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Radiation Therapy Induced-Erythema: Comparison of Spectroscopic Diffuse Reflectance Measurements and Visual Assessment


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Surveillance and assessment of radiation-induced erythema is an important aspect of managing skin toxicity in radiation therapy treated patients. Upon receiving the early fractions of radiation, an inflammatory response and vascular dilation takes place due to damage of basal cells in the skin’s epidermal layer. This process of skin reddening known as erythema. The gold standard used for assessing and grading erythema is visual assessment (VA) by an experienced clinician/ radiotherapist using toxicity scoring tools. This method is limited by the assessor’s experience, vision acuity, and the subjectivity of qualitative scores. An alternative optical technique to VA, is diffuse reflectance spectroscopy (DRS). A comparison between both techniques performance in detecting radiation therapy-induced erythema is demonstrated in this pilot study. The results evidenced that DRS is capable of detecting skin erythema before an expert eye could do so.
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Radiation therapy induced-erythema:
comparison of spectroscopic diffuse
reflectance measurements and visual
Ramy Abdlaty, Lilian Doerwald, Joseph Hayward, Qiyin
Ramy Abdlaty, Lilian Doerwald, Joseph Hayward, Qiyin Fang, "Radiation
therapy induced-erythema: comparison of spectroscopic diffuse reflectance
measurements and visual assessment," Proc. SPIE 10952, Medical Imaging
2019: Image Perception, Observer Performance, and Technology
Assessment, 109520H (4 March 2019); doi: 10.1117/12.2506306
Event: SPIE Medical Imaging, 2019, San Diego, California, United States
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Radiation Therapy Induced-Erythema:
Comparison of Spectroscopic Diffuse Reflectance
Measurements and Visual Assessment
Ramy Abdlaty 1, Lilian Doerwald 2, Joseph Hayward 2, Qiyin Fang 1.3
1 Biomedical Engineering, Military Technical College, Cairo, Egypt
2 Juravinski Cancer Centre, Hamilton Health Sciences, Ontario, Canada
3 Engineering Physics, McMaster University, Ontario, Canada
Surveillance and assessment of radiation-induced erythema is an important aspect of managing skin toxicity in
radiation therapy treated patients. Upon receiving the early fractions of radiation, an inflammatory response and
vascular dilation takes place due to damage of basal cells in the skin’s epidermal layer. This process of skin reddening
known as erythema. The gold standard used for assessing and grading erythema is visual assessment (VA) by an
experienced clinician/ radiotherapist using toxicity scoring tools. This method is limited by the assessor’s experience,
vision acuity, and the subjectivity of qualitative scores. An alternative optical technique to VA, is diffuse reflectance
spectroscopy (DRS). A comparison between both techniques performance in detecting radiation therapy-induced
erythema is demonstrated in this pilot study. The results evidenced that DRS is capable of detecting skin erythema
before an expert eye could do so.
Keywords: Radiation Therapy, Erythema, DRS, Visual Assessment
Diverse biological, chemical, and physical interventions could provoke human skin to become erythematous.
One of the famous causes of skin to be erythematic is ultraviolet (UV) radiation in sun rays, (1,2) which progressively
damages the skin leading to skin cancer (SC) and photo aging (3). SC is basically two major categories: melanoma
skin cancer (MSC), and non-melanoma skin cancer (NMSC) (4). The lesion treatment for both categories is an
oncologist choice between surgery, radiation therapy, or a combination therapy (5). Surgery has no preference in facial
tumors and in old age patients (6). Consequently, a big ratio of SC patients is treated with local radiation therapy.
Radiotherapy points an ionizing radiation (X-rays photons/ electrons) onto sites of malignant tissue growth, in order
to induce DNA destruction within rapidly dividing tumor cells. Typically, the radiotherapy treatment plan is divided
into a set of sessions, wherein the patient receives a certain dose of ionizing radiation, called a fraction (7). The daily
radio therapeutic dose is confined between safe upper and effective lower limits quantified in Grey/ day (Gy/day) (8).
These limits are carefully considered to be far from inducing radiation side effects.
A variety of side effects are induced by radiotherapy treatment in several body organs (9). One of the early
damaged organs, due to radiation, is the skin. The skin damage varies in severity from slight allergy, to intense
inflammation, and may reach skin burning or necrosis. The damage severity is majorly dependent on the disturbance
that takes place in the rate of compensating the dead cells. Beside compensation disturbance, radiation induces
inflammatory reaction due to destruction and dilation of capillaries in the dermis layer of the skin, and thus become
erythematous. Erythema is usually combined with edema since blood vessels’ permeability is changed. In conjunction
with erythema, hair growth is suppressed as the hair follicles enter a resting phase and thus stops generating new hairs.
The side effects of radiation reduce the patients’ quality of life since it may require different clothing style,
stop practicing favorite sports, beside regular use of moisturizing creams (10). The skin reactions to radiotherapy occur
in no less than nine tenth of all patients (11,12). It usually occurs within 1-4 weeks after the first fraction of radiation
(11). In the 24 hours period following the primary fraction, individual patients may show temporary erythema
surrounding the treated region, which becomes more observable along the rest of radiation sessions. The erythematous
side effect of radiotherapy does not only reduce patients’ quality of life, but also impedes the continuity of the
Medical Imaging 2019: Image Perception, Observer Performance, and Technology Assessment,
edited by Robert M. Nishikawa, Frank W. Samuelson, Proc. of SPIE Vol. 10952, 109520H
© 2019 SPIE · CCC code: 1605-7422/19/$18 · doi: 10.1117/12.2506306
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treatment plan, unless attentively monitored and precisely addressed (13). Erythema is not only accompanying
radiation therapy treatment, but also photodynamic therapy and plastic surgery.
Erythema research has garnered interest because its association with various cutaneous diseases and their
management. This interest fueled the innovation of precise techniques for quantifying erythema. From most to least
complex, the techniques are: spectroscopy, colorimetry/ photography, and visual assessment (VA) (13). VA is still the
current gold standard for erythema assessment in dermatology clinics (14,15). However, VA is a qualitative technique
for erythema evaluation as it accounts on human sensation and clinical experience. The subjectivity, differences in
visual perception, credence on human memory and language limit the reliability and repeatability of VA. As a result,
VA is necessary for rapid checking checking but far from quantitative assessment.
To achieve objective evaluation and precise documentation, colorimetry and digital photography were used.
These techniques measure the skin redness through reflection of light within the visible spectrum. For instance,
colorimetry techniques determine the object’s color by utilizing three sensors that each count photons with a specific
wavelength. The three specified wavelengths represent a standard color space such as the L*a*b* color system (16).
Digital photography has the advantage of being able to record and display erythema progression infinitely to experts
and trainees (17). Both techniques have been effectively used in several studies for sensing dermatological diseases
and symptoms including erythema (1721). One of the drawbacks of both techniques is the need for a standard
environment (illumination, color correction charts and poses (22)), as well as daily calibration to ensure high quality
inter-measurements (23). Moreover, both techniques are far from being able to precisely discriminate between
erythema in a time-series of measurements since they suffer from insufficient spectral resolution (2426).
Diffuse reflectance spectroscopy (DRS) measurements is an erythema assessment tool with better spectral
resolution. Unlike colorimetry and digital photography, DRS discriminates between skin color changes based on the
variation in the skin’s chromophores spectral profile (15,2734). The spectral profile provides quantitative information
out of the skin’s chromophores concentration. Thus, some commercial devices used DRS for detecting cutaneous
color changes. For instance, the T-Stat® (Spectros, Portola Valley, California) is used for that purpose; however, at
~$25,000 USD, it is too expensive for walk-in clinics to afford. The inexpensive instruments are ineffective among
clinicians because of poor interface, disappointing performance and reliability. Beside the steep cost of reliable DRS
instruments, trained technician is needed for their reoperation. For the former reasons, a former study by our group,
developed an inexpensive optical setup for acquiring DRS measurements, shown in Figure 1 (35). The setup reliably
functions in both the laboratory and the clinic.
Figure 1: A schematic diagram shows the DRS system used in the study. The optical setup is composed of a fiber-coupled white
LED light source to an integrating sphere input port. The diffusely reflected light is trapped inside the sphere except the photons
which reach the exit port. The former port is fiber coupled to a spectrophotometer. The captured photons within the spectral gate
are displayed and stored on the attached computer.
The research question of the current study is: “Could DRS be considered an alternative to visual assessment
in quantifying skin erythema?” To reach an answer, a preliminary study was planned to examine the feasibility of the
custom-made DRS system for addressing the progress of erythema on SC patients referred to radiation therapy
treatment. For comparison purposes, the same patients were simultaneously visually assessed by two expert
radiotherapists. The following reasons motivated this study: (1) DRS measurements are noninvasive ones, low-cost
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and user-friendly technique; (2) DRS is an objective method and does not require special expertise to operate; and
finally (3) DRS quantitatively measures changes in skin’s chromophores concentration associated with erythema.
2.1 Study protocol
The clinical study protocol and consent were accepted by the Hamilton Integrated Research Ethics Board (HiREB)
responsible for research studies within McMaster University and affiliated regional healthcare institutions (Hamilton
Health Science and St. Joseph’s Healthcare Hamilton). All the participating subjects, in the study, signed the consent
received a schedule of the treatment and study sessions. The participants were instructed not to use any topical agent
or skin dressing, unless instructed by their oncologist, in which case they should also inform the study’s main
investigator. The study setup preparation, patient recruitment, and clinical work continued for six months.
2.2 Patients recruitment
In this study, we recruited eight patients. The patients were diagnosed with skin cancer and radiation therapy was their
way for treatment. The patient’s age ranged from 56 to 88 years (median = 79 years). Daily radiation fraction doses
ranged from 250 cGy (5000/20) up to 425 cGy (4250/10). Five patients, out of eight, completed the study successfully
till the end. The other three patients’ data were ignored according to exclusion criteria (the first patient (P01) quit the
treatment before completion, P05 initially had a high degree of skin redness, while P07 had an uneven treatment site
which would compromise the reproducibility of DRS measurements). The demographic data of the applicable five
patients is displayed in Table 1. The recruited patients have non-melanoma skin cancer (NMSC), either basal cell
carcinoma (BCC) or squamous cell carcinoma (SCC), and received at least 10 radiation fractions. The lesions in the
recruited patients were either in the arm, the leg, or the face.
Once the region of treatment/ interest (ROI) is determined, by the oncologist, it is marked in order to ensure
high precision in providing the radiation dose every day. The radiotherapist would usually use markers of different
colors such red, green, or blue. Patients may prefer to be marked with red marker for cosmetic reasons. However, in
our study, the recruited patients were marked with green or blue marker. The reason for selecting other markers than
red is to avoid any interference between the red marking and the radiation-induced erythema. For our experiments,
one or two location{s) within the ROI is/are selected by the radiotherapist to be the daily position for DRS
measurement acquisition. Identifying ROI is the radiotherapist’s decision. Two spots, within ROI, were used for DRS
measurements. The reason for using two spots instead of one is reducing the possibility of holding measurements
because of severe skin reactions such as dry and wet desquamation. Again, One or two spot(s), out of ROI, is/are
decided by the radiotherapist to act as the control region for measurement. The control region provides a baseline from
which to measure the alteration in skin optical properties due to radiation treatment.
Table 1: Demographic data of the recruited skin cancer subjects along the length of the study
1.5 cm
Left tibia
Left fore- arm
Left cheek
1 cm
Right ear
Left temple
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Figure 2: displays the region of interest (ROI) for a patient (P04). The patient has a basal cell carcinoma (BCC) in her left fore-
arm. The patient’s ROI is surrounded by a red marker. Two circles, blue and black, were selected by the radiotherapist to be the
positions of reflectance measurements on the patient’s skin. The green circle is selected as a control region since it is located in the
same arm but does not receive any radiation through the time of treatment. The size of the circles is matching the size of the
integrating sphere detection port.
2.3- Study Methods
The study daily measurements were scheduled before the irradiation session for each patient. On each day one out of
two radiotherapists, involved in the study, scores and documents her assessment of the ROI, and the second do the
same using digital captured images, as shown in Figure 3. The patient’s ROI is graded using a scoring chart ranges in
degrees from 0 to 4 as exhibited in Table 2 (15).
Table 2: Erythema visual grading scores
Very faint
Very bright
Figure 3: RGB images of the treatment site for patient number 4 in row (P04) showing a typical time sequence (date is tagged) of
progressive skin reaction over the radiation therapy plan. Starting at the top left, the images correspond to treatment days number
5, 6, 7, 8, 9, 11, 12, 14, 16, 19, and 20. The skin ROI exposed to radiation exhibited a marked increase in erythema (skin redness)
over time.
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To ensure the replicability of DRS measurements, a clinic chair-bed was used to position the patient. For calibration
purposes, two diffuse reflectance targets whose reflectance are 99% and 2% (SRS-99-010, and SRS-02-010
Labsphere, North Sutton, New Hampshire) were simultaneously measured before use on each subject. The high
reflectance standard normalizes the patient’s measurement, relative to the room environment, while the low reflectance
target accounts for the background noise (15,36).
To give more details regarding the DRS system, a brief will be presented regarding the system components.
The primary component is the light source which is selected, since the spectral absorption peaks of oxy- and
deoxyhemoglobin (37,38), to emit light within the visible light spectra. An LED source was chosen to illuminate the
ROI because of the stable emission in the visible spectra. The LED source is transmitted via Radiometric Fiber coupled
source (Newport, Irvine, California) to provide a precisely steady luminance within the visible range. The
spectrophotometer, used for detecting skin reflectance, is selected to be highly sensitive and efficient at differentiating
close spectral features. The whole system components were constrained in size, and weight to facilitate portability.
For the former purpose, the Ocean Optics (Dunedin, Florida) was utilized for developing the system of the study. One
essential reason for selecting this spectrophotometer is the relatively long range of operation, 340-1000 nm, that
includes UV-VIS, and NIR spectra. In addition, it is portable in size (< 150 mm3), and has wide integration time (3
ms < t < 60 s). The fibers used for light transmission specifications were SMA 905 with 0.22 NA, and 400 µm. The
fiber specifications were identified in order to collect the maximum possible light. The integrating sphere was custom
developed in the laboratory and the details are published elsewhere (13).
3.1 DRS measurements and processing
The diffuse reflectance data was computed by processing the acquired visible spectra measurements obtained from
the patients. Simply, the dark noise was removed from the raw spectral measurement (𝑴𝑹𝑶𝑰) by subtracting the low
reflectance standard target measurement (𝑴𝒍𝒐𝒘 ). The effect of unevenly distributed illumination was neutralized by
normalizing the ROI measurement to a high reflectance white standard target (𝑴𝒉𝒊𝒈𝒉 ). Both the white standard target
and the dark noise measurements were accomplished in the same conditions of the ROI. Hence, the skin ROI
reflectance (𝑹𝑹𝑶𝑰) was computed as follows:
𝑴𝑖𝑔− 𝑴𝑙𝑜𝑤
Using the low reflectance standard target, instead of capturing measurements for a dark background, is
advantageous in reducing variability in measurements due to the changes of ambient light. The wide integration time
of the spectrometer enabled measurements far from saturation. Three measurements were collected each turn, either
for skin or the reflectance standards. The three measurements were averaged to reduce noise and human error. The
integrating sphere detection port was protected by a layer of tight dressing (Tegaderm™ film, 3M Health Care, St.
Paul, Minnesota) against dirt and contamination. A new dressing layer was used for each individual to verify
decontamination. The individual’s layer was unchanged until the high and low standards’ measurements were
collected, so as not to alter the acquired data.
3.2- Erythema Index computation
The use of Dawson indices is a familiar approach for quantitative estimation of the skin color changes due to disease
progression (26), or medical treatment (39). Dawson derived his erythema index (DEI) formula based on the
assumption that the relation between the hemoglobin optical absorption in the range of 510-610 nm and the erythema
scores is proportional. Dawson found that the area under the curve for the hemoglobin absorption, if a baseline is
determined, is the parameter related to the skin erythema variation and calculated as follows:
𝑫𝑬𝑰 = 𝟓𝟎 ∗ [𝟐𝒓 + 𝟑(𝒒 + 𝒔)− 𝟒(𝒑 + 𝒕)]
The terms, p, q, r, s, and t are the symbols expressing the logarithm of the reciprocal of the 𝑹𝑹𝑶𝑰 (LRR)
computed at five predetermined wavelengths 510, 540, 560, 580, and 610 nm, respectively. Following the
measurements, Dawson’s relative erythema index (DEIr) is computed to assess the skin color change. The term DEIr
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is equivalent to the difference in DEIc values between two skin sites, one of which is the treated site while the other is
the control (non-treated) site. By this subtraction, the effect of the melanin presence in the skin considered.
Figure 4 is a plot of DEIr calculated from the spectral data obtained using the DRS system for each day of
the 20 treatments for patient P04. The DEIr was calculated relative to normal skin to reduce daily variations of skin
optical properties. Figure 5 is a plot of the daily erythema scores assigned by the clinician by visual inspection (gold
standard). Note the clinician scored visible erythema (above zero) for the first time on day 4, whereas the EI increased
since Day 1.
Figure 4: displays the computed relative erythema index, using Dawson erythema index, for one of the recruited patients. The
displayed results are for a patient who received 20 treatment sessions along 4 weeks.
Figure 5: displays the average clinical scores for the same patient (P04), in Figure 4, assigned by the expert radiotherapist using
the assessment criteria for erythema.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 1
3 3 3 3 3 3 3 3
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Based on the results for the 5 patients, we found that 2 out 5 had an increasing clinician scores, however,
DEIr scores displayed no particular trend after the first week of treatment. The other 3 patients had overall increasing
clinician scores that agree with the DEIr scores over the course of treatment. The advantage of computing DEIr is the
early detection of erythema compared with visual assessment by the radiotherapist. This was proved as all DEIr scores
started to increase from the baseline measurement on the first day of treatment. Thus, erythema index based on DRS
measurements is more sensitive to erythema change than VA. To sum, we suggest that radiotherapists use inexpensive
portable DRS systems in order not only to objectively score erythema, but also to detect skin reactions next to radiation
therapy treatment before being visibly apparent to the clinician.
The results of this preliminary study demonstrate the potential of using DRS technique in the clinical settings
of dermatology clinics. Extended research effort needs to be exerted to certify the reliability of the DRS system with
more patient recruited in the ongoing study. Some enhancements in the original study methodology have been planned
to streamline DRS measurements on skin cancer patients seen in clinic, as well as to verify accurate daily DRS data
acquisition. The second phase of the ongoing study is currently taking place.
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... Different stages of tumor progression require different types of surgical treatment, including breastconserving surgery (BCS) and Radical Mastectomy (RM). Modified radical mastectomy (MRM) is widely used in clinical practice for the treatment of breast cancer to ensure surgical efficacy while reducing surgical damage and improving the patient's quality of life [2]. Specifically, MRM has become a cornerstone of breast cancer treatment in China. ...
... Manual delineation of OARs and CTVs for RT is a laborious task for clinicians, which requires not only experience but also physical exertion. Repetitive work for long periods can lead to reduced productivity and even errors on the part of clinicians [2]. In this case, automatic segmentation algorithms serve as a useful tool for reducing the workload of clinicians and producing highly consistent results. ...
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Purpose: The aim of this study is to develop a practicable automatic clinical target volume (CTV) delineation method for radiotherapy of breast cancer after modified radical mastectomy. Methods: Unlike breast conserving surgery, the radiotherapy CTV for modified radical mastectomy involves several regions, including CTV in the chest wall ( CTV cw ), supra- and infra-clavicular region ( CTV sc ), and internal mammary lymphatic region ( CTV im ). For accurate and efficient segmentation of the CTVs in radiotherapy of breast cancer after modified radical mastectomy, a multi-scale convolutional neural network with an orientation attention mechanism is proposed to capture the corresponding features in different perception fields. A channel-specific local Dice loss, alongside several data augmentation methods, is also designed specifically to stabilize the model training and improve the generalization performance of the model. The segmentation performance is quantitatively evaluated by statistical metrics and qualitatively evaluated by clinicians in terms of consistency and time efficiency. Results: The proposed method is trained and evaluated on the self-collected dataset, which contains 110 computed tomography scans from patients with breast cancer who underwent modified mastectomy. The experimental results show that the proposed segmentation method achieved superior performance in terms of Dice similarity coefficient (DSC), Hausdorff distance (HD) and Average symmetric surface distance (ASSD) compared with baseline approaches. Conclusion: Both quantitative and qualitative evaluation results demonstrated that the specifically designed method is practical and effective in automatic contouring of CTVs for radiotherapy of breast cancer after modified radical mastectomy. Clinicians can significantly save time on manual delineation while obtaining contouring results with high consistency by employing this method.
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The acousto-optic tunable filter (AOTF) is one of the most used techniques for hyperspectral imaging (HSI), and is capable of fast and random wavelength access, high diffraction efficiency, and good spectral resolution. Typical AOTF-HSI works with linearly polarized light; hence, its throughput is limited for randomly polarized applications such as fluorescence imaging. We report an AOTF-based imager design using both polarized components of the input light. The imager is designed to operate in the 450 to 800 nm region with resolutions in the range of 1.5–4 nm. The performance characterization results show that this design leads to 68% improvement in throughput for randomly polarized light. We also compared its performance against a liquid crystal tunable filter (LCTF)-based imager.
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The measurement of changes in blood volume in tissue is important for monitoring the effects of a wide range of therapeutic interventions, from radiation therapy to skin-flap transplants. Many systems available for purchase are either expensive or difficult to use, limiting their utility in the clinical setting. A low-cost system, capable of measuring changes in tissue blood volume via diffuse reflectance spectroscopy is presented. The system consists of an integrating sphere coupled via optical fibers to a broadband light source and a spectrometer. Validation data are presented to illustrate the accuracy and reproducibility of the system. The validity and utility of this in vivo system were demonstrated in a skin blanching/reddening experiment using epinephrine and lidocaine, and in a study measuring the severity of radiation-induced erythema during radiation therapy. (C) 2014 Society of Photo-Optical Instrumentation Engineers (SPIE)
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Monitoring the onset of erythema following external beam radiation therapy has the potential to offer a means of managing skin toxicities via biological targeted agents - prior to full progression. However, current skin toxicity scoring systems are subjective and provide at best a qualitative evaluation. Here, we investigate the potential of diffuse optical spectroscopy (DOS) to provide quantitative metrics for scoring skin toxicity. A DOS fiberoptic reflectance probe was used to collect white light spectra at two probing depths using two short fixed source-collector pairs with optical probing depths sensitive to the skin surface. The acquired spectra were fit to a diffusion theory model of light transport in tissue to extract optical biomarkers (hemoglobin concentration, oxygen saturation, scattering power and slope) from superficial skin layers of nude mice, which were subjected to erythema inducing doses of ionizing radiation. A statistically significant increase in oxygenated hemoglobin (p < 0.0016) was found in the skin post-irradiation - confirming previous reports. More interesting, we observed for the first time that the spectral scattering parameters, A (p = 0.026) and k (p = 0.011), were an indicator of erythema at day 6 and could potentially serve as an early detection optical biomarker of skin toxicity. Our data suggests that reflectance DOS may be employed to provide quantitative assessment of skin toxicities following curative doses of external beam radiation.
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A clinical trial involving multi-spectral imaging of histologically confirmed 8 basaliomas and 30 melanomas was performed. Parametric maps of the melanin index, erythema index and melanoma-nevus differentiation parameter have been constructed and mutually compared. Specific features of basalioma and melanoma images were analyzed and discussed.
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Hyperspectral imaging of skin combines the spectral information of diffuse reflectance spectroscopy with the spatial information of 2D imaging. Skin chromophore maps can be reconstructed in which features such as pigmented lesions, diffuse and localized erythema, areas of increased blood stasis, etc. could be identified and the relative parameters quantified. Hyperspectral imaging is the only reliable method to produce a quantitative distribution map of chromophores contributing to the color appearance of the skin.
Polarization gating is a popular and widely used technique in biomedical optics to sense superficial tissues (colinear detection), deeper volumes (crosslinear detection), and also selectively probe subsuperficial volumes (using elliptically polarized light). As opposed to the conventional linearly polarized illumination, we propose a new protocol of polarization gating that combines coelliptical and counter-elliptical measurements to selectively enhance the contrast of the images. This new method of eliminating multiple-scattered components from the images shows that it is possible to retrieve a greater signal and a better contrast for subsurface structures. In vivo experiments were performed on skin abnormalities of volunteers to confirm the results of the subtraction method and access subsurface information.
Background Total body photography may aid in melanoma screening but is not widely applied due to time and cost. We hypothesized that a near-simultaneous automated skin photo-acquisition system would be acceptable to patients and could rapidly obtain total body images that enable visualization of pigmented skin lesions.Methods From February to May 2009, a study of 20 volunteers was performed at the University of Virginia to test a prototype 16-camera imaging booth built by the research team and to guide development of special purpose software. For each participant, images were obtained before and after marking 10 lesions (five “easy” and five “difficult”), and images were evaluated to estimate visualization rates. Imaging logistical challenges were scored by the operator, and participant opinion was assessed by questionnaire.ResultsAverage time for image capture was three minutes (range 2–5). All 55 “easy” lesions were visualized (sensitivity 100%, 90% CI 95–100%), and 54/55 “difficult” lesions were visualized (sensitivity 98%, 90% CI 92–100%). Operators and patients graded the imaging process favorably, with challenges identified regarding lighting and positioning.Conclusions Rapid-acquisition automated skin photography is feasible with a low-cost system, with excellent lesion visualization and participant acceptance. These data provide a basis for employing this method in clinical melanoma screening.
AimTo assess the effectiveness of conventionally fractionated radiotherapy for local control and cosmesis in elderly patients (age 70 years or older) with non-melanoma skin cancer of the head.MethodsA retrospective review of 15 patients undergoing definitive radiation (11 patients) or postoperative radiation (4 patients) for squamous cell carcinoma (9 patients) and basal cell carcinoma (6 patients) of the head was undertaken. At each follow-up visit, a radiation oncology resident and/or medical student was requested to examine the patient's head and neck, and determine the initial location of the cancer without reviewing their medical record.ResultsNo patient developed a loco-regional recurrence. The residents and medical students were unable to determine the initial location of the cancer because of the skin normalcy.Conclusion Conventionally fractionated radiotherapy is effective for local control and provides excellent cosmesis for elderly patients with skin cancer of the head. Geriatr Gerontol Int 2014; ●●: ●●–●●.