Pressure injuries (PIs) originate beneath the surface of the skin at the interface between bone and soft tissue. We used diffuse correlation spectroscopy (DCS) and diffuse near-infrared spectroscopy (DNIRS) to predict the development of PIs by measuring dermal and subcutaneous red cell motion and optical absorption and scattering properties in 11 spinal cord injury subjects with only nonbleachable redness in the sacrococcygeal area in a rehabilitation hospital and 20 healthy volunteers. A custom optical probe was developed to obtain continuous DCS and DNIRS data from sacrococcygeal tissue while the subjects were placed in supine and lateral positions to apply pressure from body weight and to release pressure, respectively. Rehabilitation patients were measured up to four times over a two-week period. Three rehabilitation patients developed open PIs (POs) within four weeks and eight patients did not (PNOs). Temporal correlation functions in the area of redness were significantly different (p<0.01) during both baseline and applied pressure stages for POs and PNOs. The results show that our optical method may be used for the early prediction of ulcer progression.
Microcirculation is essential for proper supply of oxygen and nutritive substances to the biological tissue and the removal of waste products of metabolism. The determination of microcirculatory blood flow (mBF) is therefore of substantial interest to clinicians for assessing tissue health; particularly in pressure ulceration and suspected deep tissue injury. The goal of this pilot clinical study was to assess deep-tissue pressure ulceration by non-invasively measuring mBF using Diffuse Correlation Spectroscopy (DCS). DCS provides information about the flow of red blood cells in the capillary network by measuring the temporal autocorrelation function of scattering light intensity. A novel optical probe was developed in order to obtain measurements under the load of the subject’s body as pressure is applied (ischemia) and then released (reperfusion) on sacrococcygeal tissue in a hospital bed. Prior to loading measurements, baseline readings of the sacral region were obtained by measuring the subjects in a side-lying position. DCS measurements from the sacral region of twenty healthy volunteers have been compared to those of two patients who initially had similar non-blanchable redness. The temporal autocorrelation function of scattering light intensity of the patient whose redness later disappeared was similar to that of the average healthy subject. The second patient, whose redness developed into an advanced pressure ulcer two weeks later, had a substantial decrease in blood flow while under the loading position compared to healthy subjects. Preliminary results suggest the developed system may potentially predict whether non-blanchable redness will manifest itself as advanced ulceration or dissipate over time.
Diffuse photon density wave (DPDW) methodology is widely used in a number of biomedical applications. Here, we present results of Monte Carlo simulations that employ an effective numerical procedure based upon a description of radiative transfer in terms of the Bethe–Salpeter equation. A multifrequency noncontact DPDW system was used to measure aqueous solutions of intralipid at a wide range of source–detector separation distances, at which the diffusion approximation of the radiative transfer equation is generally considered to be invalid. We find that the signal–noise ratio is larger for the considered algorithm in comparison with the conventional Monte Carlo approach. Experimental data are compared to the Monte Carlo simulations using several values of scattering anisotropy and to the diffusion approximation. Both the Monte Carlo simulations and diffusion approximation were in very good agreement with the experimental data for a wide range of source–detector separations. In addition, measurements with different wavelengths were performed to estimate the size and scattering anisotropy of scatterers.
This paper describes a novel, wearable, battery powered ultrasound applicator that was evaluated as a therapeutic tool for healing of chronic wounds, such as venous ulcers. The low frequency and low intensity (~100mW/cm<sup>2</sup>) applicator works by generating ultrasound waves with peak-to-peak pressure amplitudes of 55 kPa at 20 kHz. The device was used in a pilot human study (n=25) concurrently with remote optical (diffuse correlation spectroscopy - DCS) monitoring to assess the healing outcome. More specifically, the ulcers’ healing status was determined by measuring tissue oxygenation and blood flow in the capillary network. This procedure facilitated an early prognosis of the treatment outcome and – once verified - may eventually enable customization of wound management. The outcome of the study shows that the healing patients of the ultrasound treated group had a statistically improved (p<0.05) average rate of wound healing (20.6%/week) compared to the control group (5.3%/week). In addition, the calculated blood flow index (BFI) decreased more rapidly in wounds that decreased in size, indicating a correlation between BFI and wound healing prediction. Overall, the results presented support the notion that active low frequency ultrasound treatment of chronic venous ulcers accelerates healing when combined with the current standard clinical care. The ultrasound applicator described here provides a user-friendly, fully wearable system that has the potential for becoming the first device suitable for treatment of chronic wounds in patient's homes, which - in turn - would increase patients’ compliance and improve quality of life.
The Diffuse Photon Density Wave (DPDW) methodology is widely used in a number of biomedical applications. Here we present results of Monte Carlo simulations that employ an effective numerical procedure, based upon a description of radiative transfer in terms of the Bethe-Salpeter equation, and compare them with measurements from Intralipid aqueous solutions. In our scheme every act of scattering contributes to the signal. We find the Monte Carlo simulations and measurements to be in a very good agreement for a wide range of source –detector separations.
The ability to determine the depth and degree of cutaneous and subcutaneous tissue damage is critical for medical
applications such as burns and pressure ulcers. The Diffuse Photon Density Wave (DPDW) methodology at near infrared
wavelengths can be used to non-invasively measure the optical absorption and reduced scattering coefficients of tissue at
depths of several millimeters. A multi-frequency DPDW system with one light source and one detector was constructed
so that light is focused onto the tissue surface using an optical fiber and lens mounted to a digitally-controlled actuator
which changes the distance between light source and detector. A variable RF generator enables the modulation frequency
to be selected between 50 to 400MHz. The ability to digitally control both source-detector separation distance and
modulation frequency allows for virtually unlimited number of data points, enabling precise selection of the volume and
depth of tissue that will be characterized. Suspensions of Intralipid and india ink with known absorption and reduced
scattering coefficients were used as optical phantoms to assess device accuracy. Solid silicon phantoms were formulated
for stability testing. Standard deviations for amplitude and phase shift readings were found to be 0.9% and 0.2 degrees
respectively, over a one hour period. The ability of the system to quantify tissue damage in vivo at multiple depths was
tested in a porcine burn model.