To date, surgery is the most common and successful way to treat cancer. Tumour identification during surgery, however, can be challenging as it relies on the surgeon’s ability to differentiate healthy from diseased tissue, based on visual appearance and palpation. Additional contrast mechanisms are needed to further improve cancer detection during surgery. In this work, I explore the possibility of improving surgical outcomes by using intra-operative fluorescence imaging technologies to identify otherwise invisible lesions. A theoretical model is developed to quantify and characterise the imaging performance of fluorescence image-guided surgery (FIGS) and to guide the development of imaging systems. This model shows excellent potential for performance characterisation of FIGS devices, particularly when small lesions are involved. The design, development and testing of FIGS devices for open and keyhole surgery are described. These devices exploit near infrared (NIR) wavelengths to achieve a superior depth penetration while minimising tissue autofluorescence. Unlike existing systems, the devices described in this work use a single miniaturised camera to simultaneously detect bright-field and fluorescence from multiple dyes. Practical tests indicate nano-molar detection of clinically approved fluorescence dyes. The proposed technology is tested in a clinical study for detecting the sentinel lymph node (SLN) in gynaecological cancers. Results using two non-specific NIR dyes show excellent SLN detection rate in real time during open surgery and laparoscopy. In addition, multi-spectral fluorescence allows independent visualisation of different lymphatic pathways, crucial for understanding the mechanisms of metastasis through the lymphatic system. The FIGS devices are also used to test novel tumour-specific markers in vivo, ex vivo and in vitro. Promising results are reported, suggesting that this imaging technology is suitable for fluorescence molecular imaging. In conclusion, I report the development and applications of a novel multi-spectral FIGS technology that can effectively improve outcomes in surgical oncology.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:647638 |
| Date | January 2014 |
| Creators | Volpi, Davide |
| Contributors | Vojnovic, Borivoj |
| Publisher | University of Oxford |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://ora.ox.ac.uk/objects/uuid:33c1c1cd-af55-46be-acbe-1181848a799b |
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