Asunto(s)
Bancos de Sangre/normas , Seguridad de la Sangre/normas , Transfusión Sanguínea/normas , Infecciones por Coronavirus/epidemiología , Personal de Salud/normas , Neumonía Viral/epidemiología , Encuestas y Cuestionarios , Bancos de Sangre/estadística & datos numéricos , Donantes de Sangre/estadística & datos numéricos , Seguridad de la Sangre/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/normas , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Humanos , Pandemias , Neumonía Viral/transmisiónAsunto(s)
Bancos de Sangre/normas , Transfusión Sanguínea/normas , Infecciones por Coronavirus/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Neumonía Viral/epidemiología , Encuestas y Cuestionarios , Bancos de Sangre/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , COVID-19 , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Personal de Salud/normas , Humanos , Pandemias , Neumonía Viral/transmisión , Guías de Práctica Clínica como AsuntoAsunto(s)
Otoscopía , Telemedicina/economía , Telemedicina/instrumentación , Diseño de Equipo , Humanos , Internet , Telemedicina/métodos , Estados UnidosRESUMEN
Optical coherence tomography (OCT) is an evolving imaging modality that combines interferometry with low-coherence light to produce high-resolution tissue imaging. Cross-sectional in vivo images were obtained using an OCT device consisting of a Michelson interferometer, 1.3-microm broadband light source, and a handheld fiberoptic imaging probe. Image pixel resolution approached 10 microm. The mucosa of the oral cavity and oropharynx were examined in 41 patients during operative endoscopy. Optical coherence tomographic imaging was combined with endoscopic photography for gross and histologic image correlation. Optical coherence tomographic images of the oral cavity and oropharynx provided microanatomical information on the epithelium, basement membrane (BM), and supporting lamina propria (LP) of the mucosa. Normal microstructures identified in these tissues included an overlying keratin layer, papillae, ducts, glands, and blood vessels. Regions of pathologic features studied included mature scar, granulation tissue, mucous cysts, leukoplakia, and invasive cancer. Optical coherence tomographic imaging showed distinct zones of normal, altered, and ablated tissue microstructures for each pathologic process studied. Abnormal findings were directly compared with regions of normal tissue or conventional histopathologic features when tissue for analysis was available. This study provides a composite series of in vivo OCT images of the oral cavity and oropharynx in a variety of normal regions and pathologic states as well as outline future applications of OCT technology.
Asunto(s)
Enfermedades de la Boca/diagnóstico , Boca/patología , Orofaringe/patología , Enfermedades Faríngeas/diagnóstico , Tomografía de Coherencia Óptica , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía , Humanos , Persona de Mediana EdadRESUMEN
Optical coherence tomography (OCT) is an evolving noninvasive imaging modality and has been used to image the larynx during surgical endoscopy. The design of an OCT sampling device capable of capturing images of the human larynx during a typical office based laryngoscopy examination is discussed. Both patient's and physician's movements were addressed. In vivo OCT imaging of the human larynx is demonstrated. Though the long focal length limits the lateral resolution of the image, the basement membrane can still be readily distinguished. Office-based OCT has the potential to guide surgical biopsies, direct therapy, and monitor disease. This is a promising imaging modality to study the larynx.
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Tecnología de Fibra Óptica/instrumentación , Laringoscopios , Tomografía de Coherencia Óptica/instrumentación , Pliegues Vocales/anatomía & histología , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , MiniaturizaciónRESUMEN
OBJECTIVES: Optical coherence tomography (OCT) is a high-resolution optical imaging technique that produces cross-sectional images of living tissues using light in a manner similar to ultrasound. This prospective study evaluated the ability of OCT to identify the characteristics of laryngeal cancer and measure changes in the basement membrane, tissue microstructure, and the transition zone at the edge of tumors. MATERIALS AND METHODS: One hundred thirty-three patients underwent OCT examination during surgical endoscopy of the head and neck. Twenty-two patients with laryngeal cancer or a history of laryngeal cancer were imaged with a fiberoptic OCT system. Tumor and adjacent transition zones were imaged along with uninvolved subsites. OCT images were correlated with histopathology. RESULTS: Twenty-six OCT examinations were performed in 22 patients. Basement membrane disruption was seen in 18 subjects, all of whom had histology showing classic features of cancer. A transition zone to uninvolved epithelium at the tumor periphery was also often observed. In six studies, benign or premalignant processes were histologically confirmed. In three thin, superficial lesions, an intact basement membrane was observed. The basement membrane could not be identified in three other bulky exophytic, premalignant lesions, primarily because of increased superficial signal backscattering observed in pathologic tissues. CONCLUSIONS: OCT clearly identifies basement membrane violation from laryngeal cancer and can identify transition zones at the cancer margin. In bulky exophytic lesions, OCT signal may not penetrate deeply enough to show the basement membrane, but for many suspicious lesions that require exclusion of cancer, OCT shows potential for assisting in diagnostic assessment.
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Carcinoma de Células Escamosas/patología , Neoplasias Laríngeas/patología , Tomografía de Coherencia Óptica , Anciano , Anciano de 80 o más Años , Membrana Basal/ultraestructura , Biopsia , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Laríngeas/cirugía , Laringoscopía , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
OBJECTIVES: Optical coherence tomography (OCT) is an emerging imaging modality that combines low-coherence light with interferometry to produce cross-sectional images of tissue with resolution about 10 mum. Patients undergoing surgical head and neck endoscopy were examined using a fiberoptic OCT imaging probe to study and characterize microstructural anatomy and features of the larynx and benign laryngeal pathology in vivo. STUDY DESIGN: Prospective clinical trial. MATERIALS AND METHODS: OCT imaging of the larynx was performed in 82 of 115 patients who underwent surgical endoscopy for various head and neck pathologies. The OCT device employs a 1.3 microm broadband light source (FWHM, 80 nm). The frame rate is 1 Hz. Imaging was performed using a handheld probe placed in near contact with the target site. The maximum axial and lateral dimensions for the region of interest imaged were 2.5 mm x 6 mm, with resolutions of 10 microm. Simultaneously, conventional endoscopic images were obtained to provide anatomic correlation with OCT images and histology. Optical micrometry was performed to measure the epithelium thickness. RESULTS: Systematic OCT imaging of laryngeal structures and subsites provided information on the thickness of the epithelium, integrity of the basement membrane, and structure of the lamina propria. Microstructural features identified included glands, ducts, blood vessels, fluid collection/edema, and the transitions between pseudostratified columnar and stratified squamous epithelium. The mean epithelial thickness of laryngeal subsites was calculated: true vocal cord (129 microm), false vocal cords (124 microm), aryepiglottic fold (177 microm), subglottis (98 microm), and epiglottis (185 microm). True vocal cord pathology imaged included Reinke's edema, papillomatosis, polyps, mucous cysts, and granulation tissue. Subglottic imaging identified boundaries between epithelium, lamina propria, and cartilage. The OCT images compared favorably with conventional histopathology. CONCLUSION: OCT has the unique ability to image laryngeal tissue microstructure and can detail microanatomic changes in benign, premalignant, and malignant laryngeal pathologies. OCT holds the potential to guide surgical biopsies, direct therapy, and monitor disease, particularly when office-based systems are developed. This is a promising imaging modality to study the larynx.
Asunto(s)
Enfermedades de la Laringe/patología , Laringe/ultraestructura , Tomografía de Coherencia Óptica/métodos , Biopsia , Diagnóstico Diferencial , Endoscopía , Tecnología de Fibra Óptica , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Periodo Intraoperatorio , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To evaluate and optimize the design of a removable and inexpensive internal stabilization device to reduce the effect of intention tremor during laryngeal microsurgery. STUDY DESIGN AND SETTING: In this laboratory investigation, stabilizers were designed and constructed to allow a nonobstructing view of the surgical field, permit simple insertion and removal, and accommodate microsurgical instruments. Prototype stabilizers were tested by using a Dedo laryngoscope, a measurement grid, and video recording equipment, which recorded instrument tremor within the magnified operative field for later analysis. Physicians also rated instrument stability, mobility, visualization, and ease of use on a survey form. RESULTS: Instrument tremor was reduced approximately 90%, with little obstruction of view of the surgical field. Instrument range of motion was reduced but improved rapidly as the stabilizer bar was moved further from the tip of the laryngoscope. CONCLUSIONS: Use of a stabilization device in the laryngoscope lumen reduces instrument tremor and has the potential to improve surgical performance during laryngeal microsurgery. EBM RATING: B-3.