Intraoperative Multimodal Imaging System for Surgical Guidance

This dissertation describes the development of an Integrated Multimodal Imaging System (IMIS) for intraoperative guided surgery. The IMIS consists of an unique small field of view (FOV) gamma camera based on the silicon photomultiplier (SiPM) technology and a video camera for simultaneous visible and near infrared fluorescence (NIRF) imaging. The targeted tracers that are labeled with a radioisotope and a near infrared (NIR) fluorophore are initially injected into the patient and accumulate in the tumors or lymph nodes (surgical targets). The gamma imaging is used for initial target localization through thick overlying tissue and the optical imaging is used to help surgeons differentiate the targets from surrounding tissue once the targets are near the surface. The IMIS components are integrated on a mobile cart that allows the system to be transported to the operating room (OR). Our hope is that intraoperative imaging with IMIS can help surgeons in the OR in a wide scope of procedures, including determining the location and extent of primary carcinomas, detecting secondary lesions and identifying lymph nodes during sentinel lymph node biopsy (SLNB). The feasibility of the concept was demonstrated by successfully imaging surgical patients in a clinical study during SLNB using the gamma imaging component of IMIS, imaging tumor bearing mice pre-clinically and characterizing the performance of IMIS in multimodal imaging in bench-top and simulated surgery experiments in the laboratory.

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