Novel Intraoperative Imaging Device Advances Precision Surgery for Patients with Cancer

The Dynamic Optical Contrast Imaging (DOCI) device is a revolutionary, non-invasive imaging system that utilizes advanced high-speed cameras and LED lights to delineate margins between malignant and healthy tissue in real-time. 

This pioneering imaging device, created by a UCLA Health surgeon, does not require the use of injectables or dyes like traditional cancer-identifying devices.

The DOCI system was created by Maie St. John, MD, PhD, Professor and Chair of the Department of Head and Neck Surgery at UCLA Health; Professor of Bioengineering; and Thomas C. Calcaterra Chair of Head and Neck Surgery. This new device has demonstrated a high degree of accuracy in identifying the difference between cancerous and healthy tissues over the course of its trials among 150 patients at UCLA Health.

The current usage of the device has been focused on neck squamous cell carcinoma among other head and neck cancers; however, Dr. St. John has emphasized an interest in a broader use of the technology to identify cancer in general. Dr. St. John is hopeful that the DOCI system can help with patient care and significantly improve patient outcomes and survival.

A Delicate Balance

The device has proven to be essential in accurately identifying head and neck cancers, which are the most difficult to diagnose. In addition, more than 90% of head and neck cancer develops in the cells lining the mouth and throat, which often have been particularly challenging to identify. The prognosis is often diminished by factors such as cancer cells still living after tumors have been removed and even cancers that grow around the nerves. This is particularly crucial as surgeons want to remove the cancerous tissue completely without risking healthy tissue. If cancerous tissue remains, UCLA Health doctors have noted, it can increase the likelihood that the cancer will return, and even the risk of death, by 90%.

Accurately determining these margins is crucial, and the gap in current technology can cause poor outcomes such as decreased quality of life and a lower survival rate.

Birth of DOCI

In collaboration with engineering departments at UCLA Health and the Head and Neck Surgery Department, Dr. St. John came up with the innovative idea after realizing her Toyota Prius had sensors that would allow her not to drive into the hedges of her front lawn. Dr. St. John sought to create a machine that can effectively use the idea of a “sensor” that can detect cancer versus non-cancer margins while also finding the lowest cancer cell concentration per volume of tissue.

How It Works

The DOCI system is mounted on a physician’s arm and then swung over the patient’s bed in a wide view, while light shines on the area surrounding the tumor that has been identified. The machine uses light energy, a high-speed camera, and regular LED light resulting in two images that are then analyzed at multiple wavelengths. This allows healthcare professionals to see the difference between healthy tissues and non-healthy tissues.

DOCI imaging was initially tested on mice, who were injected subcutaneously into bilateral flanks with SCCVII SF, a neck cancer cell line. The system quickly proved its value, as tumors that were previously almost impossible to detect using existing imaging techniques were suddenly clearly identifiable. The findings of the test were extremely promising, with DOCI imaging able to detect perineural invasion with 100% accuracy, compared to the control group.

With such promising results, Dr. St. John and her team are looking to promote broader clinical uses of the DOCI system. Their first step will be to make it useful in endoscopes, enabling surgeons to see how it can be utilized during throat surgery. To further evaluate its usage, Dr. St. John is working with experts across the country to test it with other cancers and specialties such as breast and colorectal surgeries. 

Dr. St. John hopes that, one day, it can also be used for the early detection of cancer by dermatologists, dentists and primary care providers, so that as many patients as possible can have better outcomes while improving their overall quality of life.

For more information, please visit https://www.uclahealth.org/international-services/ or call +1 310-794-8759