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By Lee J. Nelson
Depending on which medical journal one elects to peruse, the father of modern endoscopy is cited as the German doctor Philipp Bozzini (1773-1809), French surgeon Antoine Jean Desormeaux (1815-1894), American otolaryngologist Chevalier Jackson (1865-1958), Polish physician Jan Mikulicz-Radecki (1850-1905), German urologist Maximilian Nitze (1848-1906), German gastroenterologist Rudolph Schindler (1888-1968) or German gynecologist Kurst Semm (1927-2003). What is quite certain, however, is that none of those pioneers could have imagined the present climate of innovative enhancements to their fundamental invention. State-of-the-art systems run the gamut from the possibility of disposable instruments through stereoscopic endoscopy to breakthrough three-dimensional imaging.
Three-dimensional ultrasound transducers, built by researchers at Duke University's Pratt School of Engineering (Durham, N.C.), are imaging beating dog hearts. Designers predict their probes could give better views during human endoscopic surgeries in which operations are performed through tiny "keyhole" incisions. If they prove beneficial in clinical testing, the advance might lead to more precise and safer outcomes for patients.
"Surgeons now use optical endoscopes or two-dimensional ultrasound when conducting minimally invasive surgery," said lead engineer Stephen Smith, Professor of Biomedical Engineering at the Pratt School. "With our scanner, doctors could see a lesion or a portion of an organ in a real-time, three-dimensional scan." "They would have the option of viewing the tissue in three perpendicular cross-sectional slices, simultaneously, or in the same way a camera would see it-except that a camera can't see through blood and tissue."
The first 3D ultrasound scanner was developed at Duke in 1987 to image the heart from outside the body. As technology enabled ever smaller ultrasound arrays, researchers engineered probes that could fit within catheters threaded through blood vessels for imaging the heart and its vasculature from the inside. This advance relies on 500 tiny cables and sensors packed into a cylinder, a scant 12 millimeters in diameter. By comparison, most two-dimensional ultrasound probes contain just 64 wires. According to Smith, "More cables translate into better image quality."
Each cable carries electrical signals from the scanner to the sensors at the tip of the tube which, in turn, transmits acoustic wave pulses into the surrounding area. The sensors pick up returning echoes and relay them back to the scanner where they produce an image of the living tissue or organ. The scanner uses parallel processing to listen to each pulse's echoes in sixteen directions at once.