A Multimodality DLP® Imaging System For Clinical Surgery

Abstract

With 1.38 million new cases and 450,000 deaths worldwide due to breast cancer, there is a clear need for safe and complete surgical intervention for the treatment of breast cancer. Imaging solutions have been created and developed to help plastic surgeons during breast reconstructive surgery. However, these solutions were implemented separately depending on their particular modality, which can result in higher costs for hospital and patient use. The digital micromirror device (DMD) developed by Texas Instruments has been shown to exhibit spectral control of light at a digital level, and could theoretically allow for the incorporation of multiple imaging modalities into one system. Therefore, a DMD-based multimodality imaging system was developed to integrate both hyperspectral imaging and fluorescence angiography into a single system for use in clinical breast reconstruction surgery. The DMD-based light source was characterized to have a spectral resolution of less than 1 nm with full-width half-maximum bandwidths as small as 7.5 nm and total power output of up to almost 200 mW. This light source was integrated with a detector that is sensitive to both visible and near-infrared light, along with a laptop computer with graphical user interface to control and synchronize the hardware. The resulting Mid-Range DLP® imaging system was found to be sensitive to changes in tissue oxygenation of skin flaps in DIEP free flap breast reconstruction surgery using hyperspectral imaging of oxy-hemoglobin and deoxy-hemoglobin. Utilizing this imaging modality, plastic surgeons were able to visualize the distribution of tissue oxygenation to avoid necrosis of skin flaps used to reconstruct breast tissue. Furthermore, the Mid-Range DLP® imaging system was successfully able to fluoresce ICG in clinical surgery in patients with lymphedema in their upper extremity. The fluorescence angiography capability of this system allowed plastic surgeons to locate healthy lymphatic vessels used in lymphaticovenous bypass surgery in a non-invasive manner that would not otherwise be possible without the fluorophore.