The University of Arizona: Translating optical imaging for guiding endocrine neck surgery

OSC Colloquium: Anita Mahadevan-Jansen Thyroid and parathyroid diseases rely on surgery for definitive treatment. In these surgeries, parathyroid glands are difficult to distinguish from the thyroid and surrounding tissues in the neck, due to its small size and variability in position. Complications occur when the parathyroid or its blood supply is accidentally injured or removed during thyroidectomies. Since this is the only organ that can regulate calcium in the human body, there is a critical need for a sensitive tool that can identify the parathyroid glands and its perfusion state intraoperatively, regardless of disease state. We have successfully demonstrated that near infrared autofluorescence can be used for anatomical identification of the parathyroid gland regardless of its disease state with near 100% accuracy. The Food and Drug Administration has cleared an imaging as well as a probe-based device based on NIRAF as an adjunct tool for label-free intraoperative parathyroid gland identification. In this talk, I will first present the journey in the development of NIRAF for parathyroid identification and show the results of a randomized multi-center clinical to determine the effect of using the fiber probe based NIRAF system in terms of surgical effectiveness, surgeon effectiveness as well as patient outcome. These results demonstrates that probe based NIRAF yields an accuracy of 94.3% and increases the confidence of all participating surgeons in correctly identifying the parathyroid gland regardless of surgeons’ experience. While surgeons like the use of the small form factor and the quantitative accuracy that the fiber probe based NIRAF provides, they also appreciate the spatial information that NIRAF imaging yields. Therefore, the next generation in the implementation of this and related technology is the development of quantitative NIRAF imaging (QFI). Towards this goal, I will present three alternative approaches - a pen-like QFI device, a projection-based tissue overlay imaging system (OTIS) and a QFI augmented reality glasses. I will also present a multimodal QFI device with perfusion imaging for intraoperative use. Dr. Mahadevan-Jansen translates optical techniques for clinical detection of tissue physiology and pathology. Her primary research is to investigate and implement optical spectroscopies and imaging including Raman spectroscopy for disease diagnosis and guidance of therapy. She was also one of the inventors of infrared neural modulation that used infrared light to activate the nervous system. She received her Bachelor’s and Master’s degrees in Physics from the University of Bombay (Mumbai), India, and a Master’s and PhD degrees in Biomedical Engineering from the University of Texas at Austin. She joined the Vanderbilt engineering faculty in 1997. She is currently the Orrin H. Ingram Professor of Biomedical Engineering at Vanderbilt University and holds a secondary appointment in the Departments of Neurological Surgery, Surgery and Otolaryngology. She is also the founding Director of the Vanderbilt Biophotonics Center, a collaborative research center that is focused on the development and translation of light and light-based technologies. She also leads BioMIID, a CZI funded program to disseminate advanced microscopies to biomedical scientists globally. She was the 2022 President of SPIE, the International Society of Optics and Photonics. She is a fellow of SPIE, Optica (OSA), American Institute of Medical and Biological Engineering (AIMBE) and the National Academy of Inventors.