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Table 1 Summary of imaging modalities advantages, disadvantages, and potential applications

From: Upcoming imaging concepts and their impact on treatment planning and treatment response in radiation oncology

MODALITY Advantages Disadvantages Applications
Autofluorescence Real-time imaging;
no fluorophore needed;
wide FOV
Shallow DOF; low specificity; high cost Superficial tumor monitoring; pre-neoplastic evaluation; surgical margin assessment
Near-infrared fluorescent imaging Real-time imaging; deep DOF; high signal-to-noise Need of imaging device; dye administration time Surgical guidance; real-time monitoring and modulation of EBRT dose
Nonspecific Fluorescent Contrast Agents Low dye toxicity; rapid hepatic clearance of dye Contraindicated with contrast allergy; low signal-to-noise; no intracellular dye accumulation Staging; guidance of radiotherapy planning; imaging for treatment delivery
Targeted Contrast Agents Use Ig-based therapies as ligand; deep DOF via NIRF imaging Require external fluorophore; few agents currently available Diagnosis; staging
Radiofrequency Spectroscopy No fluorophore needed; real-time imaging; handheld devices now exist Limited FOV; shallow DOF Residual disease detection; improved diagnostic imaging in solid tumors
Raman Spectroscopy Real-time imaging; determine tissue response to radiation Shallow DOF; low signal-to-noise; thermally damage samples Measuring treatment response; post-op residual disease detection
Elastic Scattering Spectroscopy Handheld devices; no fluorophore needed; rapid image acquisition; strong optical signal Signal interference; variable DOF Radiation damage detection; radiotherapy response monitoring
High-frequency Ultrasound Sub-millimeter resolution; no fluorophore needed; approved devices No ionizing radiation; variable sensitivity and specificity; complex image analysis algorithms Superficial tumor assessment; reduce morbidity of prostate radiotherapy
Contrast-enhanced ultrasound Real-time, continuous imaging; compatible with targeted contrast agents; widely-available; inexpensive; relatively safe Shallow DOF; short half-life of contrast; potential for microvascular collapse Primary/ metastasis characterization; ablation guidance
Optical Coherence Tomography Cellular-level resolution; real-time imaging; handheld; no fluorophore needed; automated image analysis Shallow DOF; narrow FOV Renal mass identification; prostate cancer margin assessment
Optoacoustic Imaging Real-time imaging; high resolution; enhanced by contrast agents Historically shallow DOF but now improved Staging; post-op planning for residual disease
Confocal Microscopy Micron-level resolution; real-time imaging; no fluorophore needed; enhanced with fluorophores; automated image analysis; digital staining Shallow DOF; narrow FOV; high device cost; user training necessary for manual interpretation Detection and planning of cutaneous tumors and soft-tissue sarcomas