Photodynamic therapy involves administration of a tumor-localizing photosensitizing agent, which may require metabolic synthesis (i.e., a prodrug), followed by activation of the agent by light of a specific wavelength. This therapy results in a sequence of photochemical and photobiologic processes that cause irreversible photodamage to tumor tissues. Results from preclinical and clinical studies conducted worldwide over a 25-year period have established photodynamic therapy as a useful treatment approach for some cancers. Since 1993, regulatory approval for photodynamic therapy involving use of a partially purified, commercially available hematoporphyrin derivative compound (Photofrin) in patients with early and advanced stage cancer of the lung, digestive tract, and genitourinary tract has been obtained in Canada, The Netherlands, France, Germany, Japan, and the United States. We have attempted to conduct and present a comprehensive review of this rapidly expanding field. Mechanisms of subcellular and tumor localization of photosensitizing agents, as well as of molecular, cellular, and tumor responses associated with photodynamic therapy, are discussed. Technical issues regarding light dosimetry are also considered.

Photodynamic Therapy

This chapter introduces the finite element method (FEM) as a tool for solution of classical electromagnetic problems. Although we discuss the main points in the application of the finite element method to electromagnetic design, including formulation and implementation, those who seek deeper understanding of the finite element method should consult some of the works listed in the bibliography section.

Introduction to the Finite Element Method

We review the current state-of-the-art of diffuse optical imaging, which is an emerging technique for functional imaging of biological tissue. It involves generating images using measurements of visible or near-infrared light scattered across large (greater than several centimetres) thicknesses of tissue. We discuss recent advances in experimental methods and instrumentation, and examine new theoretical techniques applied to modelling and image reconstruction. We review recent work on in vivo applications including imaging the breast and brain, and examine future challenges.

https://iopscience.iop.org/article/10.1088/0031-9155/50/4/R01/pdf

Recent advances in diffuse optical imaging.

This review describes the diffusion model for light transport in tissues and the medical applications of diffuse light. Diffuse optics is particularly useful for measurement of tissue hemodynamics, wherein quantitative assessment of oxy- and deoxy-hemoglobin concentrations and blood flow are desired. The theoretical basis for near-infrared or diffuse optical spectroscopy is developed, and the basic elements of diffuse optical tomography are outlined. We also discuss diffuse correlation spectroscopy, a technique whereby temporal correlation functions of diffusing light are transported through tissue and are used to measure blood flow. Essential instrumentation is described, and representative brain and breast functional imaging and monitoring results illustrate the workings of these new tissue diagnostics.

/pdf/diffuse-optics-for-tissue-monitoring-and-tomography-curjv2s4p6.pdf

Diffuse optics for tissue monitoring and tomography

There is a wealth of new fluorescent reporter technologies for tagging of many cellular and subcellular processes in vivo. This imposed contrast is now captured with an increasing number of available imaging methods that offer new ways to visualize and quantify fluorescent markers distributed in tissues. This is an evolving field of imaging sciences that has already achieved major advances but is also facing important challenges. It is nevertheless well poised to significantly impact the ways of biological research, drug discovery, and clinical practice in the years to come. Herein, the most pertinent technologies associated with in vivo noninvasive or minimally invasive fluorescence imaging of tissues are summarized. Focus is given to small-animal imaging. However, while a broad spectrum of fluorescence reporter technologies and imaging methods are outlined, as necessary for biomedical research, and clinical translation as well.

/pdf/fluorescence-molecular-imaging-4km00t0azo.pdf

Fluorescence molecular imaging.

Molecular targeting with exogenous near-infrared excitable fluorescent agents using time-dependent imaging techniques may enable diagnostic imaging of breast cancer and prognostic imaging of sentinel lymph nodes within the breast. However, prior to the administration of unproven contrast agents, phantom studies on clinically relevant volumes are essential to assess the benefits of fluorescence-enhanced optical imaging in humans. Diagnostic 3-D fluorescence-enhanced optical tomography is demonstrated using 0.5 to 1 cm(3) single and multiple targets differentiated from their surroundings by indocyanine green (micromolar) in a breast-shaped phantom (10-cm diameter). Fluorescence measurements of referenced ac intensity and phase shift were acquired in response to point illumination measurement geometry using a homodyned intensified charge-coupled device system modulated at 100 MHz. Bayesian reconstructions show artifact-free 3-D images (3857 unknowns) from 3-D boundary surface measurements (126 to 439). In a reflectance geometry appropriate for prognostic imaging of lymph node involvement, fluorescence measurements were likewise acquired from the surface of a semi-infinite phantom (8x8x8 cm(3)) in response to area illumination (12 cm(2)) by excitation light. Tomographic 3-D reconstructions (24,123 unknowns) were recovered from 2-D boundary surface measurements (3194) using the modified truncated Newton's method. These studies represent the first 3-D tomographic images from physiologically relevant geometries for breast imaging.

Diagnostic imaging of breast cancer using fluorescence-enhanced optical tomography: phantom studies.

The development of near-infrared (NIR) optical imaging for biomedical optical imaging is hampered by the computational intensiveness of large-scale three-dimensional (3-D) image reconstruction and the potential lack of endogenous contrast for detection of relevant tissue features. In this contribution the inverse optical imaging problem is formulated in three dimensions in a noncompressive geometry as a simple-bound constrained minimization problem in order to recover the interior fluorescence properties of exogenous contrast agent from frequency-domain photon migration measurements at the boundary. The solution of the forward optical diffusion problem for the frustum shape containing fluorescence inclusions of 10:1 contrast is accomplished by use of the Galerkin finite-element formulation. The inverse approach employs the truncated Newton method with trust region and a modification of automatic reverse differentiation to speed the computation of the optimization problem. The image-reconstruction results confirm that the constrained minimization may offer a more logical approach for the 3-D optical imaging problem than unconstrained optimization.

Three-dimensional unconstrained and constrained image-reconstruction techniques applied to fluorescence, frequency-domain photon migration.

A three-dimensional image reconstruction for fluorescence-enhanced frequency-domain photon migration (FDPM) measurements in turbid media is developed and investigated for three different simulated measurement types: 1) absolute emission measurement, or emission measurements of phase and amplitude attenuation made for a given incident point source of excitation light; 2) referenced emission measurements made relative to an excitation measurement conducted at a single reference point away from the incident source; and 3) referenced emission measurements made relative to the excitation measurement conducted at identical points of detection. The image reconstruction algorithm employs a gradient-based constrained truncated Newton (CONTN) method which implements a bounding parameter, which can be used to govern the level of contrast used to discriminate tissue volumes from heterogeneous background tissues. Reverse differentiation technique is used to calculate the gradients. Using simulated data with superimposed noise to achieve a signal-to-noise ratio of 55 and 35 dB to mimic experimental excitation and emission FDPM measurements, respectively, we show the robustness of emission measurements referenced to excitation light. We investigate the performance of algorithm CONTN using these measurement techniques and show that the absorption coefficients due to fluorophore are reconstructed by CONTN accurately and efficiently. Furthermore, we demonstrate the performance of the bounding parameter for rejection of background artifacts owing to background tissue heterogeneity.

Fluorescence-enhanced optical tomography using referenced measurements of heterogeneous media

A novel image reconstruction algorithm has been developed and demonstrated for fluorescence-enhanced frequency-domain photon migration (FDPM) tomography from measurements of area illumination with modulated excitation light and area collection of emitted fluorescence light using a gain modulated image-intensified charge-coupled device (ICCD) camera. The image reconstruction problem was formulated as a nonlinear least-squares-type simple bounds constrained optimization problem based upon the penalty/modified barrier function (PMBF) method and the coupled diffusion equations. The simple bounds constraints are included in the objective function of the PMBF method and the gradient-based truncated Newton method with trust region is used to minimize the function for the large-scale problem (39919 unknowns, 2973 measurements). Three-dimensional (3-D) images of fluorescence absorption coefficients were reconstructed using the algorithm from experimental reflectance measurements under conditions of perfect and imperfect distribution of fluorophore within a single target. To our knowledge, this is the first time that targets have been reconstructed in three-dimensions from reflectance measurements with a clinically relevant phantom.

Tomographic fluorescence imaging in tissue phantoms: a novel reconstruction algorithm and imaging geometry

In the past, nonlinear unconstrained optimization of the optical imaging problem has
 focused on Newton–Raphson techniques. Besides requiring expensive computation
 of the Jacobian, the unconstrained minimization with Tikhonov regularization can pose
 significant storage problems for large-scale reconstructions, involving a large
 number of unknowns necessary for realization of optical imaging. We formulate the
 inverse optical imaging problem as both simple-bound constrained and unconstrained
 minimization problems in order to illustrate the reduction in computational time and
 storage associated with constrained image reconstructions. The forward simulator of
 excitation and generated fluorescence, consisting of the Galerkin finite-element
 formulation, is used in an inverse algorithm to find the spatial distribution of
 absorption and lifetime that minimizes the difference between predicted and synthetic
 frequency-domain measurements. The inverse approach employs the truncated Newton
 method with trust region and a modification of automatic reverse differentiation to
 speed the computation of the optimization problem. The reconstruction results confirm
 that the physically based, constrained minimization with efficient optimization
 schemes may offer a more logical approach to the large-scale optical imaging problem
 than unconstrained minimization with regularization.

Ranadhir Roy

Papers

Diagnostic imaging of breast cancer using fluorescence-enhanced optical tomography: phantom studies.

Three-dimensional unconstrained and constrained image-reconstruction techniques applied to fluorescence, frequency-domain photon migration.

Fluorescence-enhanced optical tomography using referenced measurements of heterogeneous media

Tomographic fluorescence imaging in tissue phantoms: a novel reconstruction algorithm and imaging geometry

Active constrained truncated Newton method for simple-bound optical tomography