Future and advances in endoscopy

Ionically assembled hemostatic powders with rapid self-gelation, strong acid resistance, and on-demand removability for upper gastrointestinal bleeding

Upper gastrointestinal bleeding (UGIB) is bleeding in the upper part of the gastrointestinal tract with an acidic and dynamic environment that limits the application of conventional hemostatic materials. This study focuses on the development of N-[(2-hydroxy-3-trimethylammonium) propyl] chitosan chloride/phytic acid (HTCC/PA, HP) powders with fast hemostatic capability and strong acid resistance, for potential applications in managing UGIB. Upon contact with liquids within 5 seconds, HP powders rapidly transform into hydrogels, forming ionic networks through electrostatic interactions. The ionic crosslinking process facilitates the HP powders with high blood absorption (3.4 times of self-weight), sufficient tissue adhesion (5.2 and 6.1 kPa on porcine skin and stomach, respectively), and hemostasis (within 15 seconds for in vitro clotting). Interestingly, the PA imparts the HP powders with strong acid resistance (69.8% mass remaining after 10 days of incubation at pH 1) and on-demand removable sealing while HTCC contributes to fast hemostasis and good wet adhesion. Moreover, the HP powders show good biocompatibility and promote wound healing. Therefore, these characteristics highlight the promising clinical potential of HP powders for effectively managing UGIB.

Advances in Light-Responsive Smart Multifunctional Nanofibers: Implications for Targeted Drug Delivery and Cancer Therapy

Over the last decade, scientists have shifted their focus to the development of smart carriers for the delivery of chemotherapeutics in order to overcome the problems associated with traditional chemotherapy, such as poor aqueous solubility and bioavailability, low selectivity and targeting specificity, off-target drug side effects, and damage to surrounding healthy tissues. Nanofiber-based drug delivery systems have recently emerged as a promising drug delivery system in cancer therapy owing to their unique structural and functional properties, including tunable interconnected porosity, a high surface-to-volume ratio associated with high entrapment efficiency and drug loading capacity, and high mass transport properties, which allow for controlled and targeted drug delivery. In addition, they are biocompatible, biodegradable, and capable of surface functionalization, allowing for target-specific delivery and drug release. One of the most common fiber production methods is electrospinning, even though the relatively two-dimensional (2D) tightly packed fiber structures and low production rates have limited its performance. Forcespinning is an alternative spinning technology that generates high-throughput, continuous polymeric nanofibers with 3D structures. Unlike electrospinning, forcespinning generates fibers by centrifugal forces rather than electrostatic forces, resulting in significantly higher fiber production. The functionalization of nanocarriers on nanofibers can result in smart nanofibers with anticancer capabilities that can be activated by external stimuli, such as light. This review addresses current trends and potential applications of light-responsive and dual-stimuli-responsive electro- and forcespun smart nanofibers in cancer therapy, with a particular emphasis on functionalizing nanofiber surfaces and developing nano-in-nanofiber emerging delivery systems for dual-controlled drug release and high-precision tumor targeting. In addition, the progress and prospective diagnostic and therapeutic applications of light-responsive and dual-stimuli-responsive smart nanofibers are discussed in the context of combination cancer therapy.

Sticking to the Problem: Engineering Adhesion in Molecular Endoscopic Imaging

Cancers of the digestive tract cause nearly one quarter of the cancer deaths worldwide, and nearly half of these are due to cancers of the esophagus and colon. Early detection of cancer significantly increases the rate of survival, and thus it is critical that cancer within these organs is detected early. In this regard, endoscopy is routinely used to screen for transforming/cancerous (i.e. dysplastic to fully cancerous) tissue. Numerous studies have revealed that the biochemistry of the luminal surface of such tissue within the colon and esophagus becomes altered throughout disease progression. Molecular endoscopic imaging (MEI), an emerging technology, seeks to exploit these changes for the early detection of cancer. The general approach for MEI is as follows: the luminal surface of an organ is exposed to molecular ligands, or particulate probes bearing a ligand, cognate to biochemistry unique to pre-cancerous/cancerous tissue. After a wash, the tissue is imaged to determine the presence of the probes. Detection of the probes post-washing suggests pathologic tissue. In the current review we provide a succinct, but extensive, review of ligands and target moieties that could be, or are currently being investigated, as possible cognate chemistries for MEI. This is followed by a review of the biophysics that determines, in large part, the success of a particular MEI design. The work draws an analogy between MEI and the well-advanced field of cell adhesion and provides a road map for engineering MEI to achieve assays that yield highly selective recognition of transforming/cancerous tissue in situ.

Molecular endoscopic imaging: the future is bright

The prediction and final survival rate of gastrointestinal cancers are dependent on the stage of disease. The ideal would be to detect those gastrointestinal lesions at early stage or even premalignant forms which are difficult to detect by conventional endoscopy with white light optical imaging as they show minimum or no changes in morphological characteristics and are thus left untreated. The introduction of molecular imaging has greatly changed the pattern for detecting gastrointestinal lesions from purely macroscopic structural imaging to the molecular level. It allows microscopic examination of the gastrointestinal mucosa with endoscopy after the topical or systemic application of molecular probes. In recent years, major advancements in endoscopic instruments and specific molecular probes have been achieved. This review focuses on the current status of endoscopic imaging and highlights the application of molecular imaging in gastrointestinal and hepatic disease in the context of diagnosis and therapy based on recently published literature in this field. We also discuss the challenges of molecular endoscopic imaging, its future directions and potential that could have a tremendous impact on endoscopic research and clinical practice in future.

Identification of Tumor Specific Peptide as EpCAM Ligand and Its Potential Diagnostic and Therapeutic Clinical Application

Tumor targeting agents are being developed for early tumor detection and therapeutics. We previously identified the peptide SNFYMPL (SNF*) and demonstrated its specific binding to human esophageal specimens of high-grade dysplasia (HGD) and adenocarcinoma with imaging ex vivo. Here, we aim to identify the target for this peptide and investigate its potential applications in imaging and drug delivery. With SNF* conjugated affinity chromatography, mass spectrum, Western blot, enzyme-linked immunosorbent assay (ELISA), and molecular docking, we found that the epithelial cell adhesion molecule (EpCAM) was the potential target of SNF*. Next, we showed that FITC-labeled SNF* (SNF*-FITC) colocalized with EpCAM antibody on the surface of esophageal adenocarcinoma cells OE33, and SNF*-FITC binding patterns significantly changed after EpCAM knockdown or exogenous EpCAM transfection. With the data from TCGA, we demonstrated that EpCAM was overexpressed in 17 types of cancers. Using colon and gastric adenocarcinoma cells and tissues as examples, we found that SNF*-FITC bound in a pattern was colocalized with EpCAM antibody, and the SNF* binding did not upregulate the EpCAM downstream Wnt signals. Subsequently, we conjugated SNF* with our previously constructed poly(histidine)-PEG/DSPE copolymer micelles. SNF* labeling significantly improved the micelle binding with colon and gastric adenocarcinoma cells in vitro, and enhanced the antitumor effects and decreased the toxicities of the micelles in vivo. In conclusion, we identified and validated SNF* as a specific peptide for EpCAM. The future potential use of SNF* peptide in multiple tumor surveillance and tumor-targeted therapeutics was demonstrated.

MEMS Actuators for Optical Microendoscopy

Growing demands for affordable, portable, and reliable optical microendoscopic imaging devices are attracting research institutes and industries to find new manufacturing methods. However, the integration of microscopic components into these subsystems is one of today's challenges in manufacturing and packaging. Together with this kind of miniaturization more and more functional parts have to be accommodated in ever smaller spaces. Therefore, solving this challenge with the use of microelectromechanical systems (MEMS) fabrication technology has opened the promising opportunities in enabling a wide variety of novel optical microendoscopy to be miniaturized. MEMS fabrication technology enables abilities to apply batch fabrication methods with high-precision and to include a wide variety of optical functionalities to the optical components. As a result, MEMS technology has enabled greater accessibility to advance optical microendoscopy technology to provide high-resolution and high-performance imaging matching with traditional table-top microscopy. In this review the latest advancements of MEMS actuators for optical microendoscopy will be discussed in detail.

Recent Progress on Photoacoustic Imaging Enhanced with Microelectromechanical Systems (MEMS) Technologies

Photoacoustic imaging (PAI) is a new biomedical imaging technology currently in the spotlight providing a hybrid contrast mechanism and excellent spatial resolution in the biological tissues. It has been extensively studied for preclinical and clinical applications taking advantage of its ability to provide anatomical and functional information of live bodies noninvasively. Recently, microelectromechanical systems (MEMS) technologies, particularly actuators and sensors, have contributed to improving the PAI system performance, further expanding the research fields. This review introduces cutting-edge MEMS technologies for PAI and summarizes the recent advances of scanning mirrors and detectors in MEMS.

Speckle illumination holographic non-scanning fluorescence endoscopy

Optical sectioning endoscopy such as confocal endoscopy offers capabilities to obtain three-dimensional (3D) information from various biological samples by discriminating between the desired in-focus signals and out-of-focus background. However, in general confocal images are formed through point-by-point scanning and the scanning time is proportional to the 3D space-bandwidth product. Recently, structured illumination endoscopy has been utilized for optically sectioned wide-field imaging, but it still needs axial scanning to acquire images from different depths of focal plane. Here, we report wide-field, multiplane, optical sectioning endoscopic imaging, incorporating 3D active speckle-based illumination and multiplexed volume holographic gratings, to simultaneously obtain images of fluorescently labeled tissue structures from different depths, without the need of scanning. We present the design, and implementation, as well as experimental data, demonstrating this endoscopic system's ability to obtain optically sectioned multiplane fluorescent images of tissue samples, with cellular level resolution in wide-field fashion, and no need for mechanical or optical axial scanning.(A) Schematic drawing of the SIHN endoscopy to simultaneously acquire multiplane images from different depths. (B) Uniform, and (C) SIHN illuminated images of standard fluorescence beads (25 μm in diameter) for the two axial planes. (D) Intensity profile on fluorescently labeled signal (ie, in-focus) and background (ie, out-of-focus) of microspheres.

Modular force approximating soft robotic pneumatic actuator

PURPOSE

Soft robots are highly flexible and adaptable instruments that have proven extremely useful, especially in the surgical environment where compliance allows for improved maneuverability throughout the body. Endoscopic devices are a primary example of an instrument that physicians use to navigate to difficult-to-reach areas inside the body. This paper presents a modular soft robotic pneumatic actuator as a proof of concept for a compliant endoscopic device.

METHODS

The actuator is 3D printed using an FDM printer. Maximum bending angle is measured using image processing in MATLAB at a gauge pressure level of 35 psi. End-effector displacement is measured using electromagnetic tracking as gauge pressure ranges from 10 to 35 psi, and uniaxial tensile loading ranges from 0 to 120 g.

RESULTS

The actuator achieves a maximum bending angle of 145°. Fourth-order polynomial regression is used to model the actuator displacement upon inflation and tensile loading with an average coefficient of correlation value of 0.998. We also develop a feedforward neural network as a robust computer-assisted method for controlling the actuator that achieves a coefficient of correlation value of 0.996.

CONCLUSION

We propose a novel modular soft robotic pneumatic actuator that is developed via rapid prototyping and evaluated using image processing and machine learning models. The curled resting shape allows for simple manufacturing and achieves a greater range of bending than other actuators of its kind. A feedforward neural network provides accurate prediction of end-effector displacement upon inflation and loading to deliver precise manipulation and control.

Endoscopic imaging using surface-enhanced Raman scattering

In this review, we assessed endoscopic imaging using surface-enhanced Raman scattering (SERS). As white-light endoscopy, the current standard for gastrointestinal endoscopy, is limited to morphology, Raman endoscopy using surface-enhanced Raman scattering nanoparticles (SERS endoscopy) was introduced as one of the novel functional modalities. SERS endoscopy has multiplex capability and high sensitivity with low autofluorescence and photobleaching. As a result, multiple molecular characteristics of the lesion can be accurately evaluated in real time while performing endoscopy using SERS probes and appropriate instrumentation. Especially, recently developed dual modality of fluorescence and SERS endoscopy offers easy localization with identification of multiple target molecules. For clinical use of SERS endoscopy in the future, problems of limited field of view and cytotoxicity should be addressed by fusion imaging, topical administration, and non-toxic coating of nanoparticles. We expect SERS endoscopic imaging would be an essential endoscopic technique for diagnosis of cancerous lesions, assessment of resection margins and evaluation of therapeutic responses.

Development of a Mechanical Scanning Device With High-Frequency Ultrasound Transducer for Ultrasonic Capsule Endoscopy

Wireless capsule endoscopy has opened a new era by enabling remote diagnostic assessment of the gastrointestinal tract in a painless procedure. Video capsule endoscopy is currently commercially available worldwide. However, it is limited to visualization of superficial tissue. Ultrasound (US) imaging is a complementary solution as it is capable of acquiring transmural information from the tissue wall. This paper presents a mechanical scanning device incorporating a high-frequency transducer specifically as a proof of concept for US capsule endoscopy (USCE), providing information that may usefully assist future research. A rotary solenoid-coil-based motor was employed to rotate the US transducer with sectional electronic control. A set of gears was used to convert the sectional rotation to circular rotation. A single-element focused US transducer with 39-MHz center frequency was used for high-resolution US imaging, connected to an imaging platform for pulse generation and image processing. Key parameters of US imaging for USCE applications were evaluated. Wire phantom imaging and tissue phantom imaging have been conducted to evaluate the performance of the proposed method. A porcine small intestine specimen was also used for imaging evaluation in vitro. Test results demonstrate that the proposed device and rotation mechanism are able to offer good image resolution ( [Formula: see text]) of the lumen wall, and they, therefore, offer a viable basis for the fabrication of a USCE device.

New Endoscopic Imaging Technology Based on MEMS Sensors and Actuators

Over the last decade, optical fiber-based forms of microscopy and endoscopy have extended the realm of applicability for many imaging modalities. Optical fiber-based imaging modalities permit the use of remote illumination sources and enable flexible forms supporting the creation of portable and hand-held imaging instrumentations to interrogate within hollow tissue cavities. A common challenge in the development of such devices is the design and integration of miniaturized optical and mechanical components. Until recently, microelectromechanical systems (MEMS) sensors and actuators have been playing a key role in shaping the miniaturization of these components. This is due to the precision mechanics of MEMS, microfabrication techniques, and optical functionality enabling a wide variety of movable and tunable mirrors, lenses, filters, and other optical structures. Many promising results from MEMS based optical fiber endoscopy have demonstrated great potentials for clinical translation. In this article, reviews of MEMS sensors and actuators for various fiber-optical endoscopy such as fluorescence, optical coherence tomography, confocal, photo-acoustic, and two-photon imaging modalities will be discussed. This advanced MEMS based optical fiber endoscopy can provide cellular and molecular features with deep tissue penetration enabling guided resections and early cancer assessment to better treatment outcomes.

High power, ultrashort pulse control through a multi-core fiber for ablation

Ultrashort pulse ablation has become a useful tool for micromachining and biomedical surgical applications. Implementation of ultrashort pulse ablation in confined spaces has been limited by endoscopic delivery and focusing of a high peak power pulse. Here we demonstrate ultrashort pulse ablation through a thin multi-core fiber (MCF) using wavefront shaping, which allows for focusing and scanning the pulse without requiring distal end optics and enables a smaller ablation tool. The intensity necessary for ablation is significantly higher than for multiphoton imaging. We show that the ultimate limitations of the MCF based ablation are the nonlinear effects induced by the pulse in the MCFs cores. We characterize and compare the performance of two devices utilizing a different number of cores and demonstrate ultrashort pulse ablation on a thin film of gold.

An Insect Eye Inspired Miniaturized Multi-Camera System for Endoscopic Imaging

In this work, we present a miniaturized high definition vision system inspired by insect eyes, with a distributed illumination method, which can work in dark environments for proximity imaging applications such as endoscopy. Our approach is based on modeling biological systems with off-the-shelf miniaturized cameras combined with digital circuit design for real time image processing. We built a 5 mm radius hemispherical compound eye, imaging a 180^°×180^° degrees field of view while providing more than 1.1 megapixels (emulated ommatidias) as real-time video with an inter-ommatidial angle ∆ϕ = 0.5^° at 18 mm radial distance. We made an FPGA implementation of the image processing system which is capable of generating 25 fps video with 1080 × 1080 pixel resolution at a 120 MHz processing clock frequency. When compared to similar size insect eye mimicking systems in literature, the system proposed in this paper features 1000 × resolution increase. To the best of our knowledge, this is the first time that a compound eye with built-in illumination idea is reported. We are offering our miniaturized imaging system for endoscopic applications like colonoscopy or laparoscopic surgery where there is a need for large field of view high definition imagery. For that purpose we tested our system inside a human colon model. We also present the resulting images and videos from the human colon model in this paper.

Phase retrieval in multicore fiber bundles

Multicore fiber bundles are widely used in endoscopy due to their miniature size and their direct imaging capabilities. They have recently been used, in combination with spatial light modulators, in various realizations of endoscopy with little or no optics at the distal end. These schemes require characterization of the relative phase offsets between the different cores, typically done using off-axis holography, thus requiring both an interferometric setup and, typically, access to the distal tip. Here we explore the possibility of employing phase retrieval to extract the necessary phase information. We show that in the noise-free case, disordered fiber bundles are superior for phase retrieval over their periodic counterparts, and demonstrate experimentally accurate retrieval of phase information for up to 10 simultaneously illuminated cores. Thus, phase retrieval is presented as a viable alternative for real-time monitoring of phase distortions in multicore fiber bundles.

Fluorescence lifetime measurement with confocal endomicroscopy for direct analysis of tissue biochemistry in vivo

Confocal endomicroscopy is a powerful tool for in vivo real-time imaging at cellular resolution inside a living body without tissue resection. Microscopic fluorescence lifetime measurement can provide information about localized biochemical conditions such as pH and the concentrations of oxygen and calcium. We hypothesized that combining these techniques could assist accurate cancer discrimination by providing both biochemical and morphological information. We designed a dual-mode experimental setup for confocal endomicroscopic imaging and fluorescence lifetime measurement and applied it to a mouse xenograft model of activated human pancreatic cancer generated by subcutaneous injection of AsPC-1 tumor cells. Using this method with pH-sensitive sodium fluorescein injection, we demonstrated discrimination between normal and cancerous tissues in a living mouse. With further development, this method may be useful for clinical cancer detection.

Fluorescence-Raman dual modal endoscopic system for multiplexed molecular diagnostics

Optical endoscopic imaging, which was recently equipped with bioluminescence, fluorescence, and Raman scattering, allows minimally invasive real-time detection of pathologies on the surface of hollow organs. To characterize pathologic lesions in a multiplexed way, we developed a dual modal fluorescence-Raman endomicroscopic system (FRES), which used fluorescence and surface-enhanced Raman scattering nanoprobes (F-SERS dots). Real-time, in vivo, and multiple target detection of a specific cancer was successful, based on the fast imaging capability of fluorescence signals and the multiplex capability of simultaneously detected SERS signals using an optical fiber bundle for intraoperative endoscopic system. Human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR) on the breast cancer xenografts in a mouse orthotopic model were successfully detected in a multiplexed way, illustrating the potential of FRES as a molecular diagnostic instrument that enables real-time tumor characterization of receptors during routine endoscopic procedures.

Endoscopic molecular imaging of cancer

White light endoscopy has proven to be a very powerful tool in oncology. There is still, however, a need for better endoscopic techniques to overcome the current limitations of white light optics. New technologies that allow higher sensitivity, improved microanatomy and molecular characterization have been available for in vitro microscopy and are now being translated into in vivo endoscopy. Endoscopic molecular imaging is still in its infancy but holds the promise for enhancing sensitivity for early lesions, thus allowing earlier diagnosis and enabling early image-guided endoscopic intervention. A key feature of endoscopic molecular imaging is its increased sensitivity and specificity, which will be illustrated in this article, as well as describing perspectives on its future use in oncologic surgery.

Accumulating advantages, reducing limitations: multimodal nonlinear imaging in biomedical sciences - the synergy of multiple contrast mechanisms

Multimodal nonlinear microscopy has matured during the past decades to one of the key imaging modalities in life science and biomedicine due to its unique capabilities of label-free visualization of tissue structure and chemical composition, high depth penetration, intrinsic 3D sectioning, diffraction limited resolution and low phototoxicity. This review briefly summarizes first recent advances in the field regarding the methodology, e.g., contrast mechanisms and signal characteristics used for contrast generation as well as novel image processing approaches. The second part deals with technologic developments emphasizing improvements in penetration depth, imaging speed, spatial resolution and nonlinear labeling strategies. The third part focuses on recent applications in life science fundamental research and biomedical diagnostics as well as future clinical applications.

Numerical characterization of an ultra-high NA coherent fiber bundle part II: point spread function analysis

Straightforward numerical integration of the Rayleigh-Sommerfeld diffraction integral (R-SDI) remains computationally challenging, even with today's computational resources. As such, approximating the R-SDI to decrease the computation time while maintaining a good accuracy is still a topic of interest. In this paper, we apply an approximation for the R-SDI that is to be used to propagate the field exiting a Coherent Fiber Bundle (CFB) with ultra-high numerical aperture (0.928) of which we presented the design and modal properties in previous work. Since our CFB has single-mode cores with a diameter (550 nm) smaller than the wavelength (850 nm) for which the CFB was designed, we approximate the highly divergent fundamental modes of the cores with real Dirac delta functions. We find that with this approximation we can strongly reduce the computation time of the R-SDI while maintaining a good agreement with the results of the full R-SDI. Using this approximation, we first determine the Point Spread Function (PSF) for an 'ideal' output field exiting the CFB (identical amplitudes for cores on a perfect hexagonal lattice with the phase of each core determined by the appropriate spherical and tilted plane wave front). Next, we analyze the PSF when amplitude or phase noise is superposed onto this 'ideal' field. We find that even in the presence of these types of noise, the effect on the central peak of PSF is limited. From these types of noise, phase noise is found to have the biggest impact on the PSF.

Numerical characterization of an ultra-high NA coherent fiber bundle part I: modal analysis

Advances in fiber optics and CCD technology in the last decades have allowed for a large reduction in outer diameter (from centimeters to submillimeter) of endoscopes. Attempts to reduce the outer diameter even further, however, have been hindered by the trade-off, inherent to conventional endoscopes, between outer diameter, resolution and field of view. Several groups have shown the feasibility of further miniaturization towards so called micro-endoscopes, albeit at the cost of a very reduced field of view. In previous work we presented the design of an ultra-high NA (0.928) Coherent FiberBundle (CFB) that, in combination with proximal wave front shaping, could be used to circumvent this trade-off thus paving the way for even smaller endoscopes. In this paper we analyze how the modal properties of such an ultra-high NA CFB determine the required input field to achieve any desired output field. We use the periodicity of the hexagonal lattice which characterizes a CFB, to define a unit cell of which we analyze the eigen-modes. During the modal analysis, we also take into account realistic variations in lattice constant, core size and core shape due to the limitations of the fabrication technology. Realistic values for these types of fabrication-induced irregularities were obtained via SEM images of a CFB fabricated according to the aforementioned design. The presence of these irregularities results, for a desired output, in the required input to be different from the required input for a defect-free CFB. We find that of the different types of fabrication-induced irregularities present in the CFB, variations in core ellipticity have the biggest impact on the required input for a given desired output.

Advances in molecular imaging for diagnosis of digestive tract cancers

Digestive tract cancers are common cancer types and have high incidence and mortality. Currently available diagnostic methods have some limitations that make an early and accurate diagnosis and prompt treatment difficult. Molecular imaging, which has been formally defined as visualization, characterization and measurement at the molecular level instead of the anatomic level, significantly increases the sensitivity and specificity of cancer detection. Several modalities have been utilized for molecular imaging in digestive tract cancers, such as endoscopy, scintigraphy (PET/SPECT), magnetic resonance imaging (MRI), and ultrasound (US). Antibodies, peptides, and aptamers are classes of molecular probes that have been extensively used as affinity ligands. After being conjugated with various labels such as radioisotopes, fluorophore, supermagnetic or paramagnetic metals and microbubbles, the probes can specifically target tumor cells and stroma and are used with imaging modalities to detect cancers. Molecular imaging is a methodology for not only the early detection of cancer, but also the judgment of tumor staging and the guidance of therapy. With the development of new instrument and probes, as well as multi-modal platforms, molecular imaging has been gradually perfected and taken from bench to bedside, bringing opportunities for early, accurate and comprehensive diagnosis of digestive tract cancers.

Diagnostic imaging

Physical techniques have always had a key role in medicine, and the second half of the 20th century in particular saw a revolution in medical diagnostic techniques with the development of key imaging instruments: x-ray imaging and emission tomography (nuclear imaging and PET), MRI, and ultrasound. These techniques use the full width of the electromagnetic spectrum, from gamma rays to radio waves, and sound. In most cases, the development of a medical imaging device was opportunistic; many scientists in physics laboratories were experimenting with simple x-ray images within the first year of the discovery of such rays, the development of the cyclotron and later nuclear reactors created the opportunity for nuclear medicine, and one of the co-inventors of MRI was initially attempting to develop an alternative to x-ray diffraction for the analysis of crystal structures. What all these techniques have in common is the brilliant insight of a few pioneering physical scientists and engineers who had the tenacity to develop their inventions, followed by a series of technical innovations that enabled the full diagnostic potential of these instruments to be realised. In this report, we focus on the key part played by these scientists and engineers and the new imaging instruments and diagnostic procedures that they developed. By bringing the key developments and applications together we hope to show the true legacy of physics and engineering in diagnostic medicine.