Evaluation of a 'Hand-held' Fluorescence Digital Imaging Device for Real-Time Advanced Wound Care Monitoring (JDRTC/UHN) (JDRTC/UHN)
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| ClinicalTrials.gov Identifier: NCT01651845 |
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Recruitment Status : Unknown
Verified February 2018 by Ralph DaCosta, University Health Network, Toronto.
Recruitment status was: Active, not recruiting
First Posted : July 27, 2012
Last Update Posted : February 14, 2018
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We have developed an innovative optical molecular imaging platform (called PRODIGI) based on high-resolution fluorescence and white-light technologies in a hand-held, real-time, high-resolution, non-invasive format. PRODIGI offers a non-contact means of obtaining instantaneous image-based measurements of diagnostically-relevant biological and molecular information of a wound and surrounding skin tissues for the first time and could have significant impact on improving conventional wound care, management, and guidance of intervention.
The investigators hypothesize that real-time imaging of tissue autofluorescence signals emanating from endogenous connective tissue (e.g. collagen) and pathogenic bacteria within complex wounds can be used to determine healing status (i.e., collagen re-modeling and wound closure), detect wound bacterial contamination and/or infection that is occult under standard clinical white light evaluation, and guide intervention during wound care.
| Condition or disease |
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| Wounds Diabetic Foot Ulcers |
The investigators have recently developed an innovative optical molecular imaging platform (called PRODIGI) based on high-resolution fluorescence and white-light technologies in a hand-held, real-time, high-resolution, non-invasive format. PRODIGI offers a non-contact means of obtaining instantaneous image-based measurements of diagnostically-relevant biological and molecular information of a wound and surrounding skin tissues for the first time and could have significant impact on improving conventional wound care, management, and guidance of intervention.
In preliminary preclinical testing, the investigators have discovered that when wounds are illuminated by violet/blue light, endogenous collagen in the connective tissue matrix emit a characteristic green fluorescent signal, while most pathogenic bacterial species emit a unique red fluorescence signal due to the production of endogenous porphyrins. Therefore, with autofluorescence imaging, no exogenous contrast agents are needed during imaging, making this approach particularly appealing as a diagnostic imaging method for clinical use.
Based on extensive preclinical studies in our labs, PRODIGI has demonstrated its capability at collecting autofluorescence images of wounds and detecting the presence and relative changes in connective tissue (e.g. collagen) content and bio-distribution involved in wound healing. It can also detect the presence and relative amounts of commensal and pathogenic bacteria within the wound based on autofluorescence alone (these bacteria are invisible to standard visualization with the naked eye using white light), thus providing a measure of infection status. This could significantly impact clinical wound care and management by i) reducing the complications associated with missed detection of bacterial infection under conventional practice, ii) facilitating image-guided wound sampling by targeted swabbing/biopsy and iii) monitoring wound healing and treatment response over time.
Previous Related Studies: A pilot-level clinical study (UHN REB protocol # 09-0015-A, PI: DaCosta, 50 patients imaged to date) performed by our group from 2008-2011 to assess the clinical utility of the device successfully demonstrated that tissue autofluorescence produced by endogenous collagen/elastin in the skin appears green in the fluorescent images, while most clinically-relevant bacterial colonies present in the wound produce a red fluorescence signal caused by endogenous porphyrins. Some bacterial species (e.g. pseudomonas aeruginosa) produce a green fluorescence signal that can be differentiated spectrally and texturally from the fluorescence of the dermis (another hue of green, discernable by our proprietary image analysis software). The PRODIGI device is sensitive enough to detect these green and red fluorescence signals from tissue and bacteria confirming the utility of this compact and portable imaging platform for clinical wound care.
The investigators hypothesize that real-time imaging of tissue autofluorescence signals emanating from endogenous connective tissue (e.g. collagen) and pathogenic bacteria within complex wounds can be used to determine healing status (i.e., collagen re-modeling and wound closure), detect wound bacterial contamination and/or infection that is occult under standard clinical white light evaluation, and guide intervention during wound care.
| Study Type : | Observational |
| Estimated Enrollment : | 80 participants |
| Observational Model: | Cohort |
| Time Perspective: | Prospective |
| Official Title: | Evaluation of a 'Hand-held' Fluorescence Digital Imaging Device for Real-Time Advanced Wound Care Monitoring (JDRTC/UHN) |
| Study Start Date : | July 2012 |
| Actual Primary Completion Date : | September 2017 |
| Estimated Study Completion Date : | September 2018 |
| Group/Cohort |
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Image Guided Intervention
Standard of care white light visual wound assessment followed by fluorescence image-guided wound assessment
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- Evaluate effectiveness of the UHN handheld PRODIGI™ imaging device for real-time and non-invasive detection and tracking of pathogenic bacterial presence, contamination and infectious status in complex wounds over time. [ Time Frame: After study completion ]
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Inclusion Criteria:
- > 18 years of age
- males and females
- new patient to the JDRTC to ensure consistent work-up procedures (as described below) prior to treatment
- presenting with acute or chronic wounds (i.e., diabetic ulcers or other), with known or unknown infection status.
Exclusion Criteria:
- treatment with an investigational drug within 1 month before study enrolment
- any contra-indication to routine wound care and/or monitoring
- inability to consent
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01651845
| Canada, Ontario | |
| University Health Network - Judy Dan Research and Treatment Centre | |
| Toronto, Ontario, Canada, M2R 1N5 | |
| Principal Investigator: | Ralph S DaCosta, PhD | University Health Network, Toronto |
| Responsible Party: | Ralph DaCosta, Principal Investigator, University Health Network, Toronto |
| ClinicalTrials.gov Identifier: | NCT01651845 |
| Other Study ID Numbers: |
12-5003-A |
| First Posted: | July 27, 2012 Key Record Dates |
| Last Update Posted: | February 14, 2018 |
| Last Verified: | February 2018 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
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Diabetic Foot Foot Ulcer Wounds and Injuries Diabetic Angiopathies Vascular Diseases Cardiovascular Diseases Leg Ulcer |
Skin Ulcer Skin Diseases Diabetes Complications Diabetes Mellitus Endocrine System Diseases Diabetic Neuropathies Foot Diseases |