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Evaluation of Radiation-Induced Oral Mucositis by Optical Coherence Tomography

Authors' Affiliations: ¹ Radiation Oncology Branch, ² Radiation Biology Branch, National Cancer Institute; ³ Gene Therapy and Therapeutic Branch, National Institute of Dental and Craniofacial Research, Bethesda, Maryland; ⁴ McGill University Health Center, ⁵ Biomedical Imaging Research Services Section, CIT, NIH, and ⁶ Imalux Corporation, Cleveland, Ohio

Requests for reprints: James B. Mitchell, Radiation Biology Branch, National Cancer Institute, Room B3-B69, Building 10, 9000 Rockville Pike, Bethesda, MD 20892. Phone: 301-496-7511; Fax: 301-480-2238; E-mail: jbm{at}helix.nih.gov.

Purpose: Optical coherence tomography (OCT) imaging was evaluated to determine if radiation-induced mucosal damage could be noninvasively monitored in real time and correlated with histopathologic findings.

Experimental Design: Female C3H mice, ages 7 to 9 weeks, four per group, were immobilized in a custom-made Lucite jig and received 0, 15, 22.5, and 25 Gy in a single fraction to their oral cavity. OCT images were acquired of proximal, middle, and distal aspects of the dorsum of the tongue on days 0, 1, 3, 5, and 7 post-irradiation. Animals were sacrificed on day 7 and samples taken for histologic evaluation. OCT images were visually examined and also quantified by image analysis and compared with histologic findings.

Results: Tongues removed 7 days post-irradiation showed no visible damage; however, upon staining with toluidine blue, ulcers at the base of the tongue became visible (100% for 25 Gy, 75% after 22.5 Gy, and 0% after 15 Gy). Visual inspection of OCT images qualitatively compared with histologic findings and quantitative image analysis of the OCT images (effective light penetration depth) revealed significant changes 7 days post-irradiation compared with unirradiated controls for the base of the tongue.

Conclusions: OCT allows for direct noninvasive real-time acquisition of digitally archivable images of oral mucosa and can detect radiation-induced changes in the mucosa before visual manifestation. OCT may be a useful technique to quantify subclinical radiation-induced mucosal injury in experimental chemoradiation clinical trials.