Handheld dual fluorescence and reflection spectroscopy system for monitoring topical low dose ALA-PDT of actinic keratoses (AK)

Abstract

Photodynamic therapy is an effective, minimally invasive skin cancer treatment modality with few side effects. Improved therapeutic selectivity and efficacy is expected if treatment is optimized individually for each patient based on detailed measurements prior and during the treatment. The handheld system presented allows measuring optical properties of the skin, the rate of photosensitizer photobleaching during the ALA PDT and oxygen saturation in the tissue. The photobleaching rate is monitored using fluorescence spectroscopy, where protoporphyrin IX in tissue is exited by 410 nm (blue) or 532 nm (green) laser light, and fluorescence in the 580-800 nm range is monitored. The photobleaching rate is calculated by correlating the measured spectrum with known protoporphyrin IX, photoproduct and nonspecific tissue autofluorescence spectra using correlation analysis. Double-wavelength excitation allows a rough estimation of the depth of the fluorescence source due to the significant difference in penetration depth for blue and green light. Blood concentration and oxygenation in the tissue are found from the white light reflectance spectrum in the 460-800 nm range. Known spectra for the oxy- and deoxyhemoglobin, melanin, and tissue baseline absorption and tissue scattering are substituted in nonlinear equations to find the penetration depth and diffuse reflectance coefficient. The nonlinear equation for the diffuse reflectance coefficient is solved for blood and melanin concentrations and blood oxygenation values that provide the best fit to the measured spectrum. The optical properties of the tissue obtained from the reflectance spectroscopy are used to correct the fluorescence data. A noncontact probe with 5 fibers (3 excitation and 2 detection) focused to the same 5 mm diameter spot: 2 excitation lasers, a white light lamp and a two-channel spectrometer are used. A LabView program with custom nonlinear equation solvers written in C++ automatically performs the measurements and calculations, and writes data to a database. The system is currently used in a clinical trial to find the relationship between skin pigmentation, oxygen saturation in blood, photobleaching rate and optimal fluence rate for skin cancer treatment of actinic keratoses.