Plastic Surgery Research Council
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Presenter: Michael S Chin, MD
Co-Authors: Connor NM; Freniere BB; Saleeby JH; Lo YC; Fitzgerald TJ; Lalikos JF
University of Massachusetts Medical School

PURPOSE: Studies examining acute perfusion changes (<1 month) in irradiated fields are limited. Hyperspectral imaging (HSI) is a novel method of scanning spectroscopy that provides direct measurement of cutaneous tissue perfusion that is non-invasive. In these experiments, we examine the ability of HSI to assess cutaneous changes in skin perfusion during the acute period following irradiation in an animal model as well as patients.

METHODS: For animal experiments, hairless mice (n=10) were exposed to 50 Gy of ionizing radiation using a strontium-90 source on bilateral flanks. Imaging was performed with a hyperspectral imager immediately before irradiation on day 0, and then on subsequent select days for four weeks. For the human study, patients undergoing external beam breast conserving radiotherapy (n=5) or post-mastectomy radiation (n=1) were enrolled. Total doses ranged between 42 Gy and 50 Gy. Baseline images were obtained before irradiation for bilateral breasts in each patient (one irradiated side and one control side). Images were subsequently taken before and after each fractionated dose at clinic visits for the first month. Skin reaction assessment was performed concurrently with HSI for both murine and human studies.

RESULTS: In mice, desquamative injury formed in all irradiated areas. Skin reactions were first seen on day 7, with peak formation on day 14. HSI demonstrated increased tissue perfusion as early as day 1 before any cutaneous changes were observed. In humans, perfusion in the irradiated breast was found to increase prior to skin reaction formation and continued to steadily increase over the first 30 days in all patients. Skin reactions included erythema and dry desquamation starting at day 11.

CONCLUSIONS: HSI allows for complete and reliable quantification of perfusion changes in irradiated skin. Animal experiments have demonstrated the potential of HSI to predict acute skin reactions based on early changes seen after irradiation. Preliminary patient data suggests that HSI can visualize distinct changes similar to those seen in the murine model, and further human study is warranted.

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