The LMIT: Light-mediated minimally-invasive theranostics in oncology.

Minimally-invasive diagnosis and therapy have gradually become the trend and research hotspot of current medical applications. The integration of intraoperative diagnosis and treatment is a development important direction for real-time detection, minimally-invasive diagnosis and therapy to reduce mortality and improve the quality of life of patients, so called minimally-invasive theranostics (MIT). Light is an important theranostic tool for the treatment of cancerous tissues. Light-mediated minimally-invasive theranostics (LMIT) is a novel evolutionary technology that integrates diagnosis and therapeutics for the less invasive treatment of diseased tissues. Intelligent theranostics would promote precision surgery based on the optical characterization of cancerous tissues. Furthermore, MIT also requires the assistance of smart medical devices or robots. And, optical multimodality lay a solid foundation for intelligent MIT. In this review, we summarize the important state-of-the-arts of optical MIT or LMIT in oncology. Multimodal optical image-guided intelligent treatment is another focus. Intraoperative imaging and real-time analysis-guided optical treatment are also systemically discussed. Finally, the potential challenges and future perspectives of intelligent optical MIT are discussed.

Intelligent optical diagnosis and treatment system for automated image-guided laser ablation of tumors.

PURPOSE: For tumor resections near critical structures, accurate identification of tumor boundaries and maximum removal are the keys to improve surgical outcome and patient survival rate, especially in neurosurgery. In this paper, we propose an intelligent optical diagnosis and treatment system for tumor removal, with automated lesion localization and laser ablation. METHODS: The proposed system contains a laser ablation module, an optical coherence tomography (OCT) unit, and a robotic arm along with a stereo camera. The robotic arm can move the OCT sample arm and the laser ablation front-end to the suspected lesion area. The corresponding diagnosis and treatment procedures include computer-aided lesion segmentation using OCT, automated ablation planning, and laser control. The ablation process is controlled by a deflectable mirror, and a non-common-path ablation planning algorithm based on the transformation from lesion positions to mirror deflection angles is presented. RESULTS: Phantom and animal experiments are carried out for system verification. The robot could reach the planned position with high precision, which is approximately 1.16 mm. Tissue classification with OCT images achieves 91.7% accuracy. The error of OCT-guided automated laser ablation is approximately 0.74 mm. Experiments on mouse brain tumors show that the proposed system is capable of clearing lesions efficiently and precisely. We also conducted an ex vivo porcine brain experiment to verify the whole process of the system. CONCLUSION: An intelligent optical diagnosis and treatment system is proposed for tumor removal. Experimental results show that the proposed system and method are promising for precise and intelligent theranostics. Compared to conventional cancer diagnosis and treatment, the proposed system allows for automated operations monitored in real-time, with higher precision and efficiency.

Real-time and multimodality image-guided intelligent HIFU therapy for uterine fibroid.

Rationale: High-intensity focused ultrasound (HIFU) therapy represents a noninvasive surgical approach to treat uterine fibroids. The operation of HIFU therapy relies on the information provided by medical images. In current HIFU therapy, all operations such as positioning of the lesion in magnetic resonance (MR) and ultrasound (US) images are manually performed by specifically trained doctors. Manual processing is an important limitation of the efficiency of HIFU therapy. In this paper, we aim to provide an automatic and accurate image guidance system, intelligent diagnosis, and treatment strategy for HIFU therapy by combining multimodality information. Methods: In intelligent HIFU therapy, medical information and treatment strategy are automatically processed and generated by a real-time image guidance system. The system comprises a novel multistage deep convolutional neural network for preoperative diagnosis and a nonrigid US lesion tracking procedure for HIFU intraoperative image-assisted treatment. In the process of intelligent therapy, the treatment area is determined from the autogenerated lesion area. Based on the autodetected treatment area, the HIFU foci are distributed automatically according to the treatment strategy. Moreover, an image-based unexpected movement warning and other physiological monitoring are used during the intelligent treatment procedure for safety assurance. Results: In the experiment, we integrated the intelligent treatment system on a commercial HIFU treatment device, and eight clinical experiments were performed. In the clinical validation, eight randomly selected clinical cases were used to verify the feasibility of the system. The results of the quantitative experiment indicated that our intelligent system met the HIFU clinical tracking accuracy and speed requirements. Moreover, the results of simulated repeated experiments confirmed that the autodistributed HIFU focus reached the level of intermediate clinical doctors. Operations performed by junior- or middle-level operators with the assistance of the proposed system can reach the level of operation performed by senior doctors. Various experiments prove that our proposed intelligent HIFU therapy process is feasible for treating common uterine fibroid cases. Conclusion: We propose an intelligent HIFU therapy for uterine fibroid which integrates multiple medical information processing procedures. The experiment results demonstrated that the proposed procedures and methods can achieve monitored and automatic HIFU diagnosis and treatment. This research provides a possibility for intelligent and automatic noninvasive therapy for uterine fibroid.