Laryngoscopic Image Stitching for View Enhancement and Documentation - First Experiences

One known problem within laryngoscopy is the spatially limited view onto the hypopharynx and the larynx through the endoscope. To examine the complete larynx and hypopharynx, the laryngoscope can be rotated about its main axis, and hence the physician obtains a complete view. If such examinations are captured using endoscopic video, the examination can be reviewed in detail at a later time. Nevertheless, in order to document the examination with a single representative image, a panorama image can be computed for archiving and enhanced documentation. Twenty patients with various clinical findings were examined with a 70 rigid laryngoscope, and the video sequences were digitally stored. The image sequence for each patient was then post-processed using an image stitching tool based on SIFT features, the RANSAC approach and blending. As a result, endoscopic panorama images of the larynx and pharynx were obtained for each video sequence. The proposed approach of image stitching for laryngoscopic video sequences offers a new tool for enhanced visual examination and documentation of morphologic characteristics of the larynx and the hypopharynx

A deep learning framework for quality assessment and restoration in video endoscopy

Endoscopy is a routine imaging technique used for both diagnosis and minimally invasive surgical treatment. Artifacts such as motion blur, bubbles, specular reflections, floating objects and pixel saturation impede the visual interpretation and the automated analysis of endoscopy videos. Given the widespread use of endoscopy in different clinical applications, we contend that the robust and reliable identification of such artifacts and the automated restoration of corrupted video frames is a fundamental medical imaging problem. Existing state-of-the-art methods only deal with the detection and restoration of selected artifacts. However, typically endoscopy videos contain numerous artifacts which motivates to establish a comprehensive solution. We propose a fully automatic framework that can: 1) detect and classify six different primary artifacts, 2) provide a quality score for each frame and 3) restore mildly corrupted frames. To detect different artifacts our framework exploits fast multi-scale, single stage convolutional neural network detector. We introduce a quality metric to assess frame quality and predict image restoration success. Generative adversarial networks with carefully chosen regularization are finally used to restore corrupted frames. Our detector yields the highest mean average precision (mAP at 5% threshold) of 49.0 and the lowest computational time of 88 ms allowing for accurate real-time processing. Our restoration models for blind deblurring, saturation correction and inpainting demonstrate significant improvements over previous methods. On a set of 10 test videos we show that our approach preserves an average of 68.7% which is 25% more frames than that retained from the raw videos.Comment: 14 page

A roadmap for the clinical implementation of optical-imaging biomarkers

Clinical workflows for the non-invasive detection and characterization of disease states could benefit from optical-imaging biomarkers. In this Perspective, we discuss opportunities and challenges towards the clinical implementation of optical-imaging biomarkers for the early detection of cancer by analysing two case studies: the assessment of skin lesions in primary care, and the surveillance of patients with Barrett’s oesophagus in specialist care. We stress the importance of technical and biological validations and clinical-utility assessments, and the need to address implementation bottlenecks. In addition, we define a translational roadmap for the widespread clinical implementation of optical imaging-technologies

Today's Mistakes and Tomorrow's Wisdom in Endoscopic Imaging of Barrett's Esophagus

Background: Esophageal adenocarcinoma (EAC) is one of the main causes of cancer-related deaths worldwide and its incidence is rising. Barrett's esophagus (BE) can develop low- and high-grade dysplasia which can progress to EAC overtime. The golden standard to detect dysplastic BE (DBE) or EAC is surveillance with high-definition white-light endoscopy (HD-WLE) and random biopsies according to the Seattle protocol. However, this method is time-consuming and associated with a remarkable miss rate. Therefore, there is great need for the development of novel reliable techniques to optimize surveillance strategies and improve detection rates.Summary: Optical chromoendoscopy (OC) techniques like narrow-band imaging have shown improved detection of DBE and EAC compared to HD-WLE and random biopsies. Most recent OC techniques, including the iSCAN optical enhancement system and linked color imaging, showed improved characterization of DBE and EAC retrospectively. Fluorescence molecular endoscopy (FME) presented promising results to highlight DBE and EAC. Moreover, with the establishment of well-performing delineation computer-aided detection (CAD) algorithms and the first real-time CAD system for EAC, we expect clinical application of CAD in the near future.Key Messages: Despite impressive progress made in the development of advanced endoscopic techniques, combined HD-WLE/OC followed by random biopsies remains the golden standard for BE surveillance. Surveillance depends on appropriate mucosal cleansing, sufficient inspection time, and competence of the performing gastroenterologist to improve detection of EAC. In addition, to facilitate the clinical implementation of advanced endoscopic techniques, multicenter prospective clinical studies are demanded for OC and FME. Meanwhile, further optimization of CAD algorithms, the education of gastroenterologists, and analysis of the interaction between the clinician and the computer should be performed.</p

Technical Evolution of Medical Endoscopy

This paper gives a summary of the technical evolution of medical endoscopy. The first documented redirection of sunlight into the human body dates back to the 16th century. Rigid tubes with candle light were given a trial later on. Low light intensity forced the development of alternative light sources. Some of these experiments included burning chemical components. Electric lighting finally solved the problems of heat production and smoke. Flexible endoscopy increased the range of medical examinations as it allowed access to tight and angular body cavities. The first cameras for endoscopic applications made taking photos from inside the human body possible. Later on, digital video endoscopy made endoscopes easier to use and allowed multiple spectators to observe the endoscopic intervention. Swallowable capsules called pill-cams made endoscopic examinations of the small intestine possible. Modern technologies like narrow band imaging and fluorescence endoscopy increased the diagnostic significance of endoscopic images. Today, image processing is applied to decrease noise and enhance image quality. These enhancements have made medical endoscopy an invaluable tool in many diagnostic processes. In closing, an example is given of an interdisciplinary examination, which is taken from the archaeological field.