10.1117/2.1201103.003578 New approaches to bladder-surveillance endoscopy Timothy Soper, Michael Porter, and Eric Seibel An ultrathin scanning-fiber endoscope uses 3D digital reconstruction of endoscopic video for automated analysis. Bladder cancer is the fifth most common cancer in the United States 1 and has a 50% recurrence rate. Consequently, patients undergo frequent surveillance, where a flexible endoscope is inserted into the bladder to detect recurrent tumors. The exam can be uncomfortable, in part because of the large (5mm) de- vices currently employed. While use of smaller endoscopes is desirable, they suffer from reduced resolution and field of view, making examination and detection challenging. Additionally, bladder surveillance constitutes a significant percentage of urol- ogists’ time and resources, and is costly. While avenues for improved detection of bladder cancer—such as biomarkers, 2 flu- orescence imaging, 3 and narrow-band imaging 4 —are areas of current investigation, conventional endoscopy remains the gold standard. Limitations of current devices have spurred devel- opment of mosaicking systems that generate panoramic views of the bladder. Constructed from multiple overlapping images, mosaics provide expanded views and greater visual context for in situ detection and assessment of mucosal changes asso- ciated with carcinoma. However, the resulting panoramas are limited to localized regions of the bladder and are unable to generate full, sweeping 360 ı views. Here, we report our devel- opments toward automated surveillance that uses novel endo- scopic technology and image-analysis software to reconstruct full 3D panoramas of the bladder. 5 We developed an ultrathin scanning-fiber endoscope (SFE), whose small diameter (1.5mm) and superior imaging capabil- ities make it ideal for endoscopic surveillance (see Figure 1). 6 In addition to mitigating patient discomfort, we have con- figured the SFE with an automated tip-bending system that allows machine-controlled surveillance endoscopy. 7, 8 By em- ploying a spiral scan trajectory, we can image the entire internal surface (see Figure 2). This operationally simple system could potentially be performed by a nurse or technician, thus free- ing up the urologist’s time. In conjunction with these hardware Figure 1. Scanning-fiber endoscope image probe. Figure 2. Spiral scan trajectory used to image the entire internal blad- der surface. 5 advances, we developed post-processing software capable of converting endoscopic video into digital 3D models. By stitching endoscopic images onto a spherical surface, our models permit expedient review and interpretation of findings by the urologist. Continued on next page