Titel: Die Darstellung der Rheumatoiden Arthritis im Frühstadium mittels Streulichtanalyse der proximalen Interphalangealgelenke Zielstellung: In dieser Studie wird eine neues laser-basiertes bildgebendes Verfahren zur Darstellung entzündlich-rheumatischer Veränderungen der Fingergelenke evaluiert und mit den etablierten Verfahren Röntgen, Sonographie und Magnetresonanztomographie verglichen. Methoden: Die proximalen Interphalangealgelenke (PIP) von 102 Patienten mit Verdacht auf Rheumatoide Arthritis (RA) und 40 Kontrollpatienten wurden mit der Laser-Streulicht-Analyse untersucht und die daraus resultierende mathematische Funktion des Streulichtverteilungsbildes mittels fünf verschiedener Kennwerte berechnet. Als Referenz wurden 1136 PIP klinisch untersucht, 800 Röntgenaufnahmen angefertigt, 688 Sonographien und 208 magnetresonanztomographische Bilder erstellt, die zur Klassifizierung der Entzündungsakuität dienten. Ergebnisse: Die Ergebnisse zeigten, dass die untersuchten Kennwerte Breite, Asymmetrie, Steilheit links, Steilheit rechts und Intensität keine Korrelation mit dem Entzündungsgrad des Gelenks mit früher Rheumatoider Arthritis gaben. Schlussfolgerung: Zum jetzigen Stand der Entwicklung erbringt die laser-basierte Streulichtanalyse in der Diagnosefindung der RA keinen Fortschritt, da gesunde Gelenke von floride entzündeten nicht differenziert werden können. Die Ergebnisse legen nahe, dass die Ursache hierfür in einer zu hohen Sensitivität und mangelnder Reproduzierbarkeit bei der Fingerpositionierung in der Apparatur des Gerätes zu suchen ist. / Title: Imaging of early rheumatoid arthritis with scattering light analysis of the proximal interphalangeal joints Objective: In this study a novel laser-based imaging technique for early rheumatoid arthritis of the finger joints is evaluated and compared to radiography, ultrasound and magnetic-resonance-tomography. Methods: The proximal interphalangeal joints (PIP) of 102 patients with early rheumatoid arthritis (RA) and 40 patients of a control group were measured with laser scattering light analysis and five values describing the resulting image were calculated. The clinical examination of 1136 PIP, 800 x-rays, 688 ultrasound-pictures and 208 magnetic resonance pictures were taken as reference to assess the acuity of inflammation. Results: No correlation was seen for the values to calculate the scattering light image curve (width, asymmetry, left and right skewness and intensity) and the severity of finger joint inflammation. Conclusion: At present the new laser-based imaging technique is not superior to the usual imaging methods for diagnosis of RA This is probably due to a too high sensitivity and a lack of reproducibility for finger positioning in the measuring unit.

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: The objectives of this in-vitro study were: 1) to evaluate the ability of Near-Infrared Digital Imaging Transillumination (NIDIT) to detect non-cavitated approximal caries lesions; and 2) to compare the performance among NIDIT, Digital Radiography (DR), Digital Imaging Fiber-Optic Trans-Illumination (DIFOTI) and International Caries Detection and Assessment System (ICDAS). Methods: Thirty human extracted premolars were selected. The approximal surface status ranged from sound to surfaces with non-cavitated caries lesions into the outer one-third of the dentin. Lesion depth was determined by micro-computed tomography (μ-CT) and used as a gold standard. Teeth were mounted in a custom-made device to simulate approximal contact. ICDAS, DR, DIFOTI and NIDIT examinations were performed and repeated by three trained and calibrated examiners. Sensitivity, specificity, area under ROC curve (Az), inter- and intra-class correlation coefficients (ICCs) of each method, and correlation among the methods were determined. Results: ICCs for intra-/inter-examiner agreement were almost perfect for DIFOTI (0.85/0.83), substantial for ICDAS (0.79/0.72) and NIDIT (0.69/0.64), and moderate for DR (0.52/0.48). Sensitivity/specificity for DIFOTI, ICDAS, DR, and NIDIT were 0.91/0.69, 0.89/0.83, 0.50/0.64, and 0.68/0.93, respectively. Az of DR (0.61) was significantly lower than that of DIFOTI (0.91, p = 0.002) and ICDAS (0.90, p = 0.005), but was not significantly different from NIDIT (0.81, p = 0.052). DIFOTI, ICDAS, and NIDIT were not significantly different from each other (p > 0.13). Spearman correlation coefficients for DIFOTI (0.79, p < 0.001), ICDAS (0.74, p < 0.001), and NIDIT (0.65, p < 0.001) demonstrated a moderate association with μ-CT, while that of DR suggested no association (0.19, p = 0.289). Conclusion: Within the limitations of this in-vitro study, NIDIT system demonstrated a potential for early approximal caries detection. ICDAS, DIFOTI, and NIDIT were superior to DR in terms of validity and reliability.

La tomographie optique diffuse (TOD) et la tomographie optique diffuse par fluorescence (TODF) sont de nouvelles techniques d'imagerie médicale fort prometteuses. L'utilisation de lumière dans le proche infrarouge(PIR) permet une acquisition in vivo fréquente et même en continue sans danger pour l'opérateur ou pour le sujet. Ces méthodes sont présentement le sujet de plusieurs recherches notamment par le groupe TomOptUS. Un appareil d'imagerie optique sur petit animal, le Quidd Optical imaging System (QOS) est disponible au Centre Hospitalier Universitaire de Sherbrooke (CHUS). Muni d'une caméra refroidie à haute sensibilité et d'actionneurs contrôlés par ordinateur, il donne une grande flexibilité dans la géométrie d'acquisition en permettant notamment une rotation de la caméra sur une plage de ±60 degrés. L'appareil ne permet toutefois que l'acquisition de données en rétro-diffusion (ou épi-illumination), c'est à dire que la détection sur l'animal se fait du même côté que l'illumination. En TODF, un enjeu majeur est de pouvoir imager en profondeur dans les tissus. Pour ce faire, il devient important d'avoir accès à des mesures en transillumination. Le présent mémoire traite de l'ajout de degrés de libertés au QOS affin de permettre l'imagerie en transillumination tout en conservant la capacité d'épi-illumination. La configuration développée permet de déplacer l'excitation lumineuse indépendamment de l'acquisition et ce linéairement ainsi qu'angulairement autour du sujet. L'implantation nécessitant trois degrés de libertés (DDL) supplémentaires, l'utilisation de composantes standard a été préférée. Étant donné les contraintes identifiées, un actionneur rotatif ainsi que son contrôleur à base de micro-contrôleur ont été développés. Le présent document détaille les choix de conception ainsi que l'architecture du contrôleur. Avec la réalisation de ce projet, les utilisateurs du QOS disposent dorénavant d'un appareil flexible permettant l'acquisition de données tomographiques qui aideront à imager en profondeur dans le sujet. Quoique ceci ne fasse pas partie du cadre de cette maîtrise, le but ultime de l'acquisition de ces données est la reconstruction en trois dimensions de l'intérieur de l'animal imagé.

La tomographie optique diffuse (TOD) est une technique d’imagerie médicale relativement récente qui utilise la lumière dans le proche infrarouge pour acquérir des images in vivo de façon non invasive. Cette technique est en utilisation croissante par de nombreux chercheurs et biologistes et plusieurs équipes dans le monde travaillent sur le développement de scanners par TOD y compris notre groupe de recherche (groupe TomOptUS). Le Centre d’imagerie moléculaire de Sherbrooke dispose d’un appareil pour imagerie optique sur petit animal développé par la compagnie Quidd, soit le QOS (Quidd Optical imaging System). Cet appareil est utilisé par des biologistes et chercheurs pour diverses études précliniques sur modèles animaux (souris) de maladies humaines comme le cancer. Le QOS est entièrement contrôlé par ordinateur à l’aide d’un logiciel sophistiqué (le QOSoft) qui permet d’obtenir des images en fluorescence et en bioluminescence. Il est toutefois limité en ne permettant d’acquérir que des images planaires de la lumière sortant d’un animal ; il ne permet pas la tomographie, à savoir obtenir des images tridimensionnelles (3D) des sources fluorescentes ou bioluminescentes situées en profondeur à l’intérieur de l’animal. Bien que le QOS offre une grande flexibilité en terme d’angle d’acquisition d’images autour de l’animal avec sa caméra montée sur un bras rotatif, il a une sensibilité limitée pour de l’imagerie en profondeur, notamment parce qu’il fonctionne en mode épiillumination (détection de la lumière du même côté que l’injection de la lumière excitatrice dans l’animal) et aussi à cause de la sensibilité limitée de sa caméra. Afin d’augmenter les capacités tomographiques et la sensibilité du QOS, ainsi que le contraste des images qu’il fournit, le présent projet propose des développements logiciels intégrés au QOSoft. Ces ajouts logiciels au niveau du contrôle d’instrumentation et de l’interface graphique permettent d’intégrer une caméra EMCCD à ultra-haute sensibilité et ultra-faible bruit pour remplacer la caméra CCD refroidie existante ainsi qu’un module d’illumination laser rotatif. Ce module d’illumination, développé par le groupe TomOptUS, permet l’imagerie en mode transillumination ainsi que toutes les configurations intermédiaires jusqu’à l’épi-illumination. Ce module permet en outre d’injecter une densité de puissance lumineuse supérieure à celle possible avec la configuration actuelle du QOS. Le QOS et son logiciel mis à jour avec les ajouts faisant l’objet du présent projet sont validés par des expériences de fluorescence et de bioluminescence sur fantômes et animaux vivants.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O objetivo do presente trabalho foi avaliar in vivo a detecção de cárie através do exame visual ICDAS, transiluminação por fibra ótica combinado ao ICDAS e exame radiográfico. Um total de 2.279 superfícies proximais e cicatrículas e fissuras em incisivos superiores, pré-molares e molares permanentes e 272 superfícies em molares decíduos em72 escolares (8 a 18 anos) foram avaliadas por um examinador treinado. Os sete escores para detecção de cárie primária do sistema visual ICDAS foram aplicados. Dois equipamentos de transiluminação por fibra ótica foram avaliados: FOTI Schott (SCH), com ponta de fibra ótica com 0,5mm de diâmetro, e FOTI Microlux (MIC), com diâmetro da ponta 3 mm. Durante o exame combinado FOTI/ICDAS, a fibra ótica era utilizada tanto para iluminar quanto para transiluminar a superfície sob avaliação. O exame radiográfico (RX) consistiu de radiografias interproximais posteriores e periapicais anteriores. Os exames foram realizados em consultório odontológico após escovação supervisionada. No primeiro dia de exame, o exame visual utilizando o ICDAS era realizado e em seguida, o exame combinado ao MIC ou SCH. Logo após era realizado o exame radiográfico. Após uma semana, novamente o ICDAS era realizado, e em seguida o exame combinado com o equipamento de FOTI não utilizado na semana anterior. Os exames foram repetidos em 10 pacientes após intervalo mínimo de uma semana para avaliação da reprodutibilidade intra-examinador, a qual apresentou valores de 0,95 (ICDAS), 0,94 (MIC), 0,95 (SCH) e 0,99 (RX) pelo kappa ponderado. Em cicatrículas e fissuras de permanentes, o RX julgou que um número maior de superfícies apresentava lesão em dentina (53) do que os outros métodos (34 a 36); porém não detectou nenhuma lesão em esmalte, as quais foram identificadas pelo ICDAS (94), SCH (107) e MIC (91). Em proximais permanentes, a transiluminação por fibra ótica identificou maior número de proximais como lesão em esmalte - 150 (SCH) e 139 (MIC) - do que o exame visual (106), enquanto o RX identificou somente 43. Em oclusais de decíduos, os quatro métodos julgaram um número aproximadamente similar de superfícies sem lesão (52 a 59) ou com lesão em dentina (21 a 26), assim como para lesões proximais em dentina (31 a 36). Entretanto um número reduzido de lesões proximais decíduas em esmalte foi julgado pelo exame radiográfico (3) em comparação com os outros métodos (15 a 16). Em decíduos, o ICDAS e o FOTI combinado ao exame visual julgaram maior número de lesões proximais em esmalte que o exame radiográfico, sendo que número similar de lesões em dentina foram classificadas pelos quatro métodos em oclusais e proximais de molares decíduos. Em cicatrículas e fissuras de permanentes, tanto o exame visual ICDAS quanto sua combinação aos dois equipamentos de transiluminação apresentaram maior similaridade de superfícies julgadas como lesão em esmalte ou como lesão em dentina, enquanto o exame radiográfico classificou mais superfícies como lesão em dentina e nenhuma como lesão em esmalte. A adição da transiluminação por fibra ótica ao exame visual aumentou em um terço a detecção das lesões cariosas proximais julgadas em dentina pelo ICDAS isoladamente e aproximadamente quadruplicou o número daquelas assim classificadas pela avaliação radiográfica em permanentes. / The aim of this in vivo study was to assess the ICDAS visual method, combined ICDAS/fiber optic transillumination and bite wing radiographs. A total of 2,279 pits and fissures in upper incisors, pre-molars and molars permanent surfaces and 272 primary molars surfaces in 72 patients (aged 8 to 18 years-old) were assessed by an trained examiner. The seven scores for coronal primary caries detection criteria from ICDAS visual criteria were applied. Two fiber optic transillumination devices were assessed: FOTI Schott, SCH, tip diameter 0,5 mm and FOTI Microlux, MIC, portable device, tip diameter 3 mm. During the FOTI/ICDAS combined exam, the fiber optic was used to illuminate and also to transilluminate the surface that was being evaluated. The radiograph examination (RX) was done by bite-wings for posterior teeth and periapical for anterior teeth. Examinations were performed using dental chair after supervised toothbrushing. In the first exam day, the visual exam using ICDAS was done followed by ICDAS combined to MIC or SCH. After that the radiograph exam was done. After one week, the ICDAS was done again followed by the FOTI that was not used the week before. The exams were repeated in 10 patients after, at least, one week of interval to evaluate the intra-examiner reproducibility , presenting weighted kappa values 0.95 (ICDAS), 0.94 (MIC), 0.95 (SCH) and 0.99 (RX). In permanent pits and fissures surfaces, RX deemed a greater number of surfaces presenting dentin lesions (53) than the other methods (34 to 36). However no enamel lesion was detected which were identified by ICDAS (94),SCH (107) and MIC (91). For permanent approximal surfaces, the fiber optic transillumination identified a greater number of approximal surfaces as having enamel lesions - 150 (SCH) and 139(MIC) - than visual exam (106), while RX identified only 43. For primary occlusal surfaces, the four methods deemed a similar number of surfaces without lesion (52 to 59) or with dentin lesion (21 to 26), the same for approximal dentin lesion (31 to 36). However a reduced number of primary approximal lesions were deemed by the RX (3) compared to the other methods (15 to 16). Im primary dentition, the ICDAS and FOTI combined to visual exam deemed a great number of enamel approximal lesions compared to RX, where a similar number of dentin lesions were classified by the four methods in primary occlusal and approximal surfaces. In permanent pitts and fissures, for ICDAS and FOTI/ICDAS combined, presented similarity in surfaces deemed as having enamel lesions or dentin lesions, while the radiograph exam classified a great number as having dentin lesion and no enamel lesion. Adding fiber optic transillumination to visual exam increased in one third approximal lesions deemed in dentin by the ICDAS alone and made fourfold the number of those as classified by permanent radiograph evaluation.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O objetivo do presente trabalho foi avaliar in vivo a detecção de cárie através do exame visual ICDAS, transiluminação por fibra ótica combinado ao ICDAS e exame radiográfico. Um total de 2.279 superfícies proximais e cicatrículas e fissuras em incisivos superiores, pré-molares e molares permanentes e 272 superfícies em molares decíduos em72 escolares (8 a 18 anos) foram avaliadas por um examinador treinado. Os sete escores para detecção de cárie primária do sistema visual ICDAS foram aplicados. Dois equipamentos de transiluminação por fibra ótica foram avaliados: FOTI Schott (SCH), com ponta de fibra ótica com 0,5mm de diâmetro, e FOTI Microlux (MIC), com diâmetro da ponta 3 mm. Durante o exame combinado FOTI/ICDAS, a fibra ótica era utilizada tanto para iluminar quanto para transiluminar a superfície sob avaliação. O exame radiográfico (RX) consistiu de radiografias interproximais posteriores e periapicais anteriores. Os exames foram realizados em consultório odontológico após escovação supervisionada. No primeiro dia de exame, o exame visual utilizando o ICDAS era realizado e em seguida, o exame combinado ao MIC ou SCH. Logo após era realizado o exame radiográfico. Após uma semana, novamente o ICDAS era realizado, e em seguida o exame combinado com o equipamento de FOTI não utilizado na semana anterior. Os exames foram repetidos em 10 pacientes após intervalo mínimo de uma semana para avaliação da reprodutibilidade intra-examinador, a qual apresentou valores de 0,95 (ICDAS), 0,94 (MIC), 0,95 (SCH) e 0,99 (RX) pelo kappa ponderado. Em cicatrículas e fissuras de permanentes, o RX julgou que um número maior de superfícies apresentava lesão em dentina (53) do que os outros métodos (34 a 36); porém não detectou nenhuma lesão em esmalte, as quais foram identificadas pelo ICDAS (94), SCH (107) e MIC (91). Em proximais permanentes, a transiluminação por fibra ótica identificou maior número de proximais como lesão em esmalte - 150 (SCH) e 139 (MIC) - do que o exame visual (106), enquanto o RX identificou somente 43. Em oclusais de decíduos, os quatro métodos julgaram um número aproximadamente similar de superfícies sem lesão (52 a 59) ou com lesão em dentina (21 a 26), assim como para lesões proximais em dentina (31 a 36). Entretanto um número reduzido de lesões proximais decíduas em esmalte foi julgado pelo exame radiográfico (3) em comparação com os outros métodos (15 a 16). Em decíduos, o ICDAS e o FOTI combinado ao exame visual julgaram maior número de lesões proximais em esmalte que o exame radiográfico, sendo que número similar de lesões em dentina foram classificadas pelos quatro métodos em oclusais e proximais de molares decíduos. Em cicatrículas e fissuras de permanentes, tanto o exame visual ICDAS quanto sua combinação aos dois equipamentos de transiluminação apresentaram maior similaridade de superfícies julgadas como lesão em esmalte ou como lesão em dentina, enquanto o exame radiográfico classificou mais superfícies como lesão em dentina e nenhuma como lesão em esmalte. A adição da transiluminação por fibra ótica ao exame visual aumentou em um terço a detecção das lesões cariosas proximais julgadas em dentina pelo ICDAS isoladamente e aproximadamente quadruplicou o número daquelas assim classificadas pela avaliação radiográfica em permanentes. / The aim of this in vivo study was to assess the ICDAS visual method, combined ICDAS/fiber optic transillumination and bite wing radiographs. A total of 2,279 pits and fissures in upper incisors, pre-molars and molars permanent surfaces and 272 primary molars surfaces in 72 patients (aged 8 to 18 years-old) were assessed by an trained examiner. The seven scores for coronal primary caries detection criteria from ICDAS visual criteria were applied. Two fiber optic transillumination devices were assessed: FOTI Schott, SCH, tip diameter 0,5 mm and FOTI Microlux, MIC, portable device, tip diameter 3 mm. During the FOTI/ICDAS combined exam, the fiber optic was used to illuminate and also to transilluminate the surface that was being evaluated. The radiograph examination (RX) was done by bite-wings for posterior teeth and periapical for anterior teeth. Examinations were performed using dental chair after supervised toothbrushing. In the first exam day, the visual exam using ICDAS was done followed by ICDAS combined to MIC or SCH. After that the radiograph exam was done. After one week, the ICDAS was done again followed by the FOTI that was not used the week before. The exams were repeated in 10 patients after, at least, one week of interval to evaluate the intra-examiner reproducibility , presenting weighted kappa values 0.95 (ICDAS), 0.94 (MIC), 0.95 (SCH) and 0.99 (RX). In permanent pits and fissures surfaces, RX deemed a greater number of surfaces presenting dentin lesions (53) than the other methods (34 to 36). However no enamel lesion was detected which were identified by ICDAS (94),SCH (107) and MIC (91). For permanent approximal surfaces, the fiber optic transillumination identified a greater number of approximal surfaces as having enamel lesions - 150 (SCH) and 139(MIC) - than visual exam (106), while RX identified only 43. For primary occlusal surfaces, the four methods deemed a similar number of surfaces without lesion (52 to 59) or with dentin lesion (21 to 26), the same for approximal dentin lesion (31 to 36). However a reduced number of primary approximal lesions were deemed by the RX (3) compared to the other methods (15 to 16). Im primary dentition, the ICDAS and FOTI combined to visual exam deemed a great number of enamel approximal lesions compared to RX, where a similar number of dentin lesions were classified by the four methods in primary occlusal and approximal surfaces. In permanent pitts and fissures, for ICDAS and FOTI/ICDAS combined, presented similarity in surfaces deemed as having enamel lesions or dentin lesions, while the radiograph exam classified a great number as having dentin lesion and no enamel lesion. Adding fiber optic transillumination to visual exam increased in one third approximal lesions deemed in dentin by the ICDAS alone and made fourfold the number of those as classified by permanent radiograph evaluation.

This study investigates the potential of Spatial Frequency Domain Imaging (SFDI) as a non-invasive imaging technique for tissue analysis in the context of Mohs surgery, a standard procedure for skin cancer removal with margin control. The current practice of performing multiple histopathologic sections during the procedure is time-consuming and labor-intensive. SFDI, utilizing optical measurements, offers quantitative imaging of biological tissues, enabling the assessment of their function and structure. This makes it particularly suitable for imaging sensitive tissues like the skin and the eye. By accurately measuring the optical properties of tissues, a deeper understanding of their characteristics and the interaction of light with tissue can be achieved. In this study, a novel transillumination SFDI system was designed and utilized to obtain spectral data from examined 2 mm thick tissue-simulating phantoms. The results demonstrated the potential of the transmission-based SFDI as a valuable tool in tissue analysis,providing rapid and accurate information about tissue properties. The implementation of transmission-based SFDI system holds promise for enhancing tissue-conserving surgeries. By enabling direct analysis of tissue properties at the point of care, this system could eliminate the need for histopathologic processing. Consequently, it can provide rapid and accurate information about tissue characteristics without the need for histopathologic processing, allowing for more precise and efficient surgical procedures and better patient outcomes