Modern endoscopy has become a necessary diagnostic and therapeutic tool in many clinical specialties such as pulmonary medicine, gastroenterology, colorectal surgery, and urology.
Advances in handheld computing have created the possibility of transforming a smartphone into a completely mobile endoscopic viewing system at a substantial cost benefit.
To evaluate the ability and feasibility of an iPhone-based mobile endoscopic viewing system.
- Images of United States Air Force resolution target compared between a flexible cystoscope coupled to the Endockscope + iPhone to the Storz high definition (HD) camera (H3-Z Versatile).
- Munsell ColorChecker chart to compare the color resolution with a 0° laparoscope.
- 12 expert endoscopists blindly compared and evaluated images from a porcine model using a cystoscope and ureteroscope for both systems.
- Finally, there was a cost comparison (average of two company listed prices) and weight (lbs) comparison of the two systems.
- Overall, the image resolution allowed by the Endockscope was identical to the traditional HD camera (4.49 vs 4.49 lp/mm).
- Red (DE = 9.26 vs 9.69) demonstrated better color resolution for iPhone, but green (DE = 7.76 vs 10.95), and blue (DE=12.35 vs 14.66) revealed better color resolution with the Storz HD camera.
- Expert reviews of cystoscopic images acquired with the HD camera were superior in image, color, and overall quality (P=0.002, 0.042, and 0.003).
- In contrast, the ureteroscopic reviews yielded no statistical difference in image, color, and overall (P=1, 0.203, and 0.120) quality.
- The overall cost of the Endockscope+iPhone was $154 compared with $46,623 for a standard HD system.
iPhones can be transformed into a mobile endoscopic viewing system at a substantial cost benefit. The lighter and inexpensive Endockscope acquired images of the same resolution and acceptable color resolution. When evaluated by expert endoscopists, the quality of the images overall were equivalent for flexible ureteroscopy. It was also somewhat inferior, but still acceptable for flexible cystoscopy.
Commentary & Implication to mHealth
This feasibility study highlights the increasing power of mobile technology when applied to endoscopy. These results may have improved given the hardware development available today that includes higher resolution cameras. As with any smartphone centric system, there are barriers to widespread use at the moment such as concerns for patient privacy and integration with hospital PACS systems.
There have been a number of examples in literature of smartphone adapters for endoscopes. To date, there have been no human trials evaluating the efficacy of this technology. It also remains unclear how the positive results in this study will affect future endoscope development, although there is clearly grounds to improve accessibility to endoscopy in developing nations.
Article Name: Endockscope: Using Mobile Technology to Create Global Point of Service Endoscopy
Authors: William Sohn, Samir Shreim, Renai Yoon, Victor B. Huynh, Atreya Dash, Ralph Clayman, and Hak J. Lee
Journal Published: Journal of Endourology
Citation:J Endourol. 2013 Sep;27(9):1154-60. doi: 10.1089/end.2013.0286