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Bringing malignancy to light in the operating theatre
Surgery is likely to remain the primary treatment modality for many cancers. Precise targeting of malignant tissues during interventions is critical to both the efficacy and safety of the surgical therapy and patient outcome. Such precision would be greatly facilitated by information rich diagnostic imaging of targeted tissue at the time of intervention. Unfortunately, the ability to obtain information about the targeted tissues in real-time is currently limited. A new generation of optical spectroscopy and imaging techniques combined with computational advances (i.e. machine-learning and artificial intelligence) now holds great promise for vast improvement in the area of intraoperative diagnostics and smart guided personalized therapeutic interventions. Here, I will present clinically-compatible multispectral fluorescence lifetime imaging (FLIm) techniques and studies demonstrating that tissue autofluorescence lifetime properties can be associated with distinct tissue pathologies. I will show the ability of FLIm to operate in conjunction with surgical robots and microscopes used in standard-of-care and present studies conducted in patients in the operating theatre. Current results demonstrate FLIm’s potential for intraoperative delineation of brain tumors and brain radiation necrosis as well as head and neck cancer including image-guided augmented reality during trans-oral robotic surgery (TORS). Challenges and solutions for practical and broader implementation of FLIm in surgical oncology are discussed.