NURSING AND CYSTOSCOPIC PHOTOGRAPHY Harold
H. Tara, M.D.
Endoscopic photography is the photographic documentation of such human cavities as the stomach, the bladder, etc., which can be visualized by means of the endoscope. Great advances have been made in this process in the past decade because of the overwhelming interest in documenting lesions seen by means of the instrument. Development of improved instruments and more sensitive film has also been a great asset in refining the techniques of endoscopic photography. Each kind of endoscopic photography deals with some common and some specific criteria which are necessary to obtain good photographic results. In urology, endoscopic photography is called, more specifically, cystoscopic photography. Cystoscopic photography deals with the photographic documentation of the bladder as well as the entire urethra. The instruments employed in this work should be of modest size, but of course, equipment will vary with the age and sex of the patient. In an adult male, an instrument larger than a 26 French size is not recommended. The urethra of some individuals may accept the 28F. with ease after preliminary urethral dilation. A male patient with a urethral stricture or stenotic urethra is not a good candidate for cystoscopic photography. In the adult female, an instrument of 28 to 32 F. size could be used after preliminary
urethral dilation. In older female children after preliminary urethral dilation, a 26 F. instrument may be used, while in the male child, a much smaller instrument should be used. In general, the small caliber instrument is preferable to a larger one if the same photographic results can be obtained. Equipment utilized in cystoscopic photog raphy includes the cysto-urethroscope, a light source, a light carrier, the camera, film, an adapter, and irrigating fluid.
CYSTO-URETHROSCOPE Each cystoscope or cysto-urethroscope incorporates a telescope for visualization, a light element for illumination, and an irrigating fluid channel. The conventional cystoscope has a light bulb at the end and receives electric current through the wiring in its shaft. For cystoscopic photography, a larger bulb and more intense current is necessary to provide maximum light intensity. The telescope is a combination of numerous small lenses placed in sequence, making it possible for the operator to visualize the interior of the urinary bladder and urethra. For greater light intensity, the conventional light system of the cystoscope has been replaced by the Fiber-optic system in recent years. The Fiber-optic bundles are fiber bundles which transport light rays fed by an Harold H. Tarn, M.D., Department of Urology at outside light source. The Fiber-optic system Columbia University, College of Physicians and has two main photographic advantages over Surgeons, discussed photography in Urology, the the conventional light cystoscope: (1) By scientific study of the urine and urinary tract, as a increasing the light intensity outside of the participant on WNBC-TV’s “Research Project.”
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patient, it enables us to have sufficient light for photography. (2) A minimum amount of heat is produced at the site of the projection of light.
LIGHT SOURCE Several models of the Fiber-optic source are being made with basic differences in light intensity. FCB-100 is one of those most commonly used. Additional light intensity can be obtained from this light source upon request to manufacturer. The Fiber-optic light source with the highest intensity is the FCB-1000 model. The most advanced system available for highintensity white-light generation, it contains two lamps, including an incandescent lamp for routine work, similar to the FCB-75, FCB-100, FCB-150 units. The other lamp is a new avc lamp designed for photographic purposes. The intensity generated at the input face of the connected fiber bundles is 300 to 500 per cent greater than that of an incandescent lamp. At the end of a standard 6 foot 5 mm. fiber bundle, 40,000 foot candles are emitted. Even more beneficial for photographic work is the far higher color temperature of 5000 degrees K which permits better color film balance. The conventional light source for cystoscopy is a 6 volt DC current generated from a dry battery or AC-DC transformer. Acting as a light carrier from power source to cystoscope for a conventional light source is a cord of plain lamp wire. The Fiber-optic light carrier is 3 mm or 5 mm in diameter and 36 to 72 inches long. The 5mm diameter is especially recommended for photography.
STILL CAMERA Any reflex camera with a clear prism can be used for endoscopic photography. The lens of camera need not be any faster than f:3.5. Faster lenses are more expensive and do not allow the passage of any more light than less expensive lenses. The lens opening necessary
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to permit maximum light is f5.6 or lower. We recommend the full opening of the diaphragm for practical purposes. The shutter speed of the camera will vary with the light intensity, the type of lens and the sensitivity of the film. We used Exakta Camera from 1960 to 1965. This camera was chosen because it has a shutter speed from 1/1000 seconds to 12 seconds. However, with the development of Fiber-optic cystoscope, a shutter speed of 1/15 to 1/30 of a second gave a satisfactory photograph. In the last three years, I have been using Olympus Pen-F. This is the most compact 35 mm camera recommended. It is a 1/2 frame type 35mm camera. Although reflex cameras can be used satisfactorily, clear or nearly clear prism is necessary.
MOVIE CAMERA Until recently we have used 8mm movie camera for endoscopic photography. The camera should be a reflex type. It is compact and much easier to handle. The 8mm film can be enlarged to 16mm for projection in a larger room. We have used the Camex Camera, but any available reflex camera can be used. Again, a clear prism is necessary for ease of visualization. The lens opening is full, the distance, to be set at infinity. Using high-speed Ektachrome film, Fiber-optic cystoscope, and speed of 16 frames per second, one may obtain a satisfactory photograph.
A 16mm camera produces a much larger photograph frame with better details for projection in the large auditorium. However, for routine use, it is very bulky. The Beauliev 16mm is recommended.
FILM High speed Ektachrome with ASA 125 indoor type is to be used with conventional light source, FCB-75, FCB-100 and FCB-150. Daylight type should be used with the FCB1000 light source.
AORN Journal
Endoscopic photography reveals (upper left) Moderate cystitis; (upper right) Prostatic hypertrophy with complete obstruction (note lateral lobes) ; (middle left) Bladder tumor; (middle right) Severe cystitis; (lower left) Middle prostatic hypertrophy; (lower right) Bladder calculus.
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SUMMARY: ADAPTER The eye-piece of the cystoscope should be The cystoscopy nurse should be familiar with adapted to the camera lens to prevent entrance the technic of photography in order to save of outside light into the photographic com- time and facilitate the procedure. The following points are important: ponent. 1) Proper care of the cystoscope, particularly, cleaning the lens system. IRRIGATING FLUID Irrigating fluid should be clear, isotonic 2) Checking cystoscope parts prior to solution. The conventional fluids used for photography. transurethral resection or cystoscopic proce3) Checking the light source and always dures is satisfactory. Care must be taken to having an extra bulb available. pass no air into the bladder; air bubbles 4) If photography is scheduled with other interfere with the photography. urological procedures, the photographic inContraindications for doing endoscopic struments should be prepared on a separate photography are the following: urethral table. After photography, a complete change stricture; bleeding from the kidney, ureter, of gown and gloves is recommended. 5 ) Sufficient irrigating fluid. bladder or urethra; severe to moderate urinary infection; urethritis and a poor 6) An extra roll of film. 7) Properly documented photography. general condition.
AORN J O U R N A L WRITER'S A W A R D S If you are interested in writing, feel you have the necessary ability and meet the eligibility requirements, I/OU are encouraged to submit your manuscript for consideration as a winner o f a 1970 A O R N J o u r a l Writer's Award. Three awards will be presented, two to operating room nurses and one to a student in an accredited school o f nursing. T h e purpose o f the O R nurse award is to recognize writing ability among O R nurses and to encourage OR nurses to share experiences and information through writing. T h e purpose o f the student award is to promote O R nursing among students and motivate them to think and write about this specialty. Articles will be chosen for content, clarity of thought and presentation, individuality and originality. All articles submitted by O R nurses in 1969 will be eligible. Manuscripts will be judged bI/ a panel o f editors. Winners will be announced at the 1970 Congress. T o be eligible for an Award, a manuscript must be written either b y a registered, professional O R nurse who is a member of A O R N , or a student nurse who is enrolled in an accredited school of professional nursing. All manuscripts contributed must adhere to the following guidelines : a ) They must be on subjects of professional interest to O R nurses. b ) They must follow the suggestions appearing on page five o f every issue under General Information. Every operating room nurse entrant and every student nurse entrant during 1969 will be considered.
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A O R N Journal