Muhammad Rashed, DB; (2015) Assessment of new real-time in-situ optical coherence tomography instrumentation and techniques for diagnosing and monitoring oral and cutaneous lesions. Doctoral thesis , UCL (University College London).

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Abstract

Head and neck cancer is the sixth most common cancer worldwide, with 686,328 new cases per year. Most head and neck cancers are squamous cell carcinomas of the oral cavity and oropharynx, and are burdened by high mortality (50% at 5 years from diagnosis), notwithstanding recent progress in treatment methods. The vast majority of oro-pharyngeal cancers are late diagnosed, with significant adverse effects on cure, morbidity and prognosis. There is general consensus that earlier diagnosis contributes to better outcome measures. Current diagnostic standards consist of clinical examination and surgical biopsy, which are associated with delayed presentation, diagnosis and greater mortality. There is an unmet need for effective diagnostic techniques to aid early identification of cancers. Optical coherence tomography (OCT) is one of a number of non-invasive real-time imaging systems, introduced during the last two decades aiming to provide tissue information similar to conventional histopathological examination. The technique is similar to a B-mode ultrasound section, but employs a scanning near infrared light source rather than ultrasound waves, generating cross-sectional images of the sample tissue in an X-Z orientation. In this study, I investigated a modified OCT oral instrument (VivoSight® Michelson Diagnostics Ltd, Orpington, Kent, UK) with adapted probe for intraoral use. The new oral instrument was not CE marked, was uncalibrated and consequently a non-standard instrument. Therefore, prior to clinical application, the new instrument required calibration and comparison with the conventional instrument to assess and confirm performance in image quality and resolution in X, Y, and Z-planes. A series of laboratory engineering standards were created and compared by scanning with both instruments in X, Y & Z planes. A second series of experiments were conducted using porcine tissue as models for human tissue, confirming the similarities of fact and artefact observable when the two instruments were applied to challenging imaging scenarios, in particular, the effects of dissimilar target tissue refractive indices on the OCT image. The effects (tissue dimensional changes) of fixing samples in formal-incontaining media and tissue processing were also then investigated using this non-invasive measuring technique.

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