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New Horizons in Urology with Cystoscopic Photography
THE JOURNAL O.F UROLOGY
Vol. 81, No. 6, June 1959 Pri:nted ~·n U.S.A.
NEW HORIZOKS I.'.'J UROLOGY WITH CYSTOSCOPIC PHOTOGRAPHY LOWRAIN E. McCREA The vista of possibilities of present day intravesical endoscopic photography is such, that as time goes on, more and more artist's depictions of the normal and the pathological lesions of the bladder and the posterior urethra will be replaced by actual photographs. It is believed that in the not too distant future a greater number of urologists, not only those associated with teaching institutions hut also those in private prn.ctice, will recognize the potentialities of this type of procedure for both teaching demonstration and record purposes, together with illustrations for articles and textbooks. It is the intent of this presentation to proffer the most recent personal achievements in research of the cystoscopic camera utilizing four different of lens systems. In 1940, it was my privilege to present to the profession a cystoscopic ramera restricted to black and white photographs. Two years later an endoscopic camera was introduced capable of obtaining photographs in both black and white and in color. However, although efficient to a degree, this camera was only adequate to acquire ,::olor photographs using time exposure. Pursuant to many years of systematic study and investigation by competent lighting research engineers, it was found impossible to attain sufficient brilliance with an electric bulb of low wattage of such size to be introduced into the bladder to permit instantaneous photographic exposure in color. Realizing the limitations of the incandescent lamp of low voltage for intravesical photography, the field of indirect lighting by quartz rod, as introduced by the French investigators, was explored. Quartz rod light transmission, in its present form, was introduced Fourestier, Gladu and Vulmiere (1952) for endobronchoscopic pho-· tography and was later applied to intravesical photography by .Jaupitrie (1956). Working in full collaboration with the French investigators, research on quartz rod light transmission as applied to intravesical photography was under-
taken.* As a result of substantiating the value of light transmission by quartz rod technique, camera equipment utilizing such principles was presented in 2\Iarch 1957. The equipment for intrnvesical photography i~ composed of several units, each an integral part in the function and operation of the instrument. Control cabinet: The control cabinet contains a transformer to reduce the line voltage to the filament requirements of the lamp, togr.thcr with a motor driven blower of high velocity and a capacity to cool the lamp. The primary and secondary windings of the~ transformer are isolated from each other by 2500 volt insulation so that only the very low voltage is delivered to the lamp. On the front panrl of the cabinet is 11 meter indicating the voltage being applied to the filament, a rheostat to control the filament voltage in gradual steps, a pilot light and a control switch. It is only through the control cabinet that constant voltage is maintained for illumination. Illumination: Intravesical illumination IS derived from an air-cooled 60 watt, 8 to l I volt tungsten filament lamp and is transmitted by a 4uartz rod 2.9 millimeters in diameter. The rod is mounted and scaled within a nickel tubing for its protection. The quartz rods used in cystoscopic work vary in length but generally are 21 cm. long. The distal end of the quart:,; rods arc ground and polished and placed at au angle to deflect the light rays as to interned the field of vision. Howewr, with th(~ right, angle and retrospective telescopes, lnrnek and prisms are used to aid in directing the light beam. The lamp is housed within a "luminntor" or light housing whicb also contains a heat absorbing glass filter, a pair of asphcric condensing lenses and a spherical concave mirror The heat absorbing glass filters out a portion of the infra-red rays, to proclucP a cooler beam of light. The mirror and lenses concc,ntratc the filament image upon reflecting surfaces of a right angle prism that bends and projects the
Read at annual meeting of Mid-Atlantic Section of American Urological Association, Inc., Richmond, Va., October 1-4, 1958.
* This research together with the final ment was supplied by Mr. Henry Pilling George P. Pilling Co., Philadelphia.
795
796
LOWRAIN E. McCREA
beam of light into the polished encl of a quartz rod. Light of intensity and color temperature that is well above 3200 Kelvin is delivered, which range is best suited for color reproduction (fig. 1). Telescopes: Four telescopes are available for intravesical photography: a direct forward, a forward oblique, a right angle and a retrospective. Although each lens performs a different function, each is properly adapted to the "luminator." In general, the optical systems used in intravcsical photography are 3 mm. in diameter
and 25 cm. long. Each optical system is color corrected and adjusted to sharp focus for the various distances encountered in cystoscopic photographic proc:cdures (fig. 2). Camera: Any camera with an F.3.5 lens or better may be adapted to the intravesical photographic equipment. The camera routinely employed is the Robot Royal for both color and black and white transparencies. The Robot being equipped with an automatic advancing mechanism, moves the film forward following
:~tr- -~l! VIEWING SCOPE
FILM
1·
I
a~,
BLADDER WALL CYSTOSCOPE
QUARTZ
I
ROD
PRISM
- - - - - _J CAMERA
=====::::i ILLUMINATOR
~
HEAT ABSORBING GLASS
CONDENSING LENS
~ FIG. 1. Schematic drawing of principles of McCrea cystoscopic photographic system
TELE.
TELE.
~~~~~-~- -
•,"."
,01' WARD
\\
\
TELE.
/1
;, ti /
\/\
RIGHT ANGLE
fO~WARD
• ~
OBLIQUE
"
' ~ °"';-
ii
"'· I\
TELE.
~-...\
\
'~
RETROSPECTIVE
FIG. 2. Four systems of lenses for complete visualization, as used with McCrea cystoscopic photographic equipment.
CYSTOSCOPlC PHOTOGRAPHY
797
B
Fm. :1. Photographs of hlaclder and prost,atic urethra using cystoscopic camera of recent de,sign, Comparative value bct,rnen eolor photographs in relatiou to black an
1'ach exposme, thereb>· permitting multiple serial photographs to be taken \Yithout stopping; to advance the film b>· hand. An optical reflex has )wen so arranged tlrnt \"isualization of the photog;rnphic field i~ possible until tlw actual exposure is completed. The Camex reflex used for 8 mm. movie s('rials is a through the lens n'flex camera which permits visualization of the photographic field constantly during actual photographic rxposures. Both of the ahoYe mc11tio11ed cameras are adapted to eaeh of the indiYidual, interchangeable lens systems. Films: The films emplo:-·ed for intrnvesical photography have been of scvnal Yarieties. For color transparencies, ;35 mm. Super Anscochrome (135) or Kodachrome Profossional film (KA 1:15) may he employed. Both films function excellently hut at different shutter speeds. Satisfactory color photographs may be obtained \Yith the Anscochrome film which has an exposme index of 100
\\·ith an exposure of )f, to ~/10 ,;ecornl. Hm1exer, exposmes \Yith Kodachrorm, professional film. which has an exposure index of 12 for tung;st· lw used. This film permits an expos\ll"l: of ){ 0 to !:2 5 second. Panc·hrnmntic Triple (TX 135) ;35 mm. film may also be used. This film has a tungsten rating of WO and n'quire:s an C'Xposure of Vi scconcl. Either film will prorh1ce excrllent results (fig. :3). The moYie film utilized is Kodachrome, type A (KA 459) with an emulsion speecl of 10. Tht: best results are obtainer! with the camera opernting at 9 frames per srcond. The horizons of application arC' limitlt>,;s for
798
LOWRAIN E. McCREA
this versatile, endoscopic equipment. The 7 mm. photographs, both in black and white or in color, are sharply depicted, the color values are excellent and reproduce with exceptional brilliance. These photographs become of inestimable value in the teaching of students or the presentation of case reports by lantern demonstration, in the portrayal of the normal appearance or of pathological lesions of the bladder. The accumulation of photographic records of intravesical lesions before, during, or following treatment cannot be considered lightly and without value. Since the beginning of medical history there have been many rare and unusual lesions completely lost to science because of the lack of
proper equipment to actually depict them before they had been removed or destroyed. Possibly the greatest value of these photographs is their reproduction in text-book illustration. A full appraisal of the worth of serial photographs and/or movie sequences of the bladder and posterior urethra by urologists has yet to be made. It is believed by the author that the ultimate appreciation of the actual value of endoscopic intravesical photography, with its limitless possibilities, will do much to stimulate the accession of such equipment to urological armamentarium. 1930 Chestnut St., Philadelphia 3, Pa.
Vol. 81, No. 6, June 1959 Pri:nted ~·n U.S.A.
NEW HORIZOKS I.'.'J UROLOGY WITH CYSTOSCOPIC PHOTOGRAPHY LOWRAIN E. McCREA The vista of possibilities of present day intravesical endoscopic photography is such, that as time goes on, more and more artist's depictions of the normal and the pathological lesions of the bladder and the posterior urethra will be replaced by actual photographs. It is believed that in the not too distant future a greater number of urologists, not only those associated with teaching institutions hut also those in private prn.ctice, will recognize the potentialities of this type of procedure for both teaching demonstration and record purposes, together with illustrations for articles and textbooks. It is the intent of this presentation to proffer the most recent personal achievements in research of the cystoscopic camera utilizing four different of lens systems. In 1940, it was my privilege to present to the profession a cystoscopic ramera restricted to black and white photographs. Two years later an endoscopic camera was introduced capable of obtaining photographs in both black and white and in color. However, although efficient to a degree, this camera was only adequate to acquire ,::olor photographs using time exposure. Pursuant to many years of systematic study and investigation by competent lighting research engineers, it was found impossible to attain sufficient brilliance with an electric bulb of low wattage of such size to be introduced into the bladder to permit instantaneous photographic exposure in color. Realizing the limitations of the incandescent lamp of low voltage for intravesical photography, the field of indirect lighting by quartz rod, as introduced by the French investigators, was explored. Quartz rod light transmission, in its present form, was introduced Fourestier, Gladu and Vulmiere (1952) for endobronchoscopic pho-· tography and was later applied to intravesical photography by .Jaupitrie (1956). Working in full collaboration with the French investigators, research on quartz rod light transmission as applied to intravesical photography was under-
taken.* As a result of substantiating the value of light transmission by quartz rod technique, camera equipment utilizing such principles was presented in 2\Iarch 1957. The equipment for intrnvesical photography i~ composed of several units, each an integral part in the function and operation of the instrument. Control cabinet: The control cabinet contains a transformer to reduce the line voltage to the filament requirements of the lamp, togr.thcr with a motor driven blower of high velocity and a capacity to cool the lamp. The primary and secondary windings of the~ transformer are isolated from each other by 2500 volt insulation so that only the very low voltage is delivered to the lamp. On the front panrl of the cabinet is 11 meter indicating the voltage being applied to the filament, a rheostat to control the filament voltage in gradual steps, a pilot light and a control switch. It is only through the control cabinet that constant voltage is maintained for illumination. Illumination: Intravesical illumination IS derived from an air-cooled 60 watt, 8 to l I volt tungsten filament lamp and is transmitted by a 4uartz rod 2.9 millimeters in diameter. The rod is mounted and scaled within a nickel tubing for its protection. The quartz rods used in cystoscopic work vary in length but generally are 21 cm. long. The distal end of the quart:,; rods arc ground and polished and placed at au angle to deflect the light rays as to interned the field of vision. Howewr, with th(~ right, angle and retrospective telescopes, lnrnek and prisms are used to aid in directing the light beam. The lamp is housed within a "luminntor" or light housing whicb also contains a heat absorbing glass filter, a pair of asphcric condensing lenses and a spherical concave mirror The heat absorbing glass filters out a portion of the infra-red rays, to proclucP a cooler beam of light. The mirror and lenses concc,ntratc the filament image upon reflecting surfaces of a right angle prism that bends and projects the
Read at annual meeting of Mid-Atlantic Section of American Urological Association, Inc., Richmond, Va., October 1-4, 1958.
* This research together with the final ment was supplied by Mr. Henry Pilling George P. Pilling Co., Philadelphia.
795
796
LOWRAIN E. McCREA
beam of light into the polished encl of a quartz rod. Light of intensity and color temperature that is well above 3200 Kelvin is delivered, which range is best suited for color reproduction (fig. 1). Telescopes: Four telescopes are available for intravesical photography: a direct forward, a forward oblique, a right angle and a retrospective. Although each lens performs a different function, each is properly adapted to the "luminator." In general, the optical systems used in intravcsical photography are 3 mm. in diameter
and 25 cm. long. Each optical system is color corrected and adjusted to sharp focus for the various distances encountered in cystoscopic photographic proc:cdures (fig. 2). Camera: Any camera with an F.3.5 lens or better may be adapted to the intravesical photographic equipment. The camera routinely employed is the Robot Royal for both color and black and white transparencies. The Robot being equipped with an automatic advancing mechanism, moves the film forward following
:~tr- -~l! VIEWING SCOPE
FILM
1·
I
a~,
BLADDER WALL CYSTOSCOPE
QUARTZ
I
ROD
PRISM
- - - - - _J CAMERA
=====::::i ILLUMINATOR
~
HEAT ABSORBING GLASS
CONDENSING LENS
~ FIG. 1. Schematic drawing of principles of McCrea cystoscopic photographic system
TELE.
TELE.
~~~~~-~- -
•,"."
,01' WARD
\\
\
TELE.
/1
;, ti /
\/\
RIGHT ANGLE
fO~WARD
• ~
OBLIQUE
"
' ~ °"';-
ii
"'· I\
TELE.
~-...\
\
'~
RETROSPECTIVE
FIG. 2. Four systems of lenses for complete visualization, as used with McCrea cystoscopic photographic equipment.
CYSTOSCOPlC PHOTOGRAPHY
797
B
Fm. :1. Photographs of hlaclder and prost,atic urethra using cystoscopic camera of recent de,sign, Comparative value bct,rnen eolor photographs in relatiou to black an
1'ach exposme, thereb>· permitting multiple serial photographs to be taken \Yithout stopping; to advance the film b>· hand. An optical reflex has )wen so arranged tlrnt \"isualization of the photog;rnphic field i~ possible until tlw actual exposure is completed. The Camex reflex used for 8 mm. movie s('rials is a through the lens n'flex camera which permits visualization of the photographic field constantly during actual photographic rxposures. Both of the ahoYe mc11tio11ed cameras are adapted to eaeh of the indiYidual, interchangeable lens systems. Films: The films emplo:-·ed for intrnvesical photography have been of scvnal Yarieties. For color transparencies, ;35 mm. Super Anscochrome (135) or Kodachrome Profossional film (KA 1:15) may he employed. Both films function excellently hut at different shutter speeds. Satisfactory color photographs may be obtained \Yith the Anscochrome film which has an exposme index of 100
\\·ith an exposure of )f, to ~/10 ,;ecornl. Hm1exer, exposmes \Yith Kodachrorm, professional film. which has an exposure index of 12 for tung;st
798
LOWRAIN E. McCREA
this versatile, endoscopic equipment. The 7 mm. photographs, both in black and white or in color, are sharply depicted, the color values are excellent and reproduce with exceptional brilliance. These photographs become of inestimable value in the teaching of students or the presentation of case reports by lantern demonstration, in the portrayal of the normal appearance or of pathological lesions of the bladder. The accumulation of photographic records of intravesical lesions before, during, or following treatment cannot be considered lightly and without value. Since the beginning of medical history there have been many rare and unusual lesions completely lost to science because of the lack of
proper equipment to actually depict them before they had been removed or destroyed. Possibly the greatest value of these photographs is their reproduction in text-book illustration. A full appraisal of the worth of serial photographs and/or movie sequences of the bladder and posterior urethra by urologists has yet to be made. It is believed by the author that the ultimate appreciation of the actual value of endoscopic intravesical photography, with its limitless possibilities, will do much to stimulate the accession of such equipment to urological armamentarium. 1930 Chestnut St., Philadelphia 3, Pa.