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Parathyroid DiseasesiEXMachyna3NCT04589884

Intraoperative EXamination Using MAChine-learning-based HYperspectral for diagNosis & Autonomous Anatomy Assessment

An observational study of Parathyroid Diseases and Thyroid Diseases, run by IHU Strasbourg at 1 site in France.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The intraoperative recognition of target structures, which need to be preserved or selectively removed, is of paramount importance during surgical procedures. This task relies mainly on the anatomical knowledge and experience of the operator. Misperception of the anatomy can have devastating consequences. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Hyperspectral Imaging
How many people
112 participants
Where
1 siteFrance
Study dates
22 Sep 2020to 15 Oct 2021
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients undergoing open surgical elective or emergency procedures. Patients undergoing laparoscopic procedure will also be informed about the study and in case of conversion to open surgery, will be enrolled in the study.

Who may be able to join

  • Man or woman over 18 years old.
  • Scheduled for elective or emergency surgery
  • Patient able to receive and understand information related to the study.
  • Patient affiliated to the French social security system.

Who cannot join

  • Contra-indication for anesthesia
  • Pregnant or lactating patient.
  • Patient under guardianship or trusteeship.
  • Patient under the protection of justice.

Trial locations and contacts

1 site in 1 country.

France1 site
  • Service de Chirurgie Digestive et Endocrinienne, NHC

    Strasbourg

Other trials in France

About this study

The intraoperative recognition of target structures, which need to be preserved or selectively removed, is of paramount importance during surgical procedures. This task relies mainly on the anatomical knowledge and experience of the operator. Misperception of the anatomy can have devastating consequences. Hyperspectral imaging (HSI) represents a promising technology that is able to perform a real-time optical scanning over a large area, providing both spatial and spectral information. HSI is an already established method of objectively classifying image information in a number of scientific fields (e.g. remote sensing).

Our group recently employed HSI as intraoperative tool in the porcine model to quantify perfusion of the organs of the gastrointestinal tract against robust biological markers. Results showed that this technology is able to quantify bowel blood supply with a high degree of precision. Hyperspectral signatures have been successfully used, coupled to machine learning algorithms, to discriminate fine anatomical structures such as nerves or ureters intraoperatively (unpublished data).

The i-EX-MACHYNA3 study aims at translating the HSI technology in combination with several deep learning algorithms to differentiate among different classes of human tissues (including key anatomical structures such as BD, nerves and ureters).

Read the detailed description

The intraoperative recognition of target structures, which need to be preserved or selectively removed, is of paramount importance during surgical procedures. This task relies mainly on the anatomical knowledge and experience of the operator. In the setting of minimally invasive surgery, there is a reduced tactile feedback and the surgeon's vision is the only clue to discriminate the tissues. Misperception of the anatomy, due to patient-specific pathologic conditions and/or to the surgeon's inexperience, can lead to an increased risk of iatrogenic injury of critical anatomical structures and can have devastating consequences. Hyperspectral imaging (HSI) represents a promising technology that combines a photo camera to a spectrometer and that is able to perform a real-time optical scanning over a large area, in a contrast-free manner, providing both spatial and spectral information, generated by the tissue/light interaction. The technology is based on the use of reflectance spectroscopic imaging measurements. The measurement consists in the irradiation of white light on the area (normal halogen lamps, in non-harmful intensity) and the recording of the remitted spectral intensities from the area in the form of remission spectra. The optical interaction (scattering, absorption) of the incident light with the various components (including the depth) of the target material (e.g. biological tissues) alters the spectral distribution of light so that the remitted light carries information about the current material or tissue composition and physiology (e.g. perfusion). HSI is an already established method of objectively classifying image information in a number of scientific fields (e.g. remote sensing), which was first applied in the area of human medicine about 15 years ago. Because of the intrinsic advantages of non-destructive sample collection, interfacing possibilities with common optical modalities (microscope, endoscope) and quantitative, examiner independent results, various approaches have been developed in the meantime to harness the potential of hyperspectral imaging in medicine.

Its usefulness in the biomedical field has been already extensively prove. It has been previously applied in digestive surgery to quantify intestinal oxygenated hemoglobin during several procedures, or in case of mesenteric ischemia. A number of previous works focused successfully on the ability of HSI to discriminate between normal and tumor tissue, in prostate cancer, colorectal cancer, gastric cancer, glioblastoma, head and neck cancers. In the oncological field, the advances in hyperspectral features classification have been remarkable and lead to the successful use of sophisticated deep learning algorithms. In surgery, the usefulness of HSI camera has been studied to visualize the operative field under difficult bleeding or to detect tumor presence within the resection margins after surgical excision.

A japanese group used an HSI system as additional visualization tool to detect intestinal ischemia and also to classify the intraabdominal anatomy. They identified a particular wavelength (756-830 nm) for the differentiation between healthy and less perfused bowel. They also demonstrated that the spleen, colon, small intestine, urinary bladder and peritoneum have different spectral features. This finding might enable in the future HSI-based navigation of the operation field. Our group recently employed HSI as intraoperative tool in the porcine model to quantify perfusion of the organs of the gastrointestinal tract against robust biological markers. Results showed that this technology is able to quantify bowel blood supply with a high degree of precision.

Other groups previously attempted to discriminate bile duct from the vessels, esophagus from tracheal tissue, thyroid from parathyroid gland, nerve and ureter from the surrounding tissue. However, those previous works directed on recognizing key anatomical structures were conducted using either simple feature discrimination algorithms or band selection methods. The amount of information obtained after each acquisition, varies according to the camera resolution, but is quite large, therefore machine and deep learning techniques for data classification and feature extraction are required. In a set of controlled experiments in the porcine model, hyperspectral signatures have been successfully used, coupled to machine learning algorithms, to discriminate fine anatomical structures such as nerves or ureters intraoperatively (unpublished data).

The i-EX-MACHYNA3 study aims at translating the HSI technology in combination with several deep learning algorithms to differentiate among different classes of human tissues (including key anatomical structures such as BD, nerves and ureters).

Being tested
Hyperspectral Imaging
Keywords
Hyperspectral Imaging, Deep learning, Autonomous tissue recognition, Tissue spectral signature
Medical subject headings
Parathyroid Diseases, Thyroid Diseases, Liver Neoplasms, Gastrointestinal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hyperspectral ImagingOther

    Hyperspectral images of the operative field will be collected at several time points during the surgical procedure. The device used is the TIVITA® compact Hyperspectral imaging system (Diaspective Vision GmbH, Germany). It is a CE (European Economic Area) mark approved device. The acquisition takes roughly 10 seconds, is contrast-free and contact-free.

Study groups in NCT04589884
Study groupRoleWhat they receive
Parathyroid diseaseNot described
Receives: Other: Hyperspectral Imaging
Thyroid diseaseNot described
Receives: Other: Hyperspectral Imaging
Liver tumors and metastasesNot described
Receives: Other: Hyperspectral Imaging
Digestive tumorsNot described
Receives: Other: Hyperspectral Imaging
Digestive perfusionNot described
Receives: Other: Hyperspectral Imaging

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. To collect human tissue spectral features to build a spectral tissue library and build successively machine learning algorithm to enable real-time automated tissue recognition

    To collect clean and consistent datasets and the evaluation of the accuracy based on ground truth evaluations, such as clinical evaluation and pathology reports.

    Measured: 1 day

Secondary outcomes (2)
  1. To correlate HSI values with biological data obtained as standard of care

    The ability to predict biological data from the spectral tissue information

    Measured: 1 day

  2. To correlate HSI values with pathological data obtained as standard of care

    The ability to predict pathological data from the spectral tissue information

    Measured: 1 day

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2020
  2. Study start22 Sep 2020
  3. Primary completion15 Oct 2021
  4. Study completion15 Oct 2021

Why it stopped: Data acquisition not possible anymore

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
112 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04589884
Sponsor's protocol ID
20-005
Acronym
iEXMachyna3
Status last verified
Jan 2024
First submitted
9 Oct 2020
Last updated
9 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Goetz AF, Vane G, Solomon JE, Rock BN. Imaging spectrometry for Earth remote sensing. Science. 1985 Jun 7;228(4704):1147-53. doi: 10.1126/science.228.4704.1147.

    PubMed 17735325
  • Lu G, Fei B. Medical hyperspectral imaging: a review. J Biomed Opt. 2014 Jan;19(1):10901. doi: 10.1117/1.JBO.19.1.010901.

    PubMed 24441941
  • Jansen-Winkeln B, Maktabi M, Takoh JP, Rabe SM, Barberio M, Kohler H, Neumuth T, Melzer A, Chalopin C, Gockel I. [Hyperspectral imaging of gastrointestinal anastomoses]. Chirurg. 2018 Sep;89(9):717-725. doi: 10.1007/s00104-018-0633-2. German.

    PubMed 29637244
  • Kohler H, Jansen-Winkeln B, Maktabi M, Barberio M, Takoh J, Holfert N, Moulla Y, Niebisch S, Diana M, Neumuth T, Rabe SM, Chalopin C, Melzer A, Gockel I. Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy. Surg Endosc. 2019 Nov;33(11):3775-3782. doi: 10.1007/s00464-019-06675-4. Epub 2019 Jan 23.

    PubMed 30675658
  • Jansen-Winkeln B, Holfert N, Kohler H, Moulla Y, Takoh JP, Rabe SM, Mehdorn M, Barberio M, Chalopin C, Neumuth T, Gockel I. Determination of the transection margin during colorectal resection with hyperspectral imaging (HSI). Int J Colorectal Dis. 2019 Apr;34(4):731-739. doi: 10.1007/s00384-019-03250-0. Epub 2019 Feb 2.

    PubMed 30712079
  • Akbari H, Kosugi Y, Kojima K, Tanaka N. Detection and analysis of the intestinal ischemia using visible and invisible hyperspectral imaging. IEEE Trans Biomed Eng. 2010 Aug;57(8):2011-7. doi: 10.1109/TBME.2010.2049110. Epub 2010 May 10.

    PubMed 20460203
  • Barberio M, Longo F, Fiorillo C, Seeliger B, Mascagni P, Agnus V, Lindner V, Geny B, Charles AL, Gockel I, Worreth M, Saadi A, Marescaux J, Diana M. HYPerspectral Enhanced Reality (HYPER): a physiology-based surgical guidance tool. Surg Endosc. 2020 Apr;34(4):1736-1744. doi: 10.1007/s00464-019-06959-9. Epub 2019 Jul 15.

    PubMed 31309313
  • Akbari H, Halig LV, Schuster DM, Osunkoya A, Master V, Nieh PT, Chen GZ, Fei B. Hyperspectral imaging and quantitative analysis for prostate cancer detection. J Biomed Opt. 2012 Jul;17(7):076005. doi: 10.1117/1.JBO.17.7.076005.

    PubMed 22894488
  • Baltussen EJM, Kok END, Brouwer de Koning SG, Sanders J, Aalbers AGJ, Kok NFM, Beets GL, Flohil CC, Bruin SC, Kuhlmann KFD, Sterenborg HJCM, Ruers TJM. Hyperspectral imaging for tissue classification, a way toward smart laparoscopic colorectal surgery. J Biomed Opt. 2019 Jan;24(1):1-9. doi: 10.1117/1.JBO.24.1.016002.

    PubMed 30701726
  • Han Z, Zhang A, Wang X, Sun Z, Wang MD, Xie T. In vivo use of hyperspectral imaging to develop a noncontact endoscopic diagnosis support system for malignant colorectal tumors. J Biomed Opt. 2016 Jan;21(1):16001. doi: 10.1117/1.JBO.21.1.016001. No abstract available.

    PubMed 26747475
  • Li Y, Deng L, Yang X, Liu Z, Zhao X, Huang F, Zhu S, Chen X, Chen Z, Zhang W. Early diagnosis of gastric cancer based on deep learning combined with the spectral-spatial classification method. Biomed Opt Express. 2019 Sep 9;10(10):4999-5014. doi: 10.1364/BOE.10.004999. eCollection 2019 Oct 1.

    PubMed 31646025
  • Hu B, Du J, Zhang Z, Wang Q. Tumor tissue classification based on micro-hyperspectral technology and deep learning. Biomed Opt Express. 2019 Nov 19;10(12):6370-6389. doi: 10.1364/BOE.10.006370. eCollection 2019 Dec 1.

    PubMed 31853405
  • Fabelo H, Ortega S, Ravi D, Kiran BR, Sosa C, Bulters D, Callico GM, Bulstrode H, Szolna A, Pineiro JF, Kabwama S, Madronal D, Lazcano R, J-O'Shanahan A, Bisshopp S, Hernandez M, Baez A, Yang GZ, Stanciulescu B, Salvador R, Juarez E, Sarmiento R. Spatio-spectral classification of hyperspectral images for brain cancer detection during surgical operations. PLoS One. 2018 Mar 19;13(3):e0193721. doi: 10.1371/journal.pone.0193721. eCollection 2018.

    PubMed 29554126
  • Ma L, Lu G, Wang D, Wang X, Chen ZG, Muller S, Chen A, Fei B. Deep Learning based Classification for Head and Neck Cancer Detection with Hyperspectral Imaging in an Animal Model. Proc SPIE Int Soc Opt Eng. 2017 Feb;10137:101372G. doi: 10.1117/12.2255562. Epub 2017 Mar 13.

    PubMed 30220770
  • Fei B, Lu G, Wang X, Zhang H, Little JV, Patel MR, Griffith CC, El-Diery MW, Chen AY. Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients. J Biomed Opt. 2017 Aug;22(8):1-7. doi: 10.1117/1.JBO.22.8.086009.

    PubMed 28849631

Questions about this trial

What is this clinical trial studying?

An observational study of Parathyroid Diseases and Thyroid Diseases, run by IHU Strasbourg at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 9 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: Data acquisition not possible anymore). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

To collect human tissue spectral features to build a spectral tissue library and build successively machine learning algorithm to enable real-time automated tissue recognition (time frame: 1 day). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04589884, which also lists 22 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2024; AzTrials last refreshed its copy on 28 Oct 2026.

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