# Non-Invasive Detection and Staging of Decubitus and Diabetic Ulcers

> **NIH NIH R21** · UNIVERSITY OF CALIFORNIA, SAN DIEGO · 2020 · $194,278

## Abstract

PROJECT SUMMARY
Chronic wounds including diabetic ulcers and decubitus ulcers are a major health concern, but tools to
diagnose these wounds before they have erupted or evaluate deep tissue response to therapy have remained
elusive. Treatment is more expensive than prevention, but there are few tools to identify early stage disease.
Indeed, visual inspection remains the standard of care for detection early stage ulcers, but it cannot map the
altered tissue in three dimensions nor can it quantify the aberrant physiology underlying the ulcer. Current
approaches to preventing decubitus ulcers are labor-intensive monitoring and repositioning. While pressure-
sensitive devices can identify when a pressure threshold has been reached, there is no correlation between
amount/duration of pressure and ulcer development. What is missing is information on changes in tissue
physiology and not simply a brute metric such as pressure. This work will use photoacoustic ultrasound to
create a detailed map of the tissue physiology at the wound site or site of a potential wound. This can then
report the exact site needing treatment or how a site is responding to treatment. Our preliminary data showed
that we could detect pressure ulcers before they erupted and thus this approach could potentially have
significant clinical value. While this preliminary data was for pressure ulcers only, we suggest that this
approach will likely have value to both decubitus and diabetic ulcers because signal in photoacoustic
ultrasound is based on changes in tissue optical absorption from hemoglobin, and diabetic and decubitus
ulcers both have a dysregulated microvasculature. This rationale motivates this study, and the clinical value
of the final imaging protocol is a 3D map of the ulcer or potential ulcer below the surface to predict ulcer
formation or monitor treatment response. Aim 1 will use a rodent model of diabetic ulcers. We hypothesize
that the photoacoustic signal will be higher in untreated animals than treated animals. Aim 2 will image human
subjects presenting to the Veterans Administration hospital in San Diego with decubitus ulcers. We will stratify
these people as a function of ulcer stage and hypothesize that more advanced stages will have higher
photoacoustic ultrasound signal in the wound. The clinical impacts include early detection of both types of
ulcers. Ulcers are currently detected based on symptoms—this work will detect them based on physiology.
This will also offer three-dimensional imaging. Visual inspection only offers information about the skin surface.
Our acoustics approach will map and measure the extent of dysregulation through the first 5 cm of tissue.
This will be particularly useful in monitoring a treatment response because areas of low response can be
prioritized for additional treatment.

## Key facts

- **NIH application ID:** 9877521
- **Project number:** 1R21AG065776-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN DIEGO
- **Principal Investigator:** Jesse Vincent Jokerst
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $194,278
- **Award type:** 1
- **Project period:** 2019-12-15 → 2021-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9877521

## Citation

> US National Institutes of Health, RePORTER application 9877521, Non-Invasive Detection and Staging of Decubitus and Diabetic Ulcers (1R21AG065776-01). Retrieved via AI Analytics 2026-06-14 from https://api.ai-analytics.org/grant/nih/9877521. Licensed CC0.

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