The laser-researcher is there at the first cancer test

In a room at Bispebjerg Hospital, there is equipment that no one else in Europe has gathered all together in one place. It will likely be here, in this very room that the researchers will discover how to give Danish skin cancer patients a vital diagnosis, faster, leading to the patient receiving the most effective treatment plan. This is important research because with 38,500 new cases of skin cancer diagnosed every year, it is the most common form of cancer in Denmark.

"We have collected five different cutting-edge scanners, which in each their own way can diagnose skin cancer without having to take biopsies," says Mette Mogensen, chief physician and clinical associate professor at the Department of Dermatology at Bispebjerg Hospital, where she is head of the “Fast Track” project. The project has a goal of being able to provide a cancer diagnosis in just ten minutes.

In the latest joint study, Bispebjerg Hospital and DTU Fotonik have collaborated to investigate how, among others, Malignant Melanoma can be diagnosed using light:

“We use white-light lasers to make in-depth images of the skin. The technology is called OCT - optical coherence tomography - and it provides images with an unprecedented degree of detail, which makes it easier to detect suspicious skin damage,” explains Niels Møller Israelsen, a researcher at DTU Fotonik. In this project, he has often been seen wearing a white coat, conducting research directly in the hospital corridor.

The best available commercial scanners were purchased for this research collaboration. On the left, is a picture taken with the most cutting-edge commercial scanner. To the right you can then see a picture taken with the scanner that DTU Fotonik researcher Niels Møller Israelsen developed expressly for the project: This OCT-scanner, based on a supercontinuum white-light laser, has proven to be much better than the commercial one, as it can take pictures in far greater detail. The dark "island" seen in the picture is a basal cell carcinoma, which is one of the primary types of skin cancer found. The two images are taken from the same patient in the same millimetre area of skin.

Essential tests in the hospital corridor

"There are many barriers in everyday hospital life that you cannot imagine when you are in a laboratory," says Niels Møller Israelsen and continues:

“For example, you cannot just place the patient on a table in some awkward position, even though doing that would provide the best scan image. No, because if the technology is to be used in practice, then it must be possible to scan the patients where they are at already. That is why we have specially designed a hand-held probe that is so flexible that it can scan the patient in, for example, the hospital chair without it being uncomfortable. Our experience is that if health technology, like what we are working on here, has to reach from the laboratory level to the hospital corridors and make a difference, it has to be made and adapted in the field,” he says.

At Bispebjerg Hospital, chief physician and clinical associate professor Mette Mogensen has experienced how Niels Møller Israelsen, as a DTU researcher, is used to being outside of the laboratory:

“It has been a huge advantage for me that Niels and the team from DTU Fotonik are used to dealing with patients. They wore coats and were completely involved in the clinical work, without anyone thinking that they were not clinical staff. The patients were, of course, informed that the researchers from DTU Fotonik were involved in the study,” she says and continues:

“Niels has had diverse tasks. He built the scanning system and participated in the subsequent data processing, which we otherwise are used to managing ourselves. It has been very rewarding. The researchers have really dived into our clinical work - of course without being directly involved in the patient's treatment - and we have benefited greatly from the fact that they have provided input on how we can analyze our data in ways that we couldn’thave previously imagined,” says Mette Mogensen.

Milestone and world record

The autumn of 2020 marks a milestone for the collaboration between DTU Fotonik and the Department of Dermatology at Bispebjerg Hospital. The collaboration began as a project idea between a professor at DTU Photonics Ole Bang and Merete Hædersdal, professor at the University of Copenhagen and chief physician at Bispebjerg and Frederiksberg Hospitals. This fall marks six years to the date. According to Merete Hædersdal, the collaboration has led to far more than she could have dreamed of:

"It has brought us closer to being able to fastly correctly diagnose skin cancer patients-- faster than I had dared to hope. I also believe that the results we have delivered along the way played a major role in getting the Videncenter for Hudkræft established, which I just had the honour of being made head of," she says.

DTU Fotonik has worked closely together with Professor Merete Hædersdal and clinical associate professor Mette Mogensen from the Department of Dermatology at Bispebjerg Hospital through the Innovation Fund project ShapeOCT, the research collaboration SCIN-CAG and the ongoing Fast Track project.

Through these activities, three clinical studies (2017, 2019 and 2020) have been realized with 58 patients who gave their approval for DTU Fotonik to participate in their first cancer examination. The collaboration has led to the world record in OCT depth-resolution of two micrometres in tissues in a clinical study in dermatology. The researchers continue to focus on how this technology of in-depth study can be used to make new discoveries about cancer and its characteristics in the skin. The researchers hope to be able to publish the results of their latest trial regarding malignant melanomas before the end of the year.

Collaborating technologies

Throughout the course of their collaboration, it has been a constant priority to use the most cutting-edge, available technologies in order to make the biggest advances. The researchers have employed the use of, among others, a 3D printer to make the handheld probe, along with artificial intelligence to efficiently and objectively record the transition between the two upper layers of the skin, which is otherwise incredibly difficult to track with a common algorithm. This distinction is important to identify, as some cancers occur in the junction between the two upper skin layers.

In the room with the world’s most advanced scanners at Bispebjerg Hospital, in addition to the DTU Fotonik-developed system, you will also find Denmark's first photo-acoustic scanner--a new technology combining the properties of both light and sound.

In total, there are five scanners, and it is by combining these with the knowledge of the people who operate them, that prompts clinical associate professor and chief physician at the Department of Dermatology at Bispebjerg Hospital Mette Mogensen to acknowledge:

“It is not one scanner, but the combination of several scanners that provides the clearest answer and therefore also, in the long run, the fastest process for the patient. It looks promising."

Read more about OCT technology.