Current urologic applications of digital imaging

[PCNL: what's changed?]

PCNL is a endourological technique for the treatment of kidney stones disease. It's aim is to achieve the complete clearance via a percutaneous access. This technique, as we know it today, was developed by Johanson and Fernstrom in 1976 who used the technological advances in percutaneous fluoroscopy to get the percutaneous access. Following the application of various sources of energy for the fragmentation of the calculi such as ultrasound energy, there was the worldwide diffusion of PCNL thanks to Alken and Marbergen in Europe, Segura and Clayman in the USA. Despite in the early '80s the PCNL lost the initial impulse in favor of the SWL, in the '90s, it revived a second golden age through the application of emerging technologies such as computed tomography, techniques of obtaining the percutaneous access, flexible instrumentation, laser energy and, more recently, robotic surgery, and virtual reality. All of these contributed to bring the PCNL on the road up of the mini-invasiveness to the latest development of Microperc. The Microperc allows the treatment of stones of 2 cm in diameter also, obtaining the access under ultrasound, fluoroscopic and direct vision guidance. A complete system including micor-optics, laser fiber and irrigation system is then inserted into the same needle with a diameter of 4.85, 8 or 10 Fr The CROES used logistic developments by creating a global network and a multi-center database. The PCNL study, concluded in 2009, has led to the publication of as many as 27 scientific papers on this subject.

New Technology for Imaging and Documenting Urologic Procedures

Recent advances in fiber optics and digital technology have dramatically improved the ability of the urologic surgeon to accurately image and document endoscopic and laparoscopic procedures. In addition, the development of digital endoscopes has expanded the armamentarium of the endoscopic surgeon greatly. Finally, new virtual reality technology has allowed increased visualization during surgery and provides excellent training for surgeons. This article details new imaging and documentation technology currently utilized during urologic procedures.

The camera phone: A novel aid in urologic practice

OBJECTIVES

To describe a novel use of the camera phone for efficient, reliable, and cost-effective collection and transmission of medical data in the urologic setting.

METHODS

We used camera phones (Verizon VGA and Sanyo-Sprint PCS) with a resolution of 640 x 480 pixels to capture images in the operating room, as well as in the outpatient clinic. Images were obtained directly from the monitor or the x-ray viewing box. These were then immediately transmitted to the office computer through a secure Internet connection. The images were then incorporated into operative and office notes, as needed.

RESULTS

The images obtained with this method were of adequate quality for demonstration purposes, with the added advantage of allowing secure transmission and storage. The best-quality images were those obtained directly from the x-ray viewing box or from a liquid crystal display monitor. In addition, the images could be edited and labels added with the aid of the software that came with the camera phone.

CONCLUSIONS

This method allows the acquisition of fair-quality digital images of surgical procedures and radiographic studies with simultaneous data transmission and storage for clinical documentation. The technology reduced costs and increased the efficiency of our practice considerably.

Advances in video and imaging in ureteroscopy

Advances in image processing and display technologies, such as digital imaging, HDTV, and virtual reality, will ultimately allow integration of endoscopic imaging with diagnosis and therapy during ureteroscopic procedures. Further improvements in simulation technology and telemedicine should improve surgical training and greatly benefit patient care.

Ureteroscopes: flexible, rigid, and semirigid

Since its introduction, the ureteroscope has undergone significant improvements. Using the currently available rigid, semirigid, and flexible ureteroscopes and working instruments, urologists can diagnose and treat lesions throughout the upper urinary tract. Over the past 25 years, the ureteroscope in combination with shock wave lithotripsy has transformed the diagnosis and treatment of more than 90% of upper urinary tract pathology from an open to an endourologic procedure. With endoscope manufacturers continually incorporating new technology into their ureteroscopes, future models will undoubtedly provide better optics, increased durability, and improved capabilities, resulting in greater success when urologists perform endoscopic forays into the upper urinary tract.

A Simple Way to Take Pictures During Endoscopic Procedures

PURPOSE

We describe a new method of taking pictures from endoscopic images using a digital photo camera coupled to the endoscopic lens without an adapter.

MATERIALS AND METHODS

We used a digital camera with 3.3 megapixel resolution and 6 x optical zoom. The camera was coupled to the endoscopic lens with no special adapter. The image was accompanied through the LCD (liquid crystal display) visor, and the picture was taken with the flash button on and with no macro resource. The image was then enlarged by optical and digital zoom before being easily stored in photo files at the personal computer.

RESULTS

The quality of the photos obtained by this method was at least similar to that of traditional photos, and the data were promptly stored.

CONCLUSIONS

We describe a simple method of taking pictures from endoscopic images with the additional advantage of a facility to edit and store the photographs.

Endoscopic data acquisition and storage

Recent developments in the field of digital image acquisition and storage provide new opportunities for recording endoscopic procedures for use in the medical record and remote access for education and consultation. This article reviews the recent literature in the field of endoscopy.

Computed tomography urography, three-dimensional computed tomography and virtual endoscopy

Spiral computed tomography technology allows an entire body region to be imaged as a continuous volume of computed tomography data. The acquisition of genitourinary images can be performed at different intervals after intravenous contrast injection in order to characterize the renal vasculature, the renal parenchyma or the collecting system. Computed tomography scanning as contrast is excreted into the collecting system is termed a 'computed tomography urogram'. Volumetric data from spiral computed tomography can be rendered into conventional two-dimensional images or even reformatted into three-dimensional views of organ systems or hollow structures, as in 'fly-through' virtual endoscopy. Although virtual endoscopy of the urinary tract remains in its infancy, three-dimensional imaging is currently a useful adjunct in the evaluation of renal transplant and donor patients and partial nephrectomy candidates. The role of computed tomography urography compared with intravenous urography in the evaluation of hematuria is discussed.