@article{92c6f4d334e44d4b886bccbaff5bc20a,
title = "Clinical optoacoustic imaging combined with ultrasound for coregistered functional and anatomical mapping of breast tumors",
abstract = "Optoacoustic imaging, based on the differences in optical contrast of blood hemoglobin and oxyhemoglobin, is uniquely suited for the detection of breast vasculature and tumor microvasculature with the inherent capability to differentiate hypoxic from the normally oxygenated tissue. We describe technological details of the clinical ultrasound (US) system with optoacoustic (OA) imaging capabilities developed specifically for diagnostic imaging of breast cancer. The combined OA/US system provides co-registered and fused images of breast morphology based upon gray scale US with the functional parameters of total hemoglobin and blood oxygen saturation in the tumor angiogenesis related microvasculature based upon OA images. The system component that enabled clinical utility of functional OA imaging is the hand-held probe that utilizes a linear array of ultrasonic transducers sensitive within an ultrawide-band of acoustic frequencies from 0.1 MHz to 12 MHz when loaded to the high-impedance input of the low-noise analog preamplifier. The fiberoptic light delivery system integrated into a dual modality probe through a patented design allowed acquisition of OA images while minimizing typical artefacts associated with pulsed laser illumination of skin and the probe components in the US detection path. We report technical advances of the OA/US imaging system that enabled its demonstrated clinical viability. The prototype system performance was validated in well-defined tissue phantoms. Then a commercial prototype system named Imagio{\texttrademark} was produced and tested in a multicenter clinical trial termed PIONEER. We present examples of clinical images which demonstrate that the spatio-temporal co-registration of functional and anatomical images permit radiological assessment of the vascular pattern around tumors, microvascular density of tumors as well as the relative values of the total hemoglobin [tHb] and blood oxygen saturation [sO2] in tumors relative to adjacent normal breast tissues. The co-registration technology enables increased accuracy of radiologist assessment of malignancy by confirming, upgrading and/or downgrading US categorization of breast tumors according to Breast Imaging Reporting And Data System (BI-RADS). Microscopic histologic examinations on the biopsied tissue of the imaged tumors served as a gold standard in verifying the functional and anatomic interpretations of the OA/US image feature analysis.",
keywords = "Breast cancer, Diagnostics, Dual modality, Functional-anatomical imaging, Optoacoustic, Photoacoustic, Ultrasound",
author = "Oraevsky, {A. A.} and B. Clingman and J. Zalev and Stavros, {A. T.} and Yang, {W. T.} and Parikh, {J. R.}",
note = "Funding Information: This research was sponsored in part by grants from the National Cancer Institute : R44CA128196 and R01CA167446 . The authors acknowledge technical contribution of scientists and engineers from Seno Medical Instruments and TomoWave Laboratories and clinical collaborators from MD Anderson Cancer Center, and 15 other breast imaging centers that took part in the PIONEER clinical trials. Authors would like to thank Barbara Lind for her management of this collaboration. Alexander A. Oraevsky is a pioneer in the field of biomedical optoacoustic imaging. Alexander obtained a doctorate in laser spectroscopy and laser biophysics from the USSR Academy of Sciences in 1986. In 1992, as Whitaker Fellow, he joined the faculty at Rice University. Prior to his leadership position at TomoWave Laboratories, he was a Chief Scientific Officer at Seno Medical Instruments, Vice President of R&D at Fairway Medical Technologies, Director of the Optoacoustic Imaging and Spectroscopy Laboratory at the University of Texas Medical Branch in Galveston and an Assistant Professor at the Department of Ophthalmology and Visual Sciences. Presently he holds a Santander Chair of Excellence in Physics at the University Carlos III of Madrid, Distinguished Professor of Medical Imaging at Guangzhou Medical University, an adjunct Professor of Biomedical Engineering at the University of Houston. Alexander is the holder of 21 patents, has published ten book chapters and over 200 scientific papers dealing with novel laser technologies applicable in biology and medicine. Dr. Oraevsky is the recipient of multiple research awards advancing biomedical applications of the optoacoustic imaging sensing and monitoring. Dr. Oraevsky is the founder and Chair of the largest conference in the field of laser optoacoustic ultrasonic imaging under the auspices of SPIE. Bryan Clingman , Vice President (Software) at Seno Medical Instruments, has more than 20 years of experience in Electrical Engineering and Software Development with focus on imaging and signal processing applications. He has worked in Optoacoustic imaging for much of that time developing the Imagio imaging system for Seno Medical. He has assisted in the transition from a research oriented system to the clinical system. Along the way, he participated heavily in the algorithm design, software architecture, and software design and implementation. Jason Zalev , MS has been involved with developing algorithms and analyzing data for Seno Medical Instruments since 2010. He is currently a 3rd year PhD candidate in Biomedical Physics at Ryerson University in Toronto, Canada. His research involves using mathematical optimization for optoacoustic image reconstruction. Anthony Thomas Stavros ,MD is a Medical Director at Seno Medical Instruments. Dr. Stavros is a women{\textquoteright}s imaging radiologist with more than 30 years in breast imaging experience. Dr. Stavros has been involved in mammography since 1976, and has been actively involved in the development of high-frequency, hand-held breast ultrasound since 1981. Dr. Stavros{\textquoteright} main interests are general ultrasound, breast imaging and intervention, and ultrasound-guided FNA and/or core biopsy in the thyroid, head and neck. Dr. Stavros is a reviewer for several medical journals and has written or co-authored numerous articles including the definitive textbook for reference and learning in the specialty, Breast Ultrasound . Dr. Stavros is a recognized as a leader in the field of breast ultrasound and speaks globally on this topic having presented more than 2,000 invited lectures and abstracts. Dr. Stavros is a fellow of the American College of Radiology, a fellow of the Society of Radiologists in Ultrasound, an honorary fellow of the Royal Australian and New Zealand College of Radiology and is Professor Specialist at the University of Texas Health Science Center at San Antonio. Wei Tse Yang , MBBS, FRCR, is the Robert D. Moreton Distinguished Chair in Diagnostic Radiology at the University of Texas MD Anderson Cancer Center. She is Medical Director, Quantitative Imaging Analysis Core and Chair, Imaging Response Assessment Team for execution of Response Evaluation Criteria in Solid Tumors (RECIST) measurements to support clinical trial development and drug discovery. She has special interest in 36 novel imaging technology such as optoacoustic ultrasound for the measurement of tumor response, and championed the multidisciplinary technique of “targeted axillary dissection”, which ensures a false negative rate of less than 5% for sentinel lymph node dissection in breast cancer patients after neoadjuvant chemotherapy. She is Co-PI in a protocol that aims to eliminate surgery for breast cancer patients who are exceptional responders to neoadjuvant chemotherapy. She is an advocate of the Divisional Council of Gender Inclusiveness Committee, and the Women Faculty and Minority Inclusion Group at MD Anderson. Jay Parikh MD, FACR, FSBI, FACPE, FRCP(c), is Professor of Diagnostic Radiology at the University of Texas MD Anderson Cancer Center at the University of Texas MD Anderson Cancer Center, Houston, Texas. He is Medical Director of the MD Anderson Breast Care and Memorial Hermann, overseeing 16 breast imaging centers currently with future projected expansion. Dr. Parikh was former Medical Director of the Swedish Breast Imaging Center and Women{\textquoteright}s Diagnostic Imaging Center for over a decade at the Swedish Cancer Institute in Seattle, Washington, both nationally recognized for their innovative patient-centric breast practices. Dr. Parikh is Past-President of the National Consortium of Breast Centers, Past- President of the Pacific Northwest Radiological Society, and Past-President of the Washington State Chapter of the American College of Radiology. Dr. Parikh also currently serves as an image reviewer for the Mammography Accreditation Program and the Breast Ultrasound Accreditation Program for the ACR. Dr. Parikh has been recognized for his leadership and clinical expertise as a Fellow of the American College of Radiology, a Fellow of the Society of Breast Imaging, a Fellow of the American College of Physician Executives, and a Fellow of the Royal College of Physicians and Surgeons of Canada. Dr. Parikh has provided over 370 educational presentations and has published over 50 research articles. His areas of educational expertise include digital mammography, breast intervention, and medico-legal issues in breast imaging. He has lectured at local, state, national, and international levels. Publisher Copyright: {\textcopyright} 2018 The Authors",
year = "2018",
month = dec,
doi = "10.1016/j.pacs.2018.08.003",
language = "English (US)",
volume = "12",
pages = "30--45",
journal = "Photoacoustics",
issn = "2213-5979",
publisher = "Elsevier GmbH",
}