Significance: Colorectal cancer is one of the major causes of cancer-related deaths worldwide. Surgical removal of the cancerous growth is the primary treatment for this disease. A colorectal cancer surgery, however, is often unsuccessful due to the anastomotic failure that may occur following the surgical incision. Prevention of an anastomotic failure requires continuous monitoring of intestinal tissue viability during and after colorectal surgery. To date, no clinical technology exists for the dynamic and continuous monitoring of the intestinal perfusion.
Aim: A dual-wavelength indwelling bowel photoplethysmography (PPG) sensor for the continuous monitoring of intestinal viability was proposed and characterized through a set of in silico and in vivo investigations.
Approach: The in silico investigation was based on a Monte Carlo model that was executed to quantify the variables such as penetration depth and detected intensity with respect to the sensor–tissue separations and tissue perfusion. Utilizing the simulated information, an indwelling reflectance PPG sensor was designed and tested on 20 healthy volunteers. Two sets of in vivo studies were performed using the driving current intensities 20 and 40 mA for a comparative analysis, using buccal tissue as a proxy tissue-site.
Results: Both simulated and experimental results showed the efficacy of the sensor to acquire good signals through the “contact” to a “noncontact” separation of 5 mm. A very slow wavelength-dependent variation was shown in the detected intensity at the normal and hypoxic states of the tissue, whereas a decay in the intensity was found with the increasing submucosal-blood volume. The simulated detected-to-incident-photon-ratio and the experimental signal-to-noise ratio exhibited strong positive correlations, with the Pearson product-moment correlation coefficient R ranging between 0.65 and 0.87.
Conclusions: The detailed feasibility analysis presented will lead to clinical trials utilizing the proposed sensor.
Photoplethysmography (PPG) is an optical noninvasive technique with the potential for assessing tissue perfusion. The relative time-change in the concentration of oxyhemoglobin and deoxyhemoglobin in the blood can be derived from DC part of the PPG signal. However, the absolute concentration cannot be determined due to the inadequate data on PPG optical paths. The optical path and differential pathlength factor (DPF) for PPG at red (660 nm) and infrared (880 nm) wavelengths were investigated using a heterogeneous Monte Carlo model of the human forearm. Using the simulated DPFs, the absolute time-change in concentrations were determined from PPG signals recorded from the same tissue site. Results were compared with three conditions of approximated DPFs. Results showed the variation of the optical-path and DPF with different wavelengths and source–detector separations. Approximations resulted in significant errors, for example, using NIRS DPF in PPG led to “cross talk” of −0.4297 and 0.060 and an error of 15.16% to 25.18%. Results confirmed the feasibility of using the PPG (DC) for the assessment of tissue perfusion. The study also identified the inappropriateness of the assumption that DPF is independent of wavelength or source–detector separations and set the platform for further studies on investigating optical pathlengths and DPF in PPG.
Despite the wide clinical uses of pulse-oximetry, the precise nature of the
light-tissue interaction underneath the technique is not clearly understood. A heterogeneous
opto-anatomical model is presented to describe the optical path in pulse oximetry.
Differential interference contrast images (DIC) are the direct representation of the refractive index fluctuations of human cervical tissues. These refractive index fluctuations are known to follow self-similar behaviour and in general are multifractal in nature. In this present study, multifractal detrended fluctuation analysis (MFDFA) on refractive index fluctuations from DIC images has been performed by unfolding the tissue-images horizontally and vertically. Our analysis clearly shows that refractive index fluctuations of human cervical tissues are anisotropic-fractal in nature and anisotropy reduced as cancer progress.
Multi-resolution analysis on the spatial refractive index inhomogeneities in the connective tissue regions of human
cervix reveals clear signature of multifractality. We have thus developed an inverse analysis strategy for extraction and
quantification of the multifractality of spatial refractive index fluctuations from the recorded light scattering signal. The method is based on Fourier domain pre-processing of light scattering data using Born approximation, and its subsequent analysis through Multifractal Detrended Fluctuation Analysis model. The method has been validated on several mono- and multi-fractal scattering objects whose self-similar properties are user controlled and known a-priori. Following successful validation, this approach has initially been explored for differentiating between different grades of precancerous human cervical tissues.
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