The preclinical and clinical trial literature is examined including applications focussed on image-guided lymph node detection and Cerenkov luminescence endoscopy, and the ongoing clinical studies and technological developments are highlighted. By intraoperatively guiding the oncosurgeon towards more accurate and complete resections, CLI has the potential to transform current surgical practice, and improve oncological and cosmetic outcomes for patients.

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Investigational intraoperative CLI imaging system used in breast-conserving surgery trial. a Computer aided design (CAD) rendering. The red object indicates the location of the tissue specimen within the specimen chamber. b Schematic diagram showing: (1) thermoelectrically-cooled EMCCD camera, (2) f/0.95 lens, (3) hinged reflex mirror, (4) CMOS reference camera for anatomical imaging, (5) specimen holder, (6) lead radiation shielding for EMCCD camera, (7) focal zone, (8) fixed lens for reference camera, (9) filter wheel, (10) LED RGB light array, (11) specimen chamber. The purple line shows the optical paths for the EMCCD camera and the reference camera as determined by the angle of the reflex mirror
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Fig3: Investigational intraoperative CLI imaging system used in breast-conserving surgery trial. a Computer aided design (CAD) rendering. The red object indicates the location of the tissue specimen within the specimen chamber. b Schematic diagram showing: (1) thermoelectrically-cooled EMCCD camera, (2) f/0.95 lens, (3) hinged reflex mirror, (4) CMOS reference camera for anatomical imaging, (5) specimen holder, (6) lead radiation shielding for EMCCD camera, (7) focal zone, (8) fixed lens for reference camera, (9) filter wheel, (10) LED RGB light array, (11) specimen chamber. The purple line shows the optical paths for the EMCCD camera and the reference camera as determined by the angle of the reflex mirror

Mentions: The successful applications of CLI for image-guided cancer surgery have resulted in several clinical studies that are currently ongoing to evaluate the feasibility of this technique in different tumour types. At Guy’s Hospital (London, UK), a first-in-woman pilot study evaluates intraoperative CLI for measuring tumour resection margins and lymph node status in 30 patients undergoing breast-conserving surgery (BCS) (ClinicalTrials.gov identifier NCT02037269). Patients receive an intravenous standard of care PET dose of 5 MBq/kg 18F-FDG, and excised wide local excision (WLE) specimens and lymph nodes are imaged within 1–3 h post-injection using an investigational intraoperative CLI specimen camera (Lightpoint Medical Ltd, UK) (Fig. 3). The investigational CLI camera consists of a light-tight sample chamber, a radiation-shielded thermoelectrically-cooled EMCCD camera, and a f/0.95 lens. The camera provides 8 × 8 cm field of view and 156 µm intrinsic spatial resolution. Interim results show that elevated radiances are detected in cancer compared to normal breast tissue, and that the radiation exposure to surgical staff is low [55, 56]. The results from comparing CLI resection margin status and lymph node status to the gold-standard, histopathology, are being prepared for publication at the time of writing. An example of a CLI image from a WLE specimen that was scanned intraoperatively in this clinical study is shown in Fig. 4. This image illustrates that CLI provides high-resolution functional information that allows surgeons to accurately assess tumour margins during surgery.Fig. 3


Cerenkov luminescence imaging (CLI) for image-guided cancer surgery
Investigational intraoperative CLI imaging system used in breast-conserving surgery trial. a Computer aided design (CAD) rendering. The red object indicates the location of the tissue specimen within the specimen chamber. b Schematic diagram showing: (1) thermoelectrically-cooled EMCCD camera, (2) f/0.95 lens, (3) hinged reflex mirror, (4) CMOS reference camera for anatomical imaging, (5) specimen holder, (6) lead radiation shielding for EMCCD camera, (7) focal zone, (8) fixed lens for reference camera, (9) filter wheel, (10) LED RGB light array, (11) specimen chamber. The purple line shows the optical paths for the EMCCD camera and the reference camera as determined by the angle of the reflex mirror
© Copyright Policy - OpenAccess
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Fig3: Investigational intraoperative CLI imaging system used in breast-conserving surgery trial. a Computer aided design (CAD) rendering. The red object indicates the location of the tissue specimen within the specimen chamber. b Schematic diagram showing: (1) thermoelectrically-cooled EMCCD camera, (2) f/0.95 lens, (3) hinged reflex mirror, (4) CMOS reference camera for anatomical imaging, (5) specimen holder, (6) lead radiation shielding for EMCCD camera, (7) focal zone, (8) fixed lens for reference camera, (9) filter wheel, (10) LED RGB light array, (11) specimen chamber. The purple line shows the optical paths for the EMCCD camera and the reference camera as determined by the angle of the reflex mirror
Mentions: The successful applications of CLI for image-guided cancer surgery have resulted in several clinical studies that are currently ongoing to evaluate the feasibility of this technique in different tumour types. At Guy’s Hospital (London, UK), a first-in-woman pilot study evaluates intraoperative CLI for measuring tumour resection margins and lymph node status in 30 patients undergoing breast-conserving surgery (BCS) (ClinicalTrials.gov identifier NCT02037269). Patients receive an intravenous standard of care PET dose of 5 MBq/kg 18F-FDG, and excised wide local excision (WLE) specimens and lymph nodes are imaged within 1–3 h post-injection using an investigational intraoperative CLI specimen camera (Lightpoint Medical Ltd, UK) (Fig. 3). The investigational CLI camera consists of a light-tight sample chamber, a radiation-shielded thermoelectrically-cooled EMCCD camera, and a f/0.95 lens. The camera provides 8 × 8 cm field of view and 156 µm intrinsic spatial resolution. Interim results show that elevated radiances are detected in cancer compared to normal breast tissue, and that the radiation exposure to surgical staff is low [55, 56]. The results from comparing CLI resection margin status and lymph node status to the gold-standard, histopathology, are being prepared for publication at the time of writing. An example of a CLI image from a WLE specimen that was scanned intraoperatively in this clinical study is shown in Fig. 4. This image illustrates that CLI provides high-resolution functional information that allows surgeons to accurately assess tumour margins during surgery.Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Cerenkov luminescence imaging (CLI) is a novel molecular optical imaging technique based on the detection of optical Cerenkov photons emitted by positron emission tomography (PET) imaging agents. The ability to use clinically approved tumour-targeted tracers in combination with small-sized imaging equipment makes CLI a particularly interesting technique for image-guided cancer surgery. The past few years have witnessed a rapid increase in proof-of-concept preclinical studies in this field, and several clinical trials are currently underway. This article provides an overview of the basic principles of Cerenkov radiation and outlines the challenges of CLI-guided surgery for clinical use. The preclinical and clinical trial literature is examined including applications focussed on image-guided lymph node detection and Cerenkov luminescence endoscopy, and the ongoing clinical studies and technological developments are highlighted. By intraoperatively guiding the oncosurgeon towards more accurate and complete resections, CLI has the potential to transform current surgical practice, and improve oncological and cosmetic outcomes for patients.

No MeSH data available.


Related in: MedlinePlus