Translating dynamic optical contrast imaging (DOCI) for operating room integration

Head and neck cancers account for approximately 890,000 new cases and 450,000 deaths annually worldwide. Achieving complete tumor resection while preserving critical anatomical structures remains a significant surgical challenge. Current visualization techniques, including white light imaging, narrow-band imaging, near-infrared fluorescence, and tactile assessment, lack real-time functional specificity. We present Dynamic Optical Contrast Imaging (DOCI), a wide-field, label-free fluorescence lifetime imaging platform designed for intraoperative use. DOCI provides high-resolution (1024×1024), wide-field (76 mm) imaging with video-rate capability and endoscopic adaptability. In a murine flank tumor resection model (n=10), DOCI-guided resection (n=5) was compared to gross inspection (n=5). DOCI guidance enabled real-time tumor bed assessment and improved identification of residual disease. Recurrence did not occur after the 3 week time point in 2 out of the 5 mice in which complete resection was confirmed by DOCI-guided resection. In the remaining 3 mice undergoing DOCI-guided resection, complete resection was not feasible due to deep tumor invasion. In contrast, all five mice who underwent gross resection without DOCI guidance demonstrated tumor recurrence within one week. These findings support the feasibility of DOCI for intraoperative tumor bed assessment and highlight its translational potential for operating room integration.