An Update on FF-OCT's Light CT from LLTECH

A few weeks ago, we showcased Paris based DAMAE MEDICAL, a two-years old startup preparing for the launch of a LC-OCT skin imaging system. I thought it would be fair to give an update on the progress of 7-year old LLTECH, also  a Paris based company offering imaging systems based on the very elegant FF-OCT optical method.

Lead by talented CEO Bertrand the Poly and world-class scientist and leader CSO Pr. Claude Boccara, the company has perfected the Light CT system over the past years into a "plug-and-play"imaging system that simplifies the sample/tissue handling and preparation process thanks to an innovative 'cassette' that holds the tissue ( for instance, directly in the surgical room) and plugs directly into the imaging system.

As a reminder, Full-field optical coherence tomography (FFOCT) offers a fast and non-destructive method of obtaining "en-face" images of biological tissues at high resolution (1μm in all 3 directions), approaching traditional histological sections.

The LLTECH team is gathering more and more clinical evidence as they build their value proposition as a stain-free digital pathology system.The product is available for sale as a research only use.

Most interestingly, a significant enhancement with "time-resolved" FF-OCT is in the works, allowing frequency-resolved imaging ! now... that is exciting as one of the weaknesses of all these OCT techniques is the lack of specificity for any given biological / cellular feature ( this is just like ultrasounds.... OCT "sees"structures"and optical-index discontinuities very well, but is poorly sensitive to chemistry".  The Method is called Dynamic FF-OCT or D-FFOCT and is another brain child of Pr. Boccara and PhD candidate Clement Apelian (read publications here). Below is an image of a cancerous skin tissue (mouse) where T-cells are tagged in red because of their specific frequency response. ( Tumor are in dark green and we can see all the T-cells around and in between the tumors, in movement in the extra-tumoral collagen matrix).

In the meantime, LLTECH is raising funds both in the US and Europe. LLTech is currently listed on PropelX www.propelx.com a US funding platform linked to the MIT making the investment easy.

French DAMAE MEDICAL prepares LC-OCT Skin System

Two-years old startup DAMAE MEDICAL (Paris,France) is already an award-winning young company. Under the leadership of a charismatic female CEO, Anais Barut (who proudly posts her pictures with former president Francois Hollande...), the company readies to launch an innovative LC-OCT hand-held skin inspection system, called OLIV.

To our desapointment, LC-OCT does not stand for Low Cost OCT! But we are really excited about the quality of the LC-OCT images produced as the optical method is strategically placed between scanning OCT and Confocal microscopy. Offering a X-Y, and Z resolution of ~1micron, even at 800 micron depth, the technique offers Z-slicing or virtual biopsie and can rebuild X-Y "en face" virtual biopsies.

Real-time imaging seems to be compatible with usual motion artifacts due to patient upper limb movement during exams, which is a good news.

Target markets include dermatology virtual-biopsy tissue/skin assesment for the triage (and hopefully soon diagnostic) of both melanoma and  carcinoma.The product is not approved by FDA , nor commercialized in the US, but the team is looking for clinical partners in the US to get on-board ( "Contact" on their webpage).

In the meantime, the usual "non-regulated" markets could be a nice way to start.We are thinking about Research only Use for Skin-condition drug development, cosmeceuticals (obviously) and Tissue / biopsy quality control.

So in short:very cool. Cannot wait to see the face of the current players when the product hits the US market. If anyone wnats to join me to invest in the company.... let me know.

Skin imaging: is it clinically useful?

Yes ! that is a great title for a very serous paper.  Skin imaging: is it clinically useful?

Kudos to Dr. Deepack Rallan of the Department of Dermatology at the St Helier's Hospital (South London, Surrey, UK) for asking the right question and providing a documented and good discussion in his paper published in the Journal of experimental dermatology ( Sept 2004). Granted..it is not a "recent" paper. But the discussion and fundamentals are still up to date. Let me quote the abstract below: ( online abstract and author contact details here)

Abstract

Non-invasive skin imaging techniques have proliferated over the last decade. Whilst most have a research role, some are routinely used in dermatology clinics. Of these, the skin surface microscope (dermatoscope), a diagnostic aid for pigmented lesions, has had most clinical impact. Such devices, when linked to a videomicroscope for computer analysis, have been dubbed as 'mole scanners'. Mole scanners are increasingly available on a commercial basis even though computer diagnosis of pigmented lesions is currently no better than diagnosis by human experts. Meanwhile, other imaging techniques, such as high-resolution ultrasonography, spectroscopy and optical coherence tomography, may yet find a role in diagnosis and disease monitoring.

New Book: "Imaging in Dermatology"

"Imaging in Dermatology" edited by Drs Michael R.Hamblin, Pinar Avci and Gaurav K.Gupta (ISBN: 978-0-12-802838-4) is a 2016 ELSEVIER publication that all the readers of this blog should be aware of.
I just ordered the book on Amazon for $120, and I can't wait to ready it and perhaps interview the authors (stay tuned). Congrats to the all the contributing Authors, Editors and ELSEVIER for their interest and work on the topic.

The table of content is rich and comprehensive (see Preview on Google Books here): 

2. Role of Clinical Photography in Dermatology

3. Dermoscopy

4. Trichoscopy: the Dermatologist's Third Eye

5. Dermatoscopy Correlates of Nail Appartus Disease

6. Optical Coherence Tomography (OCT) for Skin Cancer and Actinic Keratosis

7. OCT of Skin Scarring and Fibrosis

8. Polarization Speckles and Skin Applications

9. New Developments in Fluorescence Diagnostics

10. Ex-vivo Fluorescence Microscopy: Clinical Applications

11. Coherent Raman Scattering Microscopy in Dermatological Imaging

12.  Rapid Real-time Raman Spectroscopy and Imaging-Guided Confocal Raman Spectroscopy

13. Surface-Enhanced Raman Spectroscopy for Intradermal Measurements

14. Broadband Coherent Anti-Stokes Raman Scattering

15. In-Vivo Reflectance Confocal Microscopy (in Dematology)

16. Hyperspectral and Multispectral Imaging in Dermatology

17. Diffuse Reflectance Spectroscopy and Imaging

18. Spectral Imaging  in Dermatology

19. Applications of MultiPhoton Microscopy in Dermatology

20. Non-linear Microscopy in Clinical Dermatology

21. Confocal Reflectance Microscopy and Polarized Light Imaging

22. Polarization optical Imaging of Skin Pathology and Ageing

23. Surface Acoustic Waves

24. Photoacoustic Tomography in the diagnosis of Melanoma

25. Ultrasound imaging in Dermatology

26. Optoacoustic Imaging of Skin

27. Total Body Photography and serial Digital Dermoscopy

28.  Functional MRI behind the processing of itch (note: "?? WTH?")

...

30. Thermal Imaging in Dermatology

...

34. Imaging in Merkel Cell Carcinoma

35. Imaging Evaluation of Cutaneous Lymphoma using Functional and Structural Imaging

36. Imaging Cutaneous Squamous Cell Carcinoma of the Head and Neck

37. Imaging Patterns of Metastatic Melanoma

38. From Image to information: image Processing in dermatology and Cutaneous Biology.

(Good luck to the Google search engine to index my blog!!  will this create more traffic?)

The clinical tomograph MPTflex™ is a novel skin imaging device

(This was announced April 2011... but we missed it...better late than never)

The clinical tomograph MPTflex™, which was developed by the German university spin-off Jenlab GmbH, is a novel skin imaging device that overcomes the poor resolution of skin imaging methods such as ultrasound, optical coherence tomography (OCT) and reflection. ( Note: Do not agree on the comment on OCT... see our blog on the LLTECH Full Field OCT system)

By using two-photon technology, the system's high-resolution skin imaging provides marker-free optical biopsies.

The tomograph is a compact system, with a flexible scan head that includes two detectors for simultaneous measurement of autofluorescence and the second-harmonic generation, used mainly for the early detection of melanoma and diagnostics of dermatological disorders. Providing a fast microscopic view into the skin without any surgery, single cancer cells, as well as elastin fibers and nanoparticles, can be imaged in vivo, and skin aging can be measured. The MPTflex™ tomograph is based on the two-photon effects predicted by the 1963 German-American Nobel Prize laureate Maria Goeppert-Mayer.

The MPTflex™ received the 2011 Prism Award for Photonics Innovation in January. Co-founded in 1999 by Prof. Dr. Karsten König, Jenlab’s primary goals are the development and the establishment of innovative bioinstrumentation based on Femtosecond Laser Technology for biotechnology, cell biology and medicine. More than 2,000 patients have already been investigated at clinics in Irvine, Brisbane, London, Modena, and Berlin. In the U.S., first clinical trials have been conducted at the University of California this year.

JenLab is translating the technology to markets. See the product brochure here and the product picture below. the Product is CE Marked.

Vivascan, by Caliber I.D.

VivaScan is a safe, painless and simple in-office procedure that provides cellular images to enable your doctor to make a diagnosis and decide on treatment. 

With harmless laser light, VivaScan produces clear images of your skin cells that reveal a level of detail that, until now, was only possible with a traditional invasive biopsy. 

Because VivaScan does not damage the skin the way a biopsy does, it can take repeat images of the same area over time. With pain-free skin imaging, precise image quality, and fast results, VivaScan gives you a new level of comfort and confidence when caring for your skin.

The VivaScan® software makes it easy to schedule patients for examinations, perform imaging examinations on one or more lesions during a visit, review, and report on images obtained during an examination. VivaScan® operates each device in the VivaScope® product line. It is used on stand-alone devices, on VivaScope® imaging and reading systems connected by intranet within the same facility, and on systems at different facilities connected by way of the VivaNet® digital telepathology network.

The VivaScan® software is designed to accommodate a wide variety of customer needs, from a solo practitioner to an imaging group with several VivaScope® systems and access to more than one dermatopathologist.

CALIBER I.D. presents a full product line for Skin Imaging / Vivascope systems:

VivaScope® systems offer clinicians and researchers in the fields of medicine and product development the possibility of a real- time, noninvasive optical biopsy of the skin.

VivaScope® 1500 and VivaScope® 3000 systems are FDA 510(k) cleared and have become an integral part of many dermatology clinics and medical institutions for the diagnosis of skin cancers and diseases, and for the evaluation of wound-healing processes and treatment outcomes.

VivaScope® 1500 Multilaser systems are well suited for a wide variety of product development applications for skin care, and have been used by scientists world-wide for the evaluation of cosmeceuticals and pharmaceuticals for more than a decade.

Benefits of VivaScope® Systems:

•Quasi-histologic, cellular imaging comparable to histopathology

•Noninvasive, repeatable imaging; no tissue damage

•Skin tumor diagnosis with high sensitivity and specificity

•Real-time visualization of blood flow and inflammatory processes

•Therapeutic monitoring of the same area of skin over time

•Quantitative data for skin layer thickness and cell sizes

•FDA 510(k) cleared medical imaging technology

3Derm: Engineering undergrads win $100,000 prize for skin imaging device

A team of rising juniors at Yale beat out graduate and undergraduate students from around the country in a national competition to create novel technology for improved healthcare delivery.

Elizabeth Asai, Nick Demas and Elliot Swart won the prize for their development of an early melanoma detection device called a "Stereoscopic Plug-and-Play Dermatoscope and Web Interface." 

Their small, user-friendly, low-cost camera can be used by a doctor or patient to capture and upload 3D pictures to a web-based directory that dermatologists can access to remotely analyze and monitor the topography and volume changes of skin moles.

Next.. they create their company 3Derm:

3Derm combines breakthrough imaging hardware with secure cloud-based software to improve patient outcomes and reduce costs.

Congratulations!

Dermanest's 2013 Skin Imaging Industry Report:

Today Dermanest releases its 2013 Skin Imaging Industry Report.  The full report contains 42 pages (see table of content below) and is available on request (complimentary copies) at info@dermanest.com

 The goal of this work, developed in collaboration with DermaNest's partner TRI-Princeton, is to track the emergence of new imaging technologies that can be applied to skin and wound imaging. 

Since our last report in August 2012, we have added 17 new products to our survey (almost doubled), and included deep vein / vascularization imaging in addition to skin and wound.

Skin imaging has begun to move towards smartphone or tablet enabled technologies. The field of mobile imaging systems contains areas including smartphone accessories and enhanced software, allowing for improved mobile images an increasingly sophisticated analysis of the photos, which is performed either on the tablets ( with limited performance and questionable outcomes) or on the cloud with virtually unlimited capabilities for image management and data processing, including Artificial Intelligence based-algorithms that could offset the limited optical capabilities ( … for now) of Smart Phones. Interesting compromises are proposed by manufacturer who offer smart phone accessories coupled to Downloadable apps.

We expect an enormous development in the Smartphone optics in 2013-14. The ready-to launch iPhone 5S already brings a much more on-board camera, and there are many enhancing accessories hitting the market. In addition, several academic institutions and focusing their capabilities to innovate in the Mobile Microscopy field, which will be of very high relevance to applied skin care.

Table of Contents and List of Products

1)      Introduction  5

2)      Technologies Stratification  5

i)      In the USA  10

1.          Canfield Imaging Systems  12

2.          Enhanced Image Technologies  15

3.          DermLite  15

4.          Moritex and BrighTex Bio-Photonics  17

5.          Mobile solutions by BrighTex Bio-Photonics  17

6.          Profect Medical Technologies  18

7.          Caliber ( ex-Lucid) 18

8.          Christie Medical 19

9.          AccuVein  19

10.       VasaMed  20

11.       Wound Zoom   21

12.       Wound Matrix  21

13.       Emage  22

14.       TRUE-see Systems  22

15.       MyOwn  23

16.       SkinVision : Your Lifetime Skin Companion  24

ii)     In Europe, Australia, and Canada  25

17.       Courage + Khazaka electronic GmbH   27

18.       FotoFinder  28

19.       BME  29

20.       Astron Clinica  30

21.       Michelson Diagnostics  31

22.       Eykona Wound Measurement System   32

23.       Silhouette by Aranz  32

24.       SIMSYS  33

25.       MOWA  33

26.       Dr. Mole  34

27.       AVEAL  34

28.       Skinlabs  35

iii)         SmartPhone Optics Enhancing Devices. 36

29.       CellScope and iPadScope  36

3)      Discussion and observations  37

4)      References  40

SkinVision : Your Lifetime Skin Companion

SkinVision (https://skinvision.com) is a mobile app that allows you to understand your skin health and keep track of it. The mobile applications allow you to understand UV index along with your skin type. In addition you can easily and simply check skin lesions ( moles) by sending a photo and receiving an instant analysis and also find an appropriate dermatologist in your vicinity.

But SkinVision is simply more than an app. It is, in fact, a mobile and browser platform that enables users and dermatologists to verify suspicious skin lesions and monitor suspicious skin lesions over time. SkinVision intends to educate, raise awareness, provide automated assessments for moles, improve the relationship between dermatologists and their patients and ultimately, to reduce costs for skin care. This enables continuous supervision, independent of geographical location. SkinVision is an important and necessary step towards the future of skincare.

Skin conditions in general, and skin cancer - melanoma in particular, almost always have a cause related to lifestyle, and SkinVision's goal is to help change those lifestyles so more people stay healthy and the ones that need treatment receive it in time.

The product is not FDA approved and the company displays a very large and visible “disclaimer” related to medical applications.

SIMSYS: Mole Mate

Purpose of device: Imaging and detection of malignant moles

Main application: Medical Use

“MoleMate is a non-invasive, rapid, and painless melanoma screening device that has been specifically designed with and for General Practitioners and skin specialists.

By assisting and accelerating the diagnostic process, SIMSYT-MoleMate enables medical professionals to quickly scan and make a decision to refer a patient, to biopsy a lesion or immediately assure them that their lesion is not suspicious.”

Light-CT™ Computed Tomography provides 2D and 3D digital images of tissue microstructure without modifying tissue

LLTech’s Light-CT™ Computed Tomography provides 2D and 3D digital images of tissue microstructure without modifying tissue.

Light-CT™ uses white light to scan beneath the surface of tissue. It does not require any tissue preparation, modification, or staining of any kind. Images are provided within minutes thanks to a non-destructive process, whereas histology (the current Gold Standard) takes several hours or days, and requires an actual slicing of the sample. The images offer a cellular resolution of 1 µm in all 3 dimensions. 3D views can be reconstructed and displayed using a standard DICOM viewer.

Light-CT™ technology produces high quality images that are comparable to histology.

The Light-CT™ scanner is an automated system. Image acquisition and calibration are automatic. Light-CT™ captures “en face” images directly using a megapixel camera and a pair of microscope objectives. Light-CT™ derives from low coherence interference microscopy. The interferometer can be displaced to step the focal plane through different depths beneath the surface to create a 3D tomographic image. “En face” capture allows Light-CT™ to operate with high lateral resolution (typically ~1µm) using medium or large aperture microscope objectives. An incoherent light source illuminates the whole field of the microscope objectives. Due to the low temporal coherence of the source, interference occurs only when the optical path lengths of the two arms of the interferometer are identical within 1µm. When a biological sample is placed under the microscope objective in the sample arm, the light reflected by the reference mirror interferes with the light reflected or backscattered by the sample structures contained in a limited volume. Real time signal processing is applied during depth exploration of the sample. The image stack is thereby optimized to allow 3D imaging.

Purpose of device: digital imaging of tissue microstructure including the border between the stratum corneum and the epidermis

Main application: medical practices

Price range: $120-$150,000