University of Cyprus

Biomedical Imaging and Applied Optics

Endoscopic Imaging
History of Endoscopy

400 BC: Hippocrates

observes the anus using a
speculum
The first real endoscope that
was developed was made by
Phillip Bozzini in 1805 to
examine the urethra, the
bladder and vagina.

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History of Endoscopy

1867 Desormeaux used an

open tube to examine
the genitourinary tract
Adolf Kussmaul in 1868 used
a straight rigid metal tube
over a flexible obturator to
perform the first
gastroscopy.

3
History of Endoscopy

Building
g on the work of
others, Rudolph Schindler
constructed the first
practical gastroscope in
1932.

4
History of Endoscopy

In 1957 Basil Hirschowitz

developed his prototype
fiberscope.

5
Endoscopy

Endoscopy
A minimally invasive diagnostic
medical procedure
The examination of internal body
cavities using a specialized medical
instrument called an endoscope.
Gives visual evidence of the
problem (e.g.
( cancer, ulceration or
inflammation)
Can be used to collect a sample of
ti
tissue or remove problematic
bl ti tissue
ti
Used to take photograph of the
hollow internal organs
Performed under
Conscious sedation
Total Anesthesia

6
Endoscopy

Physicians use endoscopy to

diagnose, monitor, and surgically
treat various medical problems
A surgeon introduces the
endoscope into the body either
through a body opening, such as
the mouth or the anus
anus, or through
a small incision in the skin.

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Endoscopy

Risks of Endoscopy
Sedation
Damage to dentition
Aspiration
p
Perforation or hemorrhage after
endoscopic dilatation
Perforation,
Perforation infection,
infection and
aspiration after percutanous
endoscopic gastrostomy
insertion
Perforation or hemorrhage after
flexible sigmoidoscopy /
colonoscopy with polypectomy
Pancreatitis, cholangitis,
perforation or bleeding after
ERCP

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Endoscopy

The endoscope
A slender, flexible or rigid tube
Equipped with lenses and a light
source.
CCDs are used to feed a video to the
monitor
g the accessory
Through y channels of
the endoscope water and air is
supplied to wash and dry the surgical
site.
Also has a channel through which
surgeons can manipulate tiny
instruments, such as forceps, surgical
scissors,
i andd suction
ti d devices.
i
A variety of instruments can be fitted
to the endoscope for different
purposes
purposes.

9
The Flexible Endoscope

Fiberoptic instruments
Based
B d on optical
ti l viewing
i i bundles
b dl
23mm in diameter and contains
2000040000 fine glass fibers, each
close to 10
10m
m in diameter
Each individual glass fiber is coated with
glass of a lower optical density to prevent
leakage of light from within the fiber
The space between the fibers causes a
dark packing fraction fine mesh
frequently apparent in the fiberoptic image
Advantages
Fiberoptic bundles are extremely flexible,
and an image can be transmitted even
when tied in a knot.
Small
S ll didiameter
t
Direct view (monitor not necessary)
Limitations
The image quality of a fibreoptic bundle,
bundle
though excellent, can never equal that of a
rigid lens system or a video-endoscope
Limited number of pixels 10
The Flexible Endoscope

Video-endoscopes
Mechanically similar to fiber-endoscopes,
A CCD chip and supporting electronics mounted
at the tip
To
T and d ffro wiring
i i replacing
l i th the optical
ti l bbundle
dl
Further electronics and switches occupying the
site of the ocular lens on the upper part of the
control head.
Advantages
Improved image quality
View through a monitor
Removing any need to hold the instrument close
to the endoscopists eye has hygienic advantages
(avoidance of splash contamination)
Improved instrument design and handling
techniques
Limitations
No direct viewing
Can not be made < 5 mm

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The Flexible Endoscope

Parts of the endoscope

Connector Section
Control Section
Insertion Section

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The Flexible Endoscope

Control section
Held in the operator's left hand
Has two stacked angulation control knobs
direct up/down and left/right deflection of the endoscope tip.
Has air/water and suction valves
Has remote switches to modify or capture the video image.
Has entry port to the instrument channel(s) is (are)
Fiber optic instruments have an eyepiece located at the top of the control section
f direct
for di t iimage viewing.
i i

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The Flexible Endoscope

Insertion Section
The portion of the endoscope that is inserted into the patient
The length, diameter, and degree of stiffness of the insertion tube vary among
models.
The insertion tube contains
One or two instrument channel(s)
One or two light guide bundles (incoherent fiber optic)
An air channel, a water channel
Either an image guide bundle or a CCD chip with wire
Connections, and angulation wires.

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The Flexible Endoscope

Endoscopic Accessories
Biopsy forceps
Graspers
Baskets
Injectors
Dilators
Knives
HF endo-therapy
accessories
. . . too many types of
accessories.
accessories

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The Flexible Endoscope

Connector section
A light guide,
An air-pipe
Electrical contacts compatible with the processor/light source.
Side connectors for a water container, suction, CO2, insertion tube venting
An S (safety)-cord connecting mount, which grounds the endoscope, reducing the
electrical shock hazard to the operator.

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The Rigid Endoscope

A lens system
y
transmitting the image to
the viewer
Typically a relay lens
system
Rod lenses provide for
better image quality and
light efficiency
Different
Diff t di
diameters
t and
d
viewing angles

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Flexible Endoscopy

Dependingg on the body y part,

each type of endoscopy has
its own special term, such as
laryngoscopy (vocal cords)
bronchoscopy (lungs)
colonoscopy (colon)
Esophagoscopy (esophagus)
gastroscopy (Stomach)
Hysteroscopy (uterus)
etc

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Bronchoscopy

19
Esophagoscopy

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Surgical or Rigid Endoscopy

Laparoscopy
y
Arthroscopy
Endo-Urology
Endo Urology
Gynecology
E.N.T-applications
Proctoscopy
And many other surgical
applications
(gastrectomy,neurosurgery,
etc) .

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Arthroscopy

22
Urethrocytoscopy

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Laparoscopic Surgery

Laparoscopy is minimal access

surgery
Accomplish surgical therapeutic
goals with minimal somatic and
psychological trauma.
A rigid endoscope is
introduced through a sleeve
into the peritoneal cavity.
The abdomen inflated with
carbon dioxide
Further sleeves or ports are
inserted to enable instrument
access and their use for
dissection
dissection.

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Laparoscopic Surgery

Examples
Laparoscopic cholecystectomy has
become the standard of
management of uncomplicated
gallstone disease.
With improved instruments and
more experience it is likely that
other advanced procedures,
previously
i l regarded
d d as
controversial, will also become
fully
y accepted
p
E.g. laparoscopic colectomies for
malignancy,

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Benefits of Laparoscopic Surgery

Smaller incision
Improved cosmetics
Reduced possibility of
infection
Reduced post op pain
Reduced blood loss
Return home quicker
Return to work quicker!

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Limitations of Laparoscopic Surgery

Reliance on remote vision

and operating
Loss of tactile feedback
Dependence on handeye
coordination
Difficulty with haemostasis
Extraction of large
specimens
Reliance on new techniques

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Da Vinci Surgical System

Not really a robot!

Master-slave system
the surgeon directly
initiates all the
movements t off the
th
robotic instruments in
real time
The prototype was
developed by Stanford
Research Institute in
1980s, funded by US
Army, to perform
battlefield surgery
remotely
t l by
b a surgeon in
i
the safe rear
FDA app
approved
o ed in human
u a
operations in 2000
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Da Vinci Surgical System

Imaging
g g
Double lenses
laparoscope
3D,
3D high definition
definition,
binocular view
10-15X magnification
Dexterity
Endowrist instruments
have 6 degrees of
freedom
Filtering off hand tremor
Scaling down movements
1-5X

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Da Vinci Surgical System

DaVinci Offers
Improved dexterity
Better control
Better precision
Improved ergonomics decreased
fatigue and strain
Advantages
Reduced hospital stay
M
More hi
highh risk
i k patients
ti t can b
be ttreated
t d
Less staff required
Limitations
Cost of equipment $1 million
Steep learning curve for surgeons
Doctors training on device felt
hindered by lack of ability to feel the
tissue theyre working on
Surgery with this system takes 40-50
minutes longer than standard
procedure

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Limitation of Fiberoptic Endoscopy

Double Balloon (Push-and-Pull) Endoscopy

Fiberoptic method to visual the entire small bowel
Two balloons are inflated and deflated in sequence to
move the endoscope through the bowel
Advantages
g
Complete visualization of the entire small bowel to the
terminal ileum
Can do therapeutic interventions
Allows for sampling/biopsying of small bowel mucosa
Allows for resection of polyps
Placement of stents or dilation of small bowel
strictures
Disadvantages
Technically difficult procedure
Very time consuming (Procedure can take > 3 hours)
Patient may need to be admitted to the hospital
Higher risk of small bowel perforation
Case reports of pancreatitis and intestinal necrosis
p
Reported incidents of aspiration
p and p
pneumonia

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Capsule Endoscopy

Capsule endoscopy was first used in

humans in 1999.
1999
First publication on capsule
endoscopy was published in Nature
in 2000:
Iddan G, Meron G, Glukhovsky A,
Swain P. Wireless capsule
Endoscopy Nature.
Endoscopy. Nature 2000; 405:417.
405:417
Two major companies have capsule
endoscopy products.
Given Imaging has the PillCam
Olympus has the EndoCapsule
The latest pill camera
Sized at 26x11 mm
Capable of transmitting 50,000 color
images during its traversal through the
digestive system of patient
patient.

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Inside a Capsule Camera

1.Optical Dome
This shape res
results
lts in eas
easy
orientation of the capsule axis
along the central axis of small
intestine and so helps propel the
capsule forward easily.
easily
The Optical Dome contains the
Light Receiving Window .
2 Lens Holder
2.Lens
The Lens Holder is that part of the
capsule which accommodates the
lens. The lens is tightly fixed to the
holder so that it doesnt
doesn t get
dislocated anytime.
3.Lens
The Lens is an integral component
of the capsule.
It is arranged behind the Light
Receiving Window.

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Inside a Capsule Camera

4.Illuminating LEDs
Around the Lens & CMOS
Image Sensor, four LEDs (Light
Emitting Diodes) are present.
Th
These plural
l l lilighting
hti d devices
i
are arranged in donut shape.
5.CMOS Image g Sensor
CMOS (Complementary Metal
Oxide Semiconductor) Image
Sensor is the most important
part of the capsule. It is highly
sensitive and produces very
high quality images.
It has 140 field of view and can
detect objects as small as
possible.

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Inside a Capsule Camera

6.Battery
Two batteries
Silver Oxide primary batteries are
used (Zinc/Alkaline Electrolyte/Silver
Oxide). Such a battery has a even
discharge voltage
voltage, disposable and
doesnt cause harm to the body.
7.ASIC Transmitter
The ASIC ((Application
pp Specific
p
Integrated Circuit) Transmitter is
arranged behind the Batteries as
shown. Two Transmitting Electrodes
are connected to the outlines of the
ASIC Transmitter
Transmitter.
These electrodes are electrically
isolated from each other.
8.Antennae
As shown, the Antennae is arranged
at the end of the capsule. It is
enclosed in a dome shaped chamber.

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How does Capsule Endoscopy Work?

Capsule is swallowed by y the

patient like a conventional
pill.
It takes images as it is
propelled forward by
peristalsis.
peristalsis
A wireless recorder, worn on
a belt
belt, receives the images
transmitted by the pill.
A computer workstation
processes the data and
produces a continuous still
i
images.
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Advantages of Capsule Endoscopy

Uses
Crohn's
C h ' Disease.
Di
Malabsorption Disorders.
Tumors of the small intestine & Vascular
Disorders.
Disorders
Ulcerative Colitis
Medication Related To Small Bowel
Injury.
Injury
Advantages
Painless, no side affects or complications.
Miniature size, so can move easily
through the digestive system.
Accurate, precise and effective.
Images
I t k are off high
taken hi h quality
lit are sentt
almost instantaneously to the data
recorder for storage.
Made of bio-compatible
bio compatible material
material, doesnt
doesn t
cause any harm to the body.
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Limitations of Capsule Endoscopy

Anatomical Limitations
Slow Gastric/Intestinal Motility.
Narrowing or obstruction
Potentially obstructed views
Morbidly obese patients
Technical limitations
Poorer
oo e quality
qua ty of
o images
ages as compared
co pa ed to Fiberoptic
be opt c
scopes
The position of the capsule can not be accurately
controlled
Interpretation of results are very observer dependent
Findings may be of unknown significance or
relevance.
Inability
I bilit tto bi
biopsy or ttreatt any pathology
th l seen.
Overcomes
Smaller devices
Bi-directional telemetry camera?

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