ISSN: 0975-766X CODEN: IJPTFI Available through Online Review … · A REVIEW ON OPTICAL COHERENCE...
Transcript of ISSN: 0975-766X CODEN: IJPTFI Available through Online Review … · A REVIEW ON OPTICAL COHERENCE...
Bama Aivarasi. P*et al. /International Journal Of Pharmacy & Technology
IJPT| June-2016 | Vol. 8 | Issue No.2 | 4026-4042 Page 4026
ISSN: 0975-766X
CODEN: IJPTFI
Available through Online Review Article
www.ijptonline.com A REVIEW ON OPTICAL COHERENCE TOMOGRAPHY (OCT) TECHNOLOGY AND
ITS USAGE IN BIOMEDICAL APPLICATIONS 1Bama Aivarasi. P*,
2Dr.R.Vasuki
Research Scholar, Department Of Biomedical Engineering, Bharath University.
Head, Department Of Biomedical Engineering, Bharath University.
Email:[email protected]
Received on 15-05-2016 Accepted on 09-06-2016
Abstract
The potential of optical imaging techniques provides micrometer scale resolution without the need for ionizing
radiation and can provide non invasive cross-sectional images of biological tissues with spatial resolutions down to
few micrometers.
3D OCT is applied for imaging of biological microstructures like human retina, human skin and other developmental
model systems. Recent advances in OCT are it enables 3D volumetric information and increases image acquisition
speeds. OCT imaging depth is limited by scattering of the medium which destroys the coherence of the probe beam.
OCT is used to image the entire non-scattering ocular structures and imaging of highly scattering tissues like skin is
usually limited to a few mm.
We can get the birefringent properties of the tissue by taking OCT images for two orthogonal linear polarisations of
the scattered light. This OCT images helps in monitoring the changes in the morphology of tissue birefringent
constituents. Polarisation Sensitive OCT (PSOCT) systems are being used for monitoring changes that take place in
wounds or malignancy conditions.
Systems have been used for real time, in vivo and in vitro imaging of microstructures of biological tissues and animal
model systems with resolutions of ~ 10 to 20μm. OCT images can be used to discriminate the characteristic
morphological features and classify different tissue types using automated algorithms. This review paper discusses on
the dental applications of OCT such as Oral tissue images, Oral cancer detection and the retinal applications such as
Macular Edema, Glaucoma, and Adaptive Optics.
Keywords:
Optical Tomography, resolution, interferometry, birefringent, microleakage, fovea, restoration, histopathology.
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1. Introduction
1.1 Optical Coherence Tomography (OCT) Technology - Introduction
Optical coherence tomography (OCT) was first reported by Fujimoto et al. [1]. OCT has been widely used in
numerous clinical applications, including gastroenterology [2–4], ophthalmology [5–7], dermatology [8, 9], and
dentistry [10, 11]. OCT is a noninvasive, nonradiative optical diagnostic tool based on interferometers. Optical
Coherence Tomography (OCT) is an emerging medical imaging modality that uses light to capture images in
micrometer (µm) resolution i.e. 3D images from within optical scattering media (example-biological tissue).
Tomography refers to imaging by sections or sectioning through the use of any kind of penetrating wave.
Tomography is widely used in the areas of radiology, biology, archaeology, oceanography etc.
Optical Tomography (OT) is a form of Computed Tomography (CT) that creates a digital volumetric model of an
object by reconstructing images made from light transmitted and scattered through an object. Coherence refers to the
quality of forming a consistent unified whole image with ultrahigh resolution in micrometer range. OCT performs
ultrahigh resolution, cross-sectional imaging of the internal microstructure in biological tissues by measuring echoes
of backscattered light [1]. Tissue pathology can be imaged in situ and in real-time with ultrahigh resolutions (1-15
µm), one to two orders of magnitude finer than conventional ultrasound [1]. This OCT imaging modality plays a
major role in biomedical optics and in medicine.
By using a low coherence broadband near infrared (NIR) light source, it is possible to obtain excellent spatial
resolution (~20 μm) and real-time images [12, 13]. OCT was first applied in in- vitro in human retina and in
atherosclerotic plaque [1, 14].
OCT is an optical imaging technique that enables cross-sectional imaging of microstructures of tissue in situ. OCT
can provide “optical biopsy” without the need for excision and processing of specimens as in conventional biopsy and
histopathology.
Over the past decade, many functional OCT systems, such as Doppler OCT (DOCT) [15,16], polarization sensitive
OCT (PSOCT) [17–19], endoscopic OCT [20,21] and acoustic OCT [22,23], were reported for new biomedical
research applications. These functional systems provide not only structure images but also the specific optical
characteristics, including blood flow velocity and tissue orientation.
Moreover, deeper transmission depth is achieved with combination of fluorescence [24, 25]. OCT demonstrates great
potentials in research topics and clinical applications to date with the improvement of optical specifications and
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system capabilities. The optional functions promote the efficiency of diagnosis of OCT and the unique features of
OCT thus make it a powerful imaging modality enabling many fundamental researches on clinical applications.
2. Methods and Materials
2.1 Optical Coherence Tomography in Dental Application
The oral cavity is a diverse environment which includes teeth, gingival tissues, oral mucosa and their supporting
structures. OCT can image both hard and soft tissues of the oral cavity at high resolution and offers the unique
capacity to identify dental diseases before destructive changes could progress. OCT images depict clinically
important anatomical features such as the location of soft tissue attachments, morphological changes in gingival
tissue, tooth decay, enamel thickness and decay, and the structural integrity of dental restorations. OCT imaging
allows for earlier intervention than is possible with current diagnostic modalities.
Application of OCT in dentistry has become very popular. The first in vitro images of dental hard and soft tissues in a
porcine model were reported in 1998 [26]. Later, the in vivo imaging of human dental tissue was presented [27]. The
oral cavity consists of three main parts: (1) hard tissue, including tooth and alveolar bone, (2) soft tissue, including
mucosa and gingival tissues, and (3) periodontal tissues [28]. The traditional diagnosis of caries is based on
examination using dental exploration and radiographs. The diagnosis of periodontal disease needs the examination of
periodontal probes. The poor sensitivity and reliability of periodontal probing make it difficult for dentists to monitor
the progression of periodontal destruction and the treatment outcome [29].
Early detection of caries, periodontal disease and oral cancer is quite difficult with clinical examination using
radiographs. OCT may provide a solution to these problems. Dental OCT detects qualitative and quantitative
morphological changes of dental hard and soft tissues in vivo. Furthermore, OCT can also be used for early diagnosis
of dental diseases, including caries, periodontal disease and oral cancer, because of the excellent spatial resolution.
Early treatment can increase the survival rates of patient’s teeth. Three-dimensional imaging ability is another
advantage of dental OCT which helps clinicians to locate problems in soft and hard tissues more accurately and
rapidly. In dental OCT applications, Oral tissue images and Oral cancer detection is discussed.
2.1.1 Oral Tissue Images
A tooth structure is illustrated in Fig.1.Colston et al. first reported the 1,310 nm Time domain Optical Coherence
Tomography (TDOCT) image of teeth and compared them with a photomicrograph under 17 μm resolution [30].
They examined only the characteristics of the oral structure surface because of the insufficient penetrating depth. The
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in vitro images of enamel cementum and gingival tooth interfaces in a porcine model were shown. Otis et al.
presented the first in vivo OCT images of human dental tissues [31]. The axial resolution was 12 μm with 1,310 nm
center wavelength. They obtained a smaller but deeper (3 mm) tooth image.
OCT images provided visual recording of the dentin-enamel junction (DEJ) and periodontal structures. Feldchteine et
al. demonstrated that hard palate mucosa and gingival mucosa could be visualized [32]. The OCT images showed the
hard palate mucosa. The squamous epithelium appears as the 170 mm top layer above the 200 mm thick lamina
propria. OCT images also displayed gingival mucosa to a depth of 500 μm, although the epithelium and lamina
propria were not well differentiated in their scans. Moreover, they also presented the polarization imaging of normal
dental hard tissue. OCT images in normal polarization scan mode showed that enamel, dentin, and DEJ were clearly
visible.
Warren et al. provided more detail tooth structure along the vertical axis [33]. The axial structure from enamel to
dentin and cementum to dentin was revealed. In addition to structure image measurement, OCT is also applied for
crack (fracture) [34–36] and microleakage [37–40] detection. The definition of cracks is the “gaps” in the tooth
surface, such as enamel cracks. Cracked teeth may lead to extraction if there is no treatment intervention. Imai et al.
represented the extension of enamel cracks beyond DEJ (Fig. 2) [34].
Fig 1.Schematic diagram of a tooth structure.
Fig 2.Images of a distinct enamel crack. (A) A visual examination of enamel crack. (B) A SSOCT image along
the red line in (A). The crack extended to the DEJ. (C) A CLSM image corresponding to the cross sectioned
enamel crack along the red line in (A).
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Microleakage means the “gap” between tooth and restorative materials (Fig.3) [37–40]. Ishibashi et al. demonstrated
the microleakage beneath composite resin restorative material (Fig. 4) [39]. Hsieh et al. also detected in vivo
microleakage in OCT images with a custom made dental optical probe (Fig. 5) [40]. They also measured the
microleakage at approximately 401 μm × 148 μm in size, which is very close to the real size.
Fig.3.OCT images revealed microleakage between composite resin restoration and the tooth. (C: composite
restoration; E: enamel; D: dentin).
Fig.4 In vivo OCT image of microleakage detected by a custom made dental optical probe.
Fig.5.Photograph (A) and SSOCT image (B) of Class V restoration in the central incisor. Arrow shows
microleakage formation beneath resin material (G: gingival; RBC: resin based composite; E: enamel; D:
dentin; DEJ: dental enamel junction).
Recently, OCT was also used in imaging of the pulpdentin complex [41]. The result of this study showed the capacity
of OCT to distinguish pulp from dentin (Fig. 6). OCT can be used to predict remaining dentin thickness above pulp,
and will permit more predictive prognosis of dental treatment.
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Fig.6 Site of pulp exposure. (A) Histologic cross-section of pulp exposure. (B) The pulp and dentin were clearly
delineated in the OCT image (P: pulp; D: dentin; PE: pulp exposure).
2.1.2 Oral Cancer
Oral cancer has become the fourth leading cause of cancer death in males in Taiwan [42]. An estimated 263,900 new
cases and 128,000 deaths from oral cavity cancer (including lip cancer) occurred in worldwide. Oral cancer occurs
with an annual incidence of approximately 29,370 cases in the United States [43]. Treatment of oral cancer and the
survival rates are directly related to the stage of cancer diagnosed.
Early diagnosis permits minimally invasive treatment and greatly improves long term survival. Wilder Smith et al.
reported that OCT could detect neoplasia related epithelial, sub epithelial changes throughout carcinogenesis [44].
Jung et al. also obtained similar results with better resolution [45]. Moreover, they incorporated three dimensional
images and applied Doppler OCT for better diagnosis. Tsai et al. demonstrated swept-source OCT (SSOCT) had
better image qualities than spectral domain OCT (SDOCT) or Fourier domain OCT (FDOCT) [46, 47]. Moreover, by
utilizing nanoparticles, OCT could obtain better contrast images at early stage of oral cancer [48, 49]. OCT is a good
tool for early diagnosis of oral cancer, providing better understanding of pathological mechanisms, predictors of
malignant change, risk of tumor recurrence, and predictors of tumor response to therapy [44].
Tsai et al. utilized SSOCT to differentiate different oral carcinogenesis stages, including mild dysplasia (MiD),
moderate dysplasia (MoD), early stage squamous cell carcinoma (ESSCC), and well developed SCC (WDSCC) [50].
Fig. 7 shows histological images of normal, MiD, MoD, ESSCC and WDSCC. In the normal sample, the epithelium
propria (EP) and lamina propria (LP) layers could be clearly differentiated. Vessels could also be observed in the LP
layer. In the MiD stage, the EP layer was thickened, dysplastic cells were found in the lower one-third of EP, and
there was an increase in collagen deposition in the LP layer.
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Fig.7 shows the histological images of the (a) normal, (b) MiD, (c) MoD, (d) ESSCC, and (e) WDSCC samples.
A thick stratum corneum (SC) layer can be found on EP surface in MoD stage and EP become thicker than in MiD
stage. At ESSCC and WDSCC stages, the EP/LP boundary disappeared. On the basis of SSOCT images, oral
precancer lesion (MiD and MoD) and oral cancer (ESSCC and WDSCC) could be differentiated using OCT (Fig. 8).
It is beneficial to diagnose oral precancer patient. Minimally invasive treatment could enhance patient's life quality.
Fig.8. SSOCT scanned images of the (a) normal control and biopsied oral (b) MiD, (c) MoD, (d) ESSCC, and
(e) WDSCC lesions. Their histological images were shown in Fig.7 (a–e).
2.2 Optical Coherence Tomography In Retinal Applications
Optical coherence tomography (OCT) in retinal applications provides a non-invasive, cross-sectional ocular imaging.
Today in ophthalmology, OCT is the most promising non-contact, high resolution tomographic and biomicroscopic
imaging device. In ophthalmology, OCT has become an integral part of routine diagnostic paradigm. Due to OCT’s
ability to extract quantitative morphological information and its non-invasive nature, OCT has been extensively used
in the diagnosis of optic nerve and retinal diseases and as well in the monitoring of the disease progression with
treatments over time.
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OCT is a computerized instrument structured on the principle of low-coherence interferometry (Huang et al., 1991;
Hrynchak & Simpson., 2007) generating a pseudo-color representation of the tissue structures, based on the intensity
of light returning from the scanned tissue. This non-invasive nature and quick imaging technique has revolutionized
modern ophthalmology practice [51]. The current applications of OCT have been improvised and expanded
dramatically in precision and specificity in clinical medicine [52-57] and industrial applications. In medicine, this
technique has been compared to an in-vivo optical biopsy.
The quantification and localization of the tissues has become more refined, faster and predictable as the OCT’s
resolution has been improving with time. The various microscopic changes ranging from macular edema to
disruptions in photoreceptor layer in patients with reduction of retinal nerve fiber layer (RNFL) and various retinal
diseases in patients with glaucoma and other types of optic neuropathy has been revealed by Ultrahigh resolution
OCT. In retinal applications, OCT in Macular Edema, Glaucoma and in Adaptive Optics is discussed.
2.2.1 Macular Edema
OCT imaging is done in many disorders including diabetic retinopathy, age-related macular degeneration, retinal vein
occlusion, uveitis and macular hole. OCT imaging is used to diagnose and follow Macular Edema. Accumulation of
fluid in the retinal layers around the fovea results in Macular Edema with an increase in retinal thickness, which
contributes to vision loss [57-59]. Fluorescein angiography (FA) has been still is the critical diagnostic tool for
macular edema by identifying the characteristic stellar pattern of cystoid macular edema (CME) [60]. The appearance
of CME is shown in fig. 9 through different diagnostic modalities, namely, conventional fundus photography and
Fluorescein angiography.
Fig. 9. Cystoid Macular Edema (CME) imaged by 3 different diagnostic modalities. (a) Conventional fundus
picture (b, c) Fluorescein angiography (early and late stages respectively) – dilation and leakage of capillary
are revealed. Fluorescein dye pools in cystoid spaces and arranged radially from the fovea. (d) OCT image –
cystoid spaces are shown. The central macula is indicated with an arrow. Images from Cunha-Vaz, et al., 2010.
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A diffuse swelling is observed in the early stage of macular edema in the outer retinal layer and then leads to the
development of cystoid spaces.
Large cystoid spaces can extend from the retinal pigment epithelium (RPE) to the internal limiting membrane in the
later stage which then eventually ruptures causing macular holes. Macular Edema involves three structural changes in
diabetic patients.
The most commonly sponge-like retinal swelling (88%), then CME (47%) and then serious retinal detachment (15%)
[61-65]. Corresponding OCT images are shown in fig.10 with the fundus pictures of retinal swell and serious retinal
detachment seen in diabetic macular edema.
Fig. 10. (a) Retinal swelling. The retinal thickness at the fovea is 560 μm. (b) Serious retinal detachment with
retinal swelling. The thickness of the sub-retinal space is 420 μm. The vertical arrow on the fundus picture
indicates the line and direction of scanning. Scan length = 5 mm. Images from Otani, et al., 1999.
The OCT image of sponge-like retinal swelling showed low reflective areas in the outer retinal layers with relatively
preserved inner retinal layer with interspersed low reflective areas [61]. The inner retinal layers were displaced
anteriorly by the swollen outer retinal layers [61]. In serous retinal detachment, the OCT image clearly showed
detached retina as a highly reflective line with the formation of sub-retinal space underneath [61]. A good correlation
has been found between OCT images and visual acuity and FA findings [63-65]. Larger area of increased retinal
thickness and the involvement of the macular area correlated with greater loss of vision [65]. Correlation between
visual acuity (VA) and retinal thickness at the fovea in the eyes is shown in fig. 11. Twenty eight of 59 eyes (47%)
developed CME, and the foveal retinal thickness and the VA were found to be negatively correlated with the
correlation coefficient of -0.64, P < 0.01 [63-65].
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Fig. 11. Correlation between Visual Acuity and retinal thickness at the fovea in patients with CME.
Correlation coefficient = -0.64, P < 0.01. Figure from Otani, et al., 1999.
2.2.2 Glaucoma
OCT has shown the greatest potential for imaging glaucomatous structural changes such as the RNFL [66]. A cross-
sectional observational study involving 160 control subjects and 134 patients with Primary Open-Angle Glaucoma
(POAG) was conducted to evaluate the accuracy of OCT in detecting differences in peripapillary RNFL thickness
between normal and glaucomatous eyes as well as between different severity groups [67].
The POAG patients were divided into early (n=61), moderate (n=31), severe (n=25) and blind (n=17) groups [67].
The OCT was reliable in detecting changes in the RNFL thickness between normal and all glaucoma subgroups [68].
The RNFL thickness was significantly thinner in the POAG patients compared to the control subjects and also the
RNFL thickness continued to reduce with an increase in the severity of POAG with P < 0.001 [66-68].
The reproducibility of the RNFL thickness measurements was tested on 51 stable glaucoma patients using Stratus
OCT [66]. For the mean RNFL thickness, the intra-session and inter-session intraclass correlation coefficient (ICC)
for the standard and fast scans were 0.98 and 0.96 respectively. The coefficient of variation (COV) ranged from 3.8 to
5.2% [68].
Other study has reported lower ICC of 0.5 and higher COV of 10%. However, as a measure of glaucoma progression,
the reproducibility is still sufficient to be useful clinically. Fig. 12 shows a picture of glaucomatous optic nerve head
(ONH) with a dense superior visual field defect [64].
A circle concentric OCT scan around the ONH shows thinning of the RNFL [64] in the inferior temporal quadrant,
which corresponds to both the visual field defect and loss of the neural rim of the ONH.
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Fig.12. An ONH picture, a visual field plot and a circle concentric OCT scan around the ONH from a
glaucomatous eye. Green arrows indicate the area of thinning of the RNFL. Images from Jaffe, et al., 2004.
2.2.3 Adaptive Optics - OCT
With further improvement in lateral resolution of the OCT system, it is possible to resolve even smaller details in the
retina. As previously mentioned, Kocaoglu et al. have shown the first measurements of RNFL axonal bundles
(RNFB) in the living human eyes using their AO-OCT system [69]. Four normal subjects and one subject with an
accurate RNFL defect were imaged and they were able to visualize individual RNFB in all subjects. Fig. 13 shows
the individual RNFB in one of the normal subjects. As the RNFB approach fovea, they become thinner and separate.
In conjunction with the expected inner retinal changes such as, thinning of the RNFL in glaucoma and optic
neuropathy, AO-OCT imaging has revealed outer retinal changes as well at the retinal locations with reduced visual
function, specifically shortening of cone outer segments and blurring of the junction between the tip of the cone outer
segments and RPE [69]. These outer retinal changes occurred only when there was a permanent visual field loss [70-
71]. The same findings were observed in all types of optic neuropathy patients including glaucoma [70-71].
Fig.13. (a) A wide field SLO, (b) An averaged C-scan and (c) An averaged B-scan images acquired from
subject, S4, at 3º nasal retina (indicated with a white square). The white lines in (b) denote the area where the
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B-scans in (c) were obtained. The white solid rectangle in (c) represents 2x magnification of the area outlined
with white dotted rectangle. Images from Kocaoglu, et al., 2011.
AO-OCT images (Fig.14) obtained from a non arteritic anterior ischemic optic neuropathy (NAION) patient [70].
The AO-OCT images were taken at 2 retinal locations, 2° temporal 2° superior retina and 4° nasal 4° superior retina
[70]. The 4° nasal 4° superior retina had better visual function than 2° temporal 2° superior retina, hence, the layer
labeled 3 (the junction between the cone outer segment tip and RPE) was better defined and distinct at that location,
and it was not visible at 2° temporal 2° superior retina [70].
Fig. 14. AO-OCT images at two retinal locations in the right eye of the patient with NAION. (a) 2° temporal 2°
superior retina and (b) 4° nasal 4° superior retina. 1: ELM, 2: IS/OS, 3: OS/RPE. Images from Choi, et al.,
2008. Copyright [2008] ARVO.
III. Conclusion
In medical and clinical diagnosis, OCT has become a very important research tool. Dental OCT provides the benefits
of non-invasive, non-radiative, high resolution and low cost in dentistry. OCT provides images of dental tissue in situ
and real-time. Broad applications of OCT in Dental are in soft and hard tissue imaging and early detection of caries,
periodontal disease and oral cancer. In tissue imaging, OCT can be used for gingival, periodontal and mucosa
imaging. By conventional OCT usage, Clinicians can obtain the structural images and also blood information and
structure orientation by functional OCT methods such as DOCT and PSOCT. OCT may also apply in bone related
disease imaging with a longer center wavelength. For early diagnosis of caries OCT and PSOCT represent powerful
ability. PSOCT distinguishes mineral changes at early demineralization stages. OCT can diagnose precancerous
lesions and periodontal disease. OCT can detect subgingival calculus and minimum invasive therapy could be
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performed. Through early detection of oral cancer by using OCT application better treatment outcomes and survival
rates could be obtained.
For the practice of ophthalmology, the advent of OCT technology has allowed extensive amounts of new anatomic,
physiologic, and pathologic data. OCT imaging is an ideal modality for detection of early disease in screening and
prevention for differential diagnosis of various diseases and has the ability to image retinal and ONH structures in-
vivo in detail for identifying recurrence and quantifying therapeutic effects during follow-up. OCT imaging modality
requires further improvement to obtain motion artifact free images practically and presentation of quantified data in a
user friendly way. Also there is a need to establish adequate normative data and common clinical standards across
devices to allow for consistency and comparison between patients and diseases with an increase in the number of
OCT users and commercial systems.
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Corresponding Author:
Bama Aivarasi, P*,
Email:[email protected]