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A New Apparatus for Cystoscopic Photography with Interchangeable Lens Groups: Available for Endocinematography and Endotelevisionoscopy
Vol. 109, May Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1973 by The Williams & Wilkins Co.
A NEW APPARATUS FOR CYSTOSCOPIC PHOTOGRAPHY WITH INTERCHANGEABLE LENS GROUPS: AVAILABLE FOR ENDOCINEMATOGRAPHY AND ENDOTELEVISIONOSCOPY ROKURO KOIKE* From the Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
Cystoscopic photography was one of the earliest photoendoscopic techniques. It was attempted by Nitze in 1879. 1 In recent years photoendoscopy has made remarkable progress in other fields and the development of glass fibers has made photography of the deeper body cavities possible. In the photocystoscope, glass fibers were introduced and used in fiberoptics. 2 A small light bulb is no longer attached to the tip of a conventional cystoscope. In fiberoptics the light shines on the inside of glass fibers at a 30-degree angle with constant reflection, so that enlargement is accomplished up to 60 degrees at the tip. The light at the center is intense but the light in the periphery is weak. This is a drawback. When a lens is used to enlarge the angle of illumination, the lighted area may be enlarged but, since the amount of light is limited by the diameter of the cystoscope, photography becomes impossible. About 10 years ago the electronic flash bulb was introduced in photocystoscopy. When this is attached at the tip of the scope, an extremely distinct picture is obtained with a very short exposure time (1/800 second). However, the electronic flash bulb requires a 3 to 4-second recovery period which makes serial pictures impossible. 3 In addition, the use of high voltage (500 volts) within the body constitutes another drawback. Therefore, we have used a small electric bulb with an improved tungsten filament as a light source. Interchangeable lens groups have been developed, thus allowing ultrawide angle photography and photography through magnification at a short distance. This technique can be applied to endocinematography and endotelevisionoscopy. The apparatus is described herein.
small electric bulb is attached containing 2 tungsten filaments, one for photography and the other for observation. Five volts are applied to 1 filament during observation of the bladder. At the time of photography the voltage increases automatically in the range of 9 to 30 volts to be applied to the photographic filament. An Asahi Pentax SL Body is used as the photographic apparatus. The viewfinder is made transparent to allow clear observation of the bladder mucosa. This is connected with the cystoscope via an attachment. The diameter of the image on the film is as large as 20 mm., allowing either direct interpretation or distinct pictures for printing. Ektachrome high speed film, tungsten type EHB 135 (ASA 125), with 30 volts, 1/15 to 1/4 second exposure, produces good photographs when the film is developed 2 minutes more than normal at 29.5C. (This processing is similar to giving the film 4 times its normal emulsion speed, that is ASA 500.) The conditions for photography vary according to the nature of the illuminating light (direct, indirect or transillumination), the distance to the object and the color of the object. At the time of photography, the left elbow should be steadied by an elbow support or a monopod should be used to avoid blurring of the picture at this slow speed. In addition to the standard lens with a viewing angle of 60 degrees in the air, the following lenses are available: 1) a lens for magnification at a short distance with a viewing angle of 30 degrees, 2) 3 wide-angle lenses with viewing angles of 90, 120 and 140 degrees and 3) lenses with a viewing angle of 52 degrees and a directional angle of 120 degrees and 60 degrees (foroblique angle and backoblique angle) (fig. 1).
APPARATust AND TECHNIQUE
The cystoscope is divided into 2 parts, that is an outer sheath at a diameter of 21.5Fr and the inner endoscope of 18Fr. At the tip of the former a Accepted for publication September 22, 1972. * Current address: Department of Urology, Kyorin University School of Medicine, 6-20-2, i:,hinkawa, Mitaka-shi, Tokyo, 181, Japan. 1 Reuter, H. J .: Urological photo-, film- and television endoscopy. Urologe, 2: 187, 1963. 2 Sokeland, J.: Glasfiberlicht- und Bildubertragungsysteme in der Urologie. Urologe, 3: 330, 1964. 3 Bauer, K. M.: Cystoscopic Diagnosis, 1st ed. Philadelphia: Lea & Febiger, p. 34, 1969. t Manufactured in cooperation with Yushin Medical Endoscope Co., Ltd., 2-56-2, Shinmachi, Fuchu-shi, Tokyo, 183, Japan.
DISCCSSlON
Three types of illumination for cystoscopic photography have been used: 1) attachment of a small electronic flash bulb at the tip of the cystoscope, 2) a model in which the electronic flash bulb, the halogen or xenon light source is used outside the patient's body and the light is led into the inside of the bladder via glass fibers and 3) a type in which a small electric bulb is attached at the tip of the cystoscope and high voltage is applied only at the time of photography. These methods have some drawbacks. With the use of the first type, a 500-volt current runs
884
885
NEW APPARATUS FOR CYSTOSCOPIC PHOTOGRAPHY
Standard I ens Viewing angle Directional angle
60° 90°
Viewing angle Directional angle
30° 90°
Viewing angle Directional angle
90° 90°
Lens for magnification ~
11 mm
Wide angle lens
order to change the electric bulb when the small bulb burns out. This problem has become almost obsolete with recent progress in the manufacture of electric bulbs. This method is superior because it permits a large angle for illumination and free adjustment of exposure time with a camera. Therefore, we have adopted the third method of illumination and have placed 2 filaments (one for observation and the other for photography) within the small electric bulb to avoid a rise of temperature inside the bladder at the time of observation. A 5-volt tungsten filament is used for observation and a 12-volt filament for photography. The 12volt filament which formerly broke with the application of 22 volts was improved recently so that even the application of 30 volts scarcely breaks it.
Wide angle lens a)
angle 12 0° Viewing Directional angle 90°
angle 140° Viewing Directional angle 90°
underexposure
Foroblique angle lens
3 mm
angle 52° Viewing Directional angle 120°
b)
Backobl ique angle lens 30mm angle Viewing Directional angle
52° 60°
FIG. 1. Statistics indicate angle in air, while actual angle of figure shows angle in water. Lens with viewing angle of 140 degrees has viewing angle of 120 degrees in water.
through the body of the patient for a short time and a 3 to 4-second recovery time makes serial pictures impossible. With the use of the second type, the diameter of the cystoscope is restricted so that sufficient light for exposure and a picture large enough for observation on the film cannot be obtained. Moreover, a sufficient distance cannot be kept between the gate of illumination and the lens opening, so that it is impossible to obtain stereoscopic photographs because of difficulty in forming a shadow of the object. Furthermore, the light for exposure of some parts of the bladder becomes inadequate whenever the distance to the object is a little more or less than the adequate phase of fiberoptics, as shown in figure 2. Moreover, the difference in the intensity of light between the central and peripheral parts of the picture becomes quite pronounced. With the third model the greatest drawback is the inevitable extraction of the cystoscope from the bladder in
FIG. 2. a, illuminating angle and view angle of fiberoptics (illuminating angle is about 60 degrees). b, illuminating angle and viewing angle of electric bulb (illuminating angle is more than 140 degrees).
FIG. 3. Ureteral catheterization. It is possible to view both ureteral orifices in single field.
886
KOIKE
In order to increase the brightness further a 9-volt current is run through the observation filament at the time of photography. The use of such an improved electric bulb and high speed tungsten type Ektachrome film (EHB 135) (with effective emulsion speed of ASA 500) makes shutter time as short as ½s second even when the diameter of the image is as large as 20 mm. The greatest advantage of this apparatus for photography is the use of 7 interchangeable lenses. Among them, an ultrawide angle lens of 140 degrees makes it possible to view both ureteral orifices (fig. 3) or a hen's egg-sized tumor in one field (fig. 4). Air bubbles and the trigonal area may also be seen with the object in the one field so that their positional relationship within the bladder can be made more distinct. The spherical aberration that was feared has not been too conspicuous since the bladder surface itself is spherical. Thus, the photographs obtained are very easy to interpret. Connection of this apparatus to the body of a
Beaulieu endoscopic R16 turret camera via an attachment allows cinematography of 16 m/m at 18 to 24 volts, 24 frames per second. When it is connected to Toshiba's tele-endoscope (simultaneous type) via an attachment, a distinct television color picture can be obtained at 22 to 30 volts (with the use of a 23Fr outer sheath). SUMMARY
With this new apparatus for cystoscopic photography, a small electric bulb is attached at the tip of the cystoscope and high voltage is applied only at the time of photography. This method is superior because it permits a large angle for illumination and free adjustment of exposure time with a camera. Thus, the use of 7 interchangeable lenses (the standard lens with a viewing angle of 60 degrees, a lens for magnification at a short distance with a viewing angle of 30 degrees, 3 wide-angle lenses with viewing angles of 90, 120 and 140 degrees and lenses with a viewing angle of 52 degrees and di-
FIG. 4. A, hen's egg-sized tumor above right ureteral orifice. B, cystogram of hen's egg-sized tumor
NEW APPARATUS FOR CYSTOSCOPIC PHOTOGRAPHY
rectional angles of 120 degrees and 60 degreesforoblique angle and backoblique angle) is possible. Among them, the ultrawide 140-degree angle lens makes it possible to view both ureteral orifices or a hen's egg-sized tumor in one field. Air bubbles and the trigonal area may also be seen with the object in a single field and thus the positional relationship within the bladder can be made more distinct. Since a considerable distance is maintained between the small electric bulb and the lens, a shadow of the object is readily formed and stereoscopic photography is possible. Furthermore, there is little difference between
887
illumination in the central and in the peripheral parts of the picture. The use of an improved electric bulb and high .speed tungsten type Ektachrome film (EHB 135) (with effective emulsion speed of ASA 500) makes it possible to photograph at ½5 second even when the diameter of the image on the film is as large as 20 mm. This cystoscope is easily connected to a Beaulieu endoscopic R16 turret camera for 16 m/m cinematography. By using another attachment, it can be connected to Toshiba's tele-endoscope (simultaneous type) to obtain a clear color television picture.
THE JOURNAL OF UROLOGY
Copyright © 1973 by The Williams & Wilkins Co.
A NEW APPARATUS FOR CYSTOSCOPIC PHOTOGRAPHY WITH INTERCHANGEABLE LENS GROUPS: AVAILABLE FOR ENDOCINEMATOGRAPHY AND ENDOTELEVISIONOSCOPY ROKURO KOIKE* From the Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
Cystoscopic photography was one of the earliest photoendoscopic techniques. It was attempted by Nitze in 1879. 1 In recent years photoendoscopy has made remarkable progress in other fields and the development of glass fibers has made photography of the deeper body cavities possible. In the photocystoscope, glass fibers were introduced and used in fiberoptics. 2 A small light bulb is no longer attached to the tip of a conventional cystoscope. In fiberoptics the light shines on the inside of glass fibers at a 30-degree angle with constant reflection, so that enlargement is accomplished up to 60 degrees at the tip. The light at the center is intense but the light in the periphery is weak. This is a drawback. When a lens is used to enlarge the angle of illumination, the lighted area may be enlarged but, since the amount of light is limited by the diameter of the cystoscope, photography becomes impossible. About 10 years ago the electronic flash bulb was introduced in photocystoscopy. When this is attached at the tip of the scope, an extremely distinct picture is obtained with a very short exposure time (1/800 second). However, the electronic flash bulb requires a 3 to 4-second recovery period which makes serial pictures impossible. 3 In addition, the use of high voltage (500 volts) within the body constitutes another drawback. Therefore, we have used a small electric bulb with an improved tungsten filament as a light source. Interchangeable lens groups have been developed, thus allowing ultrawide angle photography and photography through magnification at a short distance. This technique can be applied to endocinematography and endotelevisionoscopy. The apparatus is described herein.
small electric bulb is attached containing 2 tungsten filaments, one for photography and the other for observation. Five volts are applied to 1 filament during observation of the bladder. At the time of photography the voltage increases automatically in the range of 9 to 30 volts to be applied to the photographic filament. An Asahi Pentax SL Body is used as the photographic apparatus. The viewfinder is made transparent to allow clear observation of the bladder mucosa. This is connected with the cystoscope via an attachment. The diameter of the image on the film is as large as 20 mm., allowing either direct interpretation or distinct pictures for printing. Ektachrome high speed film, tungsten type EHB 135 (ASA 125), with 30 volts, 1/15 to 1/4 second exposure, produces good photographs when the film is developed 2 minutes more than normal at 29.5C. (This processing is similar to giving the film 4 times its normal emulsion speed, that is ASA 500.) The conditions for photography vary according to the nature of the illuminating light (direct, indirect or transillumination), the distance to the object and the color of the object. At the time of photography, the left elbow should be steadied by an elbow support or a monopod should be used to avoid blurring of the picture at this slow speed. In addition to the standard lens with a viewing angle of 60 degrees in the air, the following lenses are available: 1) a lens for magnification at a short distance with a viewing angle of 30 degrees, 2) 3 wide-angle lenses with viewing angles of 90, 120 and 140 degrees and 3) lenses with a viewing angle of 52 degrees and a directional angle of 120 degrees and 60 degrees (foroblique angle and backoblique angle) (fig. 1).
APPARATust AND TECHNIQUE
The cystoscope is divided into 2 parts, that is an outer sheath at a diameter of 21.5Fr and the inner endoscope of 18Fr. At the tip of the former a Accepted for publication September 22, 1972. * Current address: Department of Urology, Kyorin University School of Medicine, 6-20-2, i:,hinkawa, Mitaka-shi, Tokyo, 181, Japan. 1 Reuter, H. J .: Urological photo-, film- and television endoscopy. Urologe, 2: 187, 1963. 2 Sokeland, J.: Glasfiberlicht- und Bildubertragungsysteme in der Urologie. Urologe, 3: 330, 1964. 3 Bauer, K. M.: Cystoscopic Diagnosis, 1st ed. Philadelphia: Lea & Febiger, p. 34, 1969. t Manufactured in cooperation with Yushin Medical Endoscope Co., Ltd., 2-56-2, Shinmachi, Fuchu-shi, Tokyo, 183, Japan.
DISCCSSlON
Three types of illumination for cystoscopic photography have been used: 1) attachment of a small electronic flash bulb at the tip of the cystoscope, 2) a model in which the electronic flash bulb, the halogen or xenon light source is used outside the patient's body and the light is led into the inside of the bladder via glass fibers and 3) a type in which a small electric bulb is attached at the tip of the cystoscope and high voltage is applied only at the time of photography. These methods have some drawbacks. With the use of the first type, a 500-volt current runs
884
885
NEW APPARATUS FOR CYSTOSCOPIC PHOTOGRAPHY
Standard I ens Viewing angle Directional angle
60° 90°
Viewing angle Directional angle
30° 90°
Viewing angle Directional angle
90° 90°
Lens for magnification ~
11 mm
Wide angle lens
order to change the electric bulb when the small bulb burns out. This problem has become almost obsolete with recent progress in the manufacture of electric bulbs. This method is superior because it permits a large angle for illumination and free adjustment of exposure time with a camera. Therefore, we have adopted the third method of illumination and have placed 2 filaments (one for observation and the other for photography) within the small electric bulb to avoid a rise of temperature inside the bladder at the time of observation. A 5-volt tungsten filament is used for observation and a 12-volt filament for photography. The 12volt filament which formerly broke with the application of 22 volts was improved recently so that even the application of 30 volts scarcely breaks it.
Wide angle lens a)
angle 12 0° Viewing Directional angle 90°
angle 140° Viewing Directional angle 90°
underexposure
Foroblique angle lens
3 mm
angle 52° Viewing Directional angle 120°
b)
Backobl ique angle lens 30mm angle Viewing Directional angle
52° 60°
FIG. 1. Statistics indicate angle in air, while actual angle of figure shows angle in water. Lens with viewing angle of 140 degrees has viewing angle of 120 degrees in water.
through the body of the patient for a short time and a 3 to 4-second recovery time makes serial pictures impossible. With the use of the second type, the diameter of the cystoscope is restricted so that sufficient light for exposure and a picture large enough for observation on the film cannot be obtained. Moreover, a sufficient distance cannot be kept between the gate of illumination and the lens opening, so that it is impossible to obtain stereoscopic photographs because of difficulty in forming a shadow of the object. Furthermore, the light for exposure of some parts of the bladder becomes inadequate whenever the distance to the object is a little more or less than the adequate phase of fiberoptics, as shown in figure 2. Moreover, the difference in the intensity of light between the central and peripheral parts of the picture becomes quite pronounced. With the third model the greatest drawback is the inevitable extraction of the cystoscope from the bladder in
FIG. 2. a, illuminating angle and view angle of fiberoptics (illuminating angle is about 60 degrees). b, illuminating angle and viewing angle of electric bulb (illuminating angle is more than 140 degrees).
FIG. 3. Ureteral catheterization. It is possible to view both ureteral orifices in single field.
886
KOIKE
In order to increase the brightness further a 9-volt current is run through the observation filament at the time of photography. The use of such an improved electric bulb and high speed tungsten type Ektachrome film (EHB 135) (with effective emulsion speed of ASA 500) makes shutter time as short as ½s second even when the diameter of the image is as large as 20 mm. The greatest advantage of this apparatus for photography is the use of 7 interchangeable lenses. Among them, an ultrawide angle lens of 140 degrees makes it possible to view both ureteral orifices (fig. 3) or a hen's egg-sized tumor in one field (fig. 4). Air bubbles and the trigonal area may also be seen with the object in the one field so that their positional relationship within the bladder can be made more distinct. The spherical aberration that was feared has not been too conspicuous since the bladder surface itself is spherical. Thus, the photographs obtained are very easy to interpret. Connection of this apparatus to the body of a
Beaulieu endoscopic R16 turret camera via an attachment allows cinematography of 16 m/m at 18 to 24 volts, 24 frames per second. When it is connected to Toshiba's tele-endoscope (simultaneous type) via an attachment, a distinct television color picture can be obtained at 22 to 30 volts (with the use of a 23Fr outer sheath). SUMMARY
With this new apparatus for cystoscopic photography, a small electric bulb is attached at the tip of the cystoscope and high voltage is applied only at the time of photography. This method is superior because it permits a large angle for illumination and free adjustment of exposure time with a camera. Thus, the use of 7 interchangeable lenses (the standard lens with a viewing angle of 60 degrees, a lens for magnification at a short distance with a viewing angle of 30 degrees, 3 wide-angle lenses with viewing angles of 90, 120 and 140 degrees and lenses with a viewing angle of 52 degrees and di-
FIG. 4. A, hen's egg-sized tumor above right ureteral orifice. B, cystogram of hen's egg-sized tumor
NEW APPARATUS FOR CYSTOSCOPIC PHOTOGRAPHY
rectional angles of 120 degrees and 60 degreesforoblique angle and backoblique angle) is possible. Among them, the ultrawide 140-degree angle lens makes it possible to view both ureteral orifices or a hen's egg-sized tumor in one field. Air bubbles and the trigonal area may also be seen with the object in a single field and thus the positional relationship within the bladder can be made more distinct. Since a considerable distance is maintained between the small electric bulb and the lens, a shadow of the object is readily formed and stereoscopic photography is possible. Furthermore, there is little difference between
887
illumination in the central and in the peripheral parts of the picture. The use of an improved electric bulb and high .speed tungsten type Ektachrome film (EHB 135) (with effective emulsion speed of ASA 500) makes it possible to photograph at ½5 second even when the diameter of the image on the film is as large as 20 mm. This cystoscope is easily connected to a Beaulieu endoscopic R16 turret camera for 16 m/m cinematography. By using another attachment, it can be connected to Toshiba's tele-endoscope (simultaneous type) to obtain a clear color television picture.