A

PAPER ON

ENDOSCOPIC INSTRUMENTATION
By
Ritesh R. Shah
B.Tech – 3/4 I - SEMESTER
ROLL NO. : 03621A1031
E-Mail: riteshshah86@rediffmail.com
riteshshah86@yahoo.co.in
AND
Ch Swetha
B.Tech – 4/4 I - SEMESTER
ROLL NO. : 02621A1045

ACADEMIC YEAR: 2004-2005.

DEPARTMENT OF ELECTRONICS AND INSTUMENTATION ENGINEERING
AURORA’S ENGINEERING COLLEGE, BHONGIRI, NALGONDA (A.P.)
Abstract:

Endoscopic Instrumentation deals with the endoscopes and its associated Instrumentation. Fiber optic
endoscopes now have widespread use in medicine and guide a myriad of diagnostic and therapeutic
procedures. Endoscopy is the examination and inspection of the interior of body organs, joints or cavities
through an endoscope. An endoscope is a device using fiber optics and powerful lens systems to provide
lighting and visualization of the interior of a joint. Endoscopy has enabled us to take panoramic views of
the integral organs. Prior to the widespread use of endoscopy and diagnostic imaging, most internal
conditions could only be diagnosed or treated with open surgery. There are other methods to see the
outline of the organs but don’t allow us to look directly into these organs itself. Endoscopy can also guide
therapy and repair, such as the removal of torn cartilage from the bearing surfaces of a joint. Biopsy
(tissue sampling for pathologic testing) may also be performed under Endoscopic guidance. To perform
the surgery, there is also a separate port to allow for administration of drugs, suction, and irrigation. The
advantages of Endoscopic surgery include Shorter recovery time, Less infection, Less risk, Less pain and
trauma for patient, reduced hospital costs, etc. The paper begins with the introduction on Endoscopy, its
applications in various areas of science and then explains the light cables used. It then explains the types
of endoscopes, its accessories, advantages, and disadvantages. The cameras, use of charge coupled
devices and Camera design for Endoscopic urology with optical and electronic characteristics are
explained in detail.

1.1 What is Endoscope?

An endoscope is a device using fiber optics and powerful lens systems to provide lighting and
visualization of the interior of a joint. The portion of the endoscope inserted into the body may be rigid or
flexible, depending upon the medical procedure. It consists of two basic parts: A tubular probe fitted with
a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which
magnifies the transmitted images of the body's internal structures. An endoscope uses two fiber optic
lines. A "light fiber" carries light into the body cavity and an "image fiber" carries the image of the body
cavity back to the physician's viewing lens. It is important to understand that the endoscope functions as a
viewing device only. To perform the surgery, there is also a separate port to allow for administration of
drugs, suction, and irrigation. Endoscopes may be used in conjunction with a camera, which sends the
images to the processing unit.

1.2 Application of Endoscopes

Fiber optic endoscopes now have widespread use in medicine and guide a myriad of diagnostic and
therapeutic procedures including [3]:
Arthroscopy: Examination of joints for diagnosis and treatment.

Bronchoscopy: Examination of the trachea and lung's bronchial trees to reveal abscesses, bronchitis,
carcinoma, tumors, tuberculosis, alveolis, inflammation.

Colonoscopy: Examination of the inside of the colon and large intestine to detect polyps, tumors,
ulceration, inflammation, colitis diverticula, Chrohn's disease, and discovery and removal of foreign
bodies.

Cystoscopy: Examination of the bladder, urethra, urinary tract, uteral orifices, and examination of the
lining of the esophagus, stomach, and duodenum.

Laparoscopy: Visualization of the stomach, liver and other abdominal organs including the female
reproductive organs.

2.1 Types of light cables

In 1954 a major breakthrough in technology occurred in the development of fiber optic cables.
The try to look principle of fiber optic cable was based on the total internal reflection of light[1]. Now a
days, there are two types of light cable available in market.

1) Fiber Optic Cables: These cables are made up of a bundle of optical fibers glass thread swaged at
both ends. The fiber size used is usually between 10 to 25 mm in diameter. They have a very high quality
of optical transmission, but are fragile.

2) Liquid Crystal Gel Cables: These cables are made up of a sheath that is filled with a clear optical gel.
Theoretically they are capable of transmitting 30% more light than optic fibers. Swaged at both ends by
quartz. Due to more light and better color temperature transmission this cable is recommended in those
circumstances where documentation is performed. Problems experienced are that the quartz swaging at
the ends is extremely fragile, these cables transmit more heat than optical fiber cables and these cables
are made more rigid by a metal sheath. In conclusion, even though the choice is a difficult one, we use
optical fiber cables.

2.2 Types of endoscopes:

2.2.1 The rigid endoscope:

1) Rod lens system: This is the

optical system of the telescope and
comprises an objective lens to
create a real and inverted image of the object. The usual viewing angle is 60-70 0 but larger angles of over
1000 can be generated using ’fish eye' lenses. Prisms produce single – axis inversion of an image, and
therefore a second prism is always necessary to invert the image at the eyepiece.

2) Fiber optic bundle: This is the means of light transmission to the objective end of the telescope and
runs down the periphery of the telescope. As the light bundle is not concerned with image transmission, it
is made from incoherent fibers and is relatively cheap to produce.

3) Irrigation / Instrument Channel: This may be an integral part of the endoscopes as in nephroscope
or contained within a sheath into which the endoscope fits. This provides a watertight locking system,
and may contain also a catherisation port for introducing ureteric catheters or manipulative instruments
such as biopsy forceps.

2.2.2 Flexible endoscopes

1) Optical system: The optical system comprises of the image guide, together with lenses at the objective
end and eyepiece of the Endoscope. The objective lens forms an image of the object under view on
the distal face of the Image guide. Light representing this image is transmitted through the image
guide and a duplicate image is formed on the proximal face of the bundle at the eyepiece. As the
objective lens produces an inverted image on the distal face of the bundle, the image on the proximal
end of the bundle will also be inverted: this is overcome by having a 180 twist in the image.
2) Illumination system: This consists of light guide, a spectral guide and spectral lens systems at both
the ends of the bundle to capture the maximum amount of light from the light source at one end, and
produce a wide angle of even illumination at the other.
3) Bending section / angulation system: One of the advantages of flexible endoscopes over a rigid one
is the ability to angulate its tip to obtain a wider field of vision, and perhaps to negotiate a narrow orifice
such as the neck of a bladder diverticulum. To achieve this, a flexible endoscope needs an angulaton
system and a bending section.
4) Irrigation channel: This is simply the channel running the length of the telescope, which can be used
for irrigation and the passage of flexible instruments such as biopsy forceps.
5) Insertion tube: This is connected in three layers. The inner layer comprises of helical steel bands,
there is then a thin layer of SS wire mesh covered on its outer surface by a plastic sheath.

2.3 Physics of light transmission through the fiber optic bundle To perform the surgery, there is also a
separate port to allow for administration of drugs, suction, and irrigation

Fibreoptic[5] can be defined as the propagation of light along thin fibers of transparent material
by multiple total internal reflection (MTIR). For this to occur, the transparent fiber must be enclosed by a
material of lower refractive index such as air or different type of glass. The lower medium is glass with a
refractive index ng and the upper medium is air or glass with a lower refractive index na .A ray of light
traveling through to the lower medium and hitting the boundary surface at the point P with the incident
angle A will be refracted and travel through the upper transparent medium at the angle The relationship
between the angle A and B is given by the equation:

ng sin A = na sin B
As the angle of incidence A is increased the angle of the refracted ray B also increases according to the
above relationship. When A equals Ac (the critical angle of incidence) the refracted ray will travel along
the boundary surface. The critical angle Ac is determined by the equation (1)

Sin Ac = ng / na (1)

If the angle of incidence is increased beyond this critical angle, the ray is totally reflected at the boundary
surface. It is the condition of total internal reflection that enables glass fibers to transmit light rays that
strike the boundary at angles of incidence will be lost and there is therefore a ‘maximum acceptance
angle of incidence ‘for light transmission. This is not determined solely by the critical angle, as it must
allow also for refraction occurring at the point of light entry into the fiber

2.4 The light source

One of the advantages of the endoscopic is that of obtaining a virtually micro-surgical view
compared to that obtained by laparotomy. Whereas in fact at present, this view has become opto-
electronic. Quality of the image obtained very much depends on the quantity of light available at each
step of optical and electronic system [3].

A typical light source is consist of

A. Lamp:

1) Halogen bulbs: Halogen bulbs provide a highly efficient, almost crisp white light source with
excellent color rendering. Electrodes in halogen lamps are made of tungsten; this is the only metal with a
sufficiently high melting temperature and sufficient vapor pressure at elevated temperatures. Halogen
bulbs are low voltage and have an average life of 2,000 hours. Color temperature of Halogen lamp is
(5000-5600 K).
2) Xenon lamps: Xenon lamps consist of a spherical or ellipsoidal envelope made of quartz glass, which
can withstand high thermal loads and high internal pressure. The color temperature of Xenon lamp is
6000-6400 K. The optimum operating temperature of the cathode tip is approximately 2000 degrees C.

3) Metal halide vapor arc lamp: In metal halide lamp the mix of compounds is carefully chosen to
produce an output, which approximates to ‘white’ light as perceived by the human eye. There are two
type of Metal halide lamp used; iron iodide lamp and gallium iodide lamp.

The intensity of the light delivered by any lamp also depends on the power supply of the source.
However, increasing the power poses a real problem as concerns the heat .The most frequently used two
main types of lamps are halogen and xenon

B. Heat Filter: For 100 % of energy consumed, a normal light source uses approximately 2 % in light
and 98 % in heat. This heat is mainly due to the infrared spectrum of light and due to obstruction in the
pathway of light. A heat filter is introduced to filter this infrared to travel in fiber optic cable.

C. Condensing lens: The purpose of condensing lens is to converge the light emitted by lamp to the area
of light cable input. In most of the light source it is used for increasing the light intensity per square cm of
area.

D. Manual or automatic intensity control circuit: Manual adjustment, which allows the light source to
be adjusted to a power level defined by the surgeon. Automatic adjustment, the advance light source
system is based on the automatic intensity adjustment technology. The video camera transforms the
signal into an electronic signal. This electronic signal is coded in order to be transported and calibrated
upto 1mV.

USE OF CHARGE COUPLED DEVICE (CCD)

3.1 Introduction

The solid state-imaging chip has now replaced the camera tube as the basis for color television
cameras in most fields. The device that has become standard is now referred as ‘CCD’ or charge coupled
device. The CCD has revolutionized television cameras in a very short time and presents many
advantages to the manufacturer of specialist cameras for Endoscopy.[5]:

1) Reduced size and weight

2) Low power consumption
3) Improved safety.
4) Improved image quality.
 5) Higher reliability.

3.2 Image sensor

The image sensor used in the design of color television cameras for endoscopy is the CCD. The light
sensitive surface has a regular pattern of picture elements or ‘pixels’. When the light falls on these pixels
a transfer of electric charge related to light intensity takes place. These points of electric charge are then
measured at the output in a time related way, via a shift register is very different in nature to a scanned
output from a picture tube and gives a measure of voltage related to time that allows viewing or recording
related to time that allows viewing or recording equipment to reconstruct the same image. Three types of
CCD design are available:

The full-frame read is the smallest type but as it does not have any storage register in which the charge
pattern can be dumped while another image is being created, the illumination must be removed while the
image is scanned out. Although this is happening in aver short periods, the absence of light for up to 50%
of the operating time makes the sensitivity poor. The interline transfer CCD has a storage register that is
integral with the picture element such that the pixel is actually an image cell, and a storage cell. This
reduces the resolution and sensitivity but the benefits are in size and lack of streaking from highlights. It
is now possible to make this type of CCD with over 400000 pixels, which gives a resolution adequate for
most endoscopic viewing.

3.3 Ways for production of color image

There are two ways to produce a color image: the one used by high quality television cameras is to
use three CCDs to split the incoming images into their red, green and blue elements and to focus these
separated images on the individual sensors. The other method is to superimpose a mosaic filter so that
each pixel is also giving information on the percentage of color in that area.
By scanning out the charge from each pixel in a time – related way, the value of luminance and
chrominance at each point of the image sensor surface is known. The choice of colors and quality of the
mosaic filter will have a significant effect upon the crispness and color fidelity of the resulting image.
3.4 Performance of cameras
The base camera chosen by the endoscopic camera manufacturer defines most of the image
quality characteristics.
1) Resolution: This describes the ability to resolve the black on white lines in the horizontal plane. For a
good single chip camera it is about 350 and for a good three-chip camera it is about 700. Resolution is
directly related to bandwidth and therefore all other devices in the system through which the signal passes
will critically affect the resolution.

2) Sensitivity: This is complicated by the technique for measurement variables include monochrome,
color subject, speed of the lens, and agreed value at which the output is too low, this value may include
the use of gain control in the camera control unit.

3) Signal to noise ratio: This is the ratio measured in db for noise occurring in the picture. Noise in the
television signal manifests as a background pattern of ‘snow ‘effect, which has the result of diminishing
perceived resolution and color quality.

4) Dynamic range: This is not a widely accepted measurement for television cameras and is seldom
quoted. However in endoscopy this could be a useful value to compare, as it is the difference between the
lightest and darkest features in a scene that can be visualized adequately.
3.5 Camera design for Endoscopic urology:
A camera to be attached either a rigid telescope or a small fibrescope is preferably as small and as
light as technology will allow. As always there is a compromise between the smallest and largest CCD
camera that an engineer can be design may lack The key factors affecting size are as follows:
1) Optical mount: Wide range of couplers for every make of endoscope is available in standard form
beam splitters and directs couplers of variety of focal lengths arte available. The penalty for the C mount
is that it is 25mm in diameter and this limits miniaturization.
2) Camera cable attachment: The camera cable should be as light and flexible as possible, while having
the required strength for constant use in the operating field. All microchip cameras have a complex
multicore cable and attaching this securely to the camera head either its almost microscopic connections
to the CCD chip is a design problem. The easiest way to satisfy the immediate physical problem of
durability is to mount the chip in a very small body, with the cable already fixed, and then to fill the
entire body to the rear of the chip with high quality plastic which is also molded out along the cable for a
short way to give adequate strain relief. This will give a very strong watertight and permanent connection
of the smallest possible size. Some cameras have reliability and low down time as higher priorities. These
have designed soakable cameras with a plug and a socket at the camera head. This entails the CCD
camera to be mounted in a complete housing with connections available for a plug, the plug should be
sealed with a high quality connectors and a good seal to the camera head and with a gland for strain relief
of the cable. The advantage to the user is that when the camera cable breaks it can be changed locally in
minutes. This prevents frustrating downtime and lowers replacement costs to the cost of the cable itself.
3) Soakability: A camera for endoscopy should be soaked and the disinfectant moat commonly used is
based on glutarldehyde. Although some users have decide that soaking the camera is not warranted,
nevertheless it will become very wet in routine use and will need thorough cleaning and disinfecting on a
regular basis. These disinfectants are highly corrosive and also leave residue, if not properly washed off.
A good design ensures that even the plug that connects to the camera control unit meets this specification,
because the camera and cable are much more easily handled and cleaned if all the parts are soakable and
can be treated as sterile when required.
3.5.1 Optical characteristics:
The difference between the camera and optics is that the camera is the electronic part of the assembly.
This is the miniature camera head containing the imaging chip and with the cable attached to the camera
control unit, which is an integral part of the camera .Within the camera may be fitted filters appropriate
for the type of lightning to be used. In front of this is an optical coupler which performs several functions
–focuses the image on the chip, gives any image magnification and then connects the camera physically
to the endoscope. Many styles of coupler exist, with free rotation or locking and with quick release or not,
a direct coupler allows only the camera to have a view from the endoscope; a beam splitter allows the
operator to see into the endoscope and the camera to have a straight configuration between the cameras at
right angles to the endoscope.
3.5.2 Electronic characteristics
Cameras built for the endoscopy consists of a camera head and a camera control unit together can
be referred as a complete camera. However various electronic features are added or modified to suit the
application by the camera designer these are as follows:
1) Color bar generator: When it is switched on, it replaces the camera image with a recognizable
pattern of vertical strips of red, white, cyan, magenta, blue and black. This very dependable output is used
to check that the whole video system is working even if the camera is not connected and is vital if the
camera seems to produce no image, in which case the color bar is a known good signal to test all the
other equipments. Without this facility the loss of picture due to failure of any component will remain
undiagnosed.
2) White balance: With many Cameras now being operated with more than one type of light source, it is
necessary to have a guaranteed way of resetting the colorimetry of the camera. The two main types of
light source in use are halogen and xenon. The color output of a lamp is measured as a color temperature
in degrees Kelvin. A halogen lamp gives a warm rather yellow light and is actually the standard on which
cameras are measured in the factory at a color temperature of 3200K. These lamps are fitted in a familiar
150W low power light sources. Xenon lamps are much more powerful at over 300W, but produce a very
cold blue light of about 6000K. The effect of different color temperature illumination on a television
camera is very much greater than it is to the eye, which makes such corrections quite quickly. The white
balance camera allows the camera to correct for the very different lightning. Setting the white balance is
usually done by pointing the endoscope with the image correctly exposed; the white balance control is
pressed. This not only improves overall hue, but also improves color separation and therefore perceives
clarity of the image.
3) Automatic light level control: For some time, light sources have been available that automatically
adjust their output to expose the camera correctly; they do this by feeding the camera signal to the light
source and reacting to the total signal level which should be 1 V at optimum. However, there are two
reasons why this does not work at well. One is that the endoscopist moves the telescope quite fast most of
the time and the light source cannot be made to react quickly enough, the result of light following the
requirement is that it works against an evenly illuminated screen should produce a signal of 1 V, the
typical endoscopic view is not evenly illuminated and the information required could be in a poor
illuminated part of the image. If the light source adjusts to cope with any flare, then darker portions will
go black. It is the most efficient to use a constant illumination and to move the endoscope to achieve
correct exposure. A different way of achieving automatic exposure is more appealing. The CCD chip can
be made to expose electronically and subsequently to unload its imager at vary ingrates; at higher speed
the exposure time is lower. The latest technology allows the camera to measure its own output on
different parts of the chip and then to compensate by raising or lowering this rate and therefore the
exposure this allows the light source to be left at one setting and for the camera to react very quickly to
correct exposure.
4) Choice of outputs: The various types of signal format to convey the camera image to other devices
are discussed above. With the range of equipment now available that may be incorporated in a system, all
cameras should have one or better stills, to composite video outputs. This is most common signal to feed
monitor, video recorders and printers. For the very serious user an RGB output will give the highest
possible quality on a suitable monitor and is also necessary for good results for the latest video ‘still
frame’ technology, such as disc recorders or printers.
5) Multiple camera head: This facility is possible only on some camera not all cameras can match extra
camera heads to one CCU. This facility can be useful in busy department that depends on television
imaging or when a system is shared between the departments. The camera head and cable account for at
least 80%of breakdowns in video systems and a spare could be useful.
6) Function button: Even though camera heads are now very small, some manufactures have
incorporated a button on the camera head. This facility allows the surgeon to control remotely entire
device in the system, which could be the start –stop on a video recorder, the print command on a video
printer, or any other device that the screen designer can interface to a simple switch.
Conclusion:
Through this paper we have come a long way in endoscopy starting from the basics of endoscopy.
However there is much to be done, especially in flexible endoscopy. The importance of documentation
has improved significantly. Models are constantly being modified and improved thus it is necessary to
differentiate between “essential development” and “optional extras”.

References:

1) Practical fibreoptic intubations, Second Edition pages 15-25 by Mansukh Poppet.

2) Gastrointestinal endoscope, Third Edition pages 23-34 by John Baillie.
3) Practical endoscope, First Edition pages 1-15 by Shepherd.
4) Olympus catalogues.
5) Operative surgery: Genitourinary Surgery, pages 1-35, by Hugh Whitfield fifth edition.