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Published on: January 22, 2013
Long-range Fourier domain optical coherence tomography of the pediatric subglottis
Veronika Volgger1, Giriraj K Sharma2, Joseph C Jing3
1Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig Maximilian University Munich, 80539 München, Germany.
Insights
Fourier domain optical coherence tomography (FD-OCT) provides high-resolution 3D imaging of the pediatric subglottis. This technology enables in vivo evaluation of airway microanatomy in intubated children, aiding in the early detection of acquired subglottic stenosis.
Area of Science:
- Medical Imaging
- Pediatric Otolaryngology
- Biomedical Engineering
Background:
- Acquired subglottic stenosis (SGS) is a complication of prolonged endotracheal intubation in children.
- Diagnosing SGS in intubated children is challenging due to limitations in current imaging modalities.
- Fourier domain optical coherence tomography (FD-OCT) offers high-resolution, 3D imaging of biological tissues.
Purpose of the Study:
- To evaluate the feasibility of using long-range FD-OCT for in vivo imaging of the pediatric subglottis.
- To assess the ability of FD-OCT to characterize subglottic microanatomy in intubated pediatric patients.
- To explore the potential of FD-OCT for early detection of acquired SGS.
Main Methods:
- A long-range FD-OCT system with rotary optical probes was developed.
- Intraoperative FD-OCT imaging of the subglottis was performed in 46 pediatric patients (ages 2-16) undergoing minor airway surgery.
- Images were analyzed for anatomical landmarks and subepithelial histology, with 3D airway models generated.
Main Results:
- FD-OCT imaging was successfully performed on 46 patients without complications.
- Airway contour was visible in all datasets; 43% provided high-quality images of airway anatomy and microanatomy.
- 3D airway models allowed for multiplanar visualization of subglottic structures.
Conclusions:
- Long-range FD-OCT generates high-resolution, 3D volumetric images of the pediatric subglottis.
- This modality provides a safe and practical method for in vivo microanatomical evaluation in intubated pediatric patients.
- FD-OCT holds potential for serial monitoring of high-risk infants to detect acquired SGS early.
Background:
Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no imaging modality allows for in vivo characterization of subglottic microanatomy to identify early signs of acquired SGS while the child remains intubated. Fourier domain optical coherence tomography (FD-OCT) is a minimally invasive, light-based imaging modality which provides high resolution, three dimensional (3D) cross-sectional images of biological tissue. We used long-range FD-OCT to image the subglottis in intubated pediatric patients undergoing minor head and neck surgical procedures in the operating room.
Methods:
A long-range FD-OCT system and rotary optical probes (1.2mm and 0.7mm outer diameters) were constructed. Forty-six pediatric patients (ages 2-16 years) undergoing minor upper airway surgery (e.g., tonsillectomy and adenoidectomy) were selected for intraoperative, trans-endotracheal tube FD-OCT of the subglottis. Images were analyzed for anatomical landmarks and subepithelial histology. Volumetric image sets were rendered into virtual 3D airway models in Mimics software.
Results:
FD-OCT was performed on 46 patients (ages 2-16 years) with no complications. Gross airway contour was visible on all 46 data sets. Twenty (43%) high-quality data sets clearly demonstrated airway anatomy (e.g., tracheal rings, cricoid and vocal folds) and layered microanatomy of the mucosa (e.g., epithelium, basement membrane and lamina propria). The remaining 26 data sets were discarded due to artifact, high signal-to-noise ratio or missing data. 3D airway models were allowed for user-controlled manipulation and multiplanar airway slicing (e.g., sagittal, coronal) for visualization of OCT data at multiple anatomic levels simultaneously.
Conclusions:
Long-range FD-OCT produces high-resolution, 3D volumetric images of the pediatric subglottis. This technology offers a safe and practical means for in vivo evaluation of lower airway microanatomy in intubated pediatric patients. Ultimately, FD-OCT may be applied to serial monitoring of the neonatal subglottis in long-term intubated infants at risk for acquired SGS.
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