It is an honour to be giving the first presentation at this symposium marking the great contributions Dave Delpy and the UCL group have made to advances in the field of near infrared spectroscopy.
When asked to give a presentation, I asked Clare if it was OK to slip up the waveband of the electromagnetic spectrum and include the visible wavelength range, which - as many of you may be aware - I have been applying for most of my clinical applications. However, I have used a number of other techniques over the years including laser Doppler measurements and imaging, NIR and indeed the long wavelength infrared range for thermographic imaging.
My interest in tissue spectrophotometry developed throughout the 80s when I worked at the Institute for Physiology and Cardiology at the University of Erlangen Nuernberg with Manfred Kessler. It was whilst there that I started going to ISOTT and met Dave, but at that time I was better known for the development and application of the hydrogen clearance technique than spectroscopy. But when I returned to Ninewells Hospital, Dundee in 1990 as a clinical physicist, I was looking for more clinically applicable methods. Tissue spectroscopy was an obvious non-invasive tool whose role in clinical diagnosis and monitoring had not yet been established. The table shows the various clinical applications to which we have applied - predominantly visible - but also NIR spectroscopy in Dundee and subsequently in Durham. Two of them - Amputation viability assessments and TRAM flap monitoring have now been adopted as routine clinical applications. In the next few minutes I shall talk briefly about these and two other promising applications: NIR for the prediction of surgical site infections and endoscope guided visible spectroscopy for diagnosing colon ischaemia.
When I left Erlangen, the EMPHO II visible spectrophotometer system was being launched onto the market. But at the time I couldn't afford to purchase one. Nor was there a sufficient clinical evidence base to put forward a business case justifying what was an extremely expensive piece of kit.
However, I was successful in obtaining a start-up grant from Dundee University and was able to purchase a Photal MCPD 1000 specrtophotometer. We developed our own algorithms for measuring SO2 and relative haemoglobin concentration (haemoglobin index, HbI) and set out to assess its possible application to the prediction of tissue viability following below knee amputation for critical limb ischaemia. This was already a success story in Dundee which had one of the highest healing rates and below-knee to above-knee amputation ratios in the world. This was accomplished using the injection of a radioactive isotope to measure skin blood flow - so clearly, the development of a non-invasive repeatable technique was highly desirable.
Harrison DK. Applications of optical spectroscopy in surgery: 15 years of clinical experience. David Delpy Workshop on Near Infrared Spectroscopy and Imaging, University College London, July 10th-11th 2008.
Dr. David K. Harrison, Durham Unit, Durham. Tel: +44 (0)191-333-2215.
Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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