EP2421425A2 - Système d'imagerie - Google Patents

Système d'imagerie

Info

Publication number
EP2421425A2
EP2421425A2 EP10767617A EP10767617A EP2421425A2 EP 2421425 A2 EP2421425 A2 EP 2421425A2 EP 10767617 A EP10767617 A EP 10767617A EP 10767617 A EP10767617 A EP 10767617A EP 2421425 A2 EP2421425 A2 EP 2421425A2
Authority
EP
European Patent Office
Prior art keywords
display unit
endoscope
interface
main body
coupled
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP10767617A
Other languages
German (de)
English (en)
Other versions
EP2421425A4 (fr
Inventor
Patrick C. Melder
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Envisionier Medical Technologies Inc
Original Assignee
Envisionier Medical Technologies Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Envisionier Medical Technologies Inc filed Critical Envisionier Medical Technologies Inc
Publication of EP2421425A2 publication Critical patent/EP2421425A2/fr
Publication of EP2421425A4 publication Critical patent/EP2421425A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00011—Operational features of endoscopes characterised by signal transmission
    • A61B1/00016—Operational features of endoscopes characterised by signal transmission using wireless means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/0002—Operational features of endoscopes provided with data storages
    • A61B1/00022—Operational features of endoscopes provided with data storages removable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00025—Operational features of endoscopes characterised by power management
    • A61B1/00027—Operational features of endoscopes characterised by power management characterised by power supply
    • A61B1/00032—Operational features of endoscopes characterised by power management characterised by power supply internally powered
    • A61B1/00034—Operational features of endoscopes characterised by power management characterised by power supply internally powered rechargeable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00039—Operational features of endoscopes provided with input arrangements for the user
    • A61B1/0004—Operational features of endoscopes provided with input arrangements for the user for electronic operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00043—Operational features of endoscopes provided with output arrangements
    • A61B1/00045—Display arrangement
    • A61B1/00052—Display arrangement positioned at proximal end of the endoscope body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00108—Constructional details of the endoscope body characterised by self-sufficient functionality for stand-alone use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/20—ICT specially adapted for the handling or processing of medical images for handling medical images, e.g. DICOM, HL7 or PACS
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/67—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation

Definitions

  • the present invention relates generally to portable imaging systems, and more particularly to an endoscopic imaging system having a flexible tube with a distal image sensor, further having a detachable liquid crystal display and capability for wireless data transmission.
  • a bronchoscope can be used by way of the nose, mouth or tracheostomy to visualize the inside of the airways; laryngoscopes can be used for intubation, to detect causes of voice problems, to detects causes of throat and ear pain, to evaluates difficulty in swallowing, and to detect strictures or injury to the throat, or obstructive masses in the airway; a gastroscope can be used to diagnose the cause of unexplained anemia, upper gastrointestinal bleeding, persistent dyspepsia, heartburn and chronic acid reflux, persistent vomiting, dysphagia, and odynophagia.
  • a gastroscope can also be used to monitor Barrett's esophagus, gastric ulcer or duodenal ulcer, and post healing gastric surgery.
  • otolaryngologists often require an endoscopic examination of the patient's upper respiratory system.
  • One of the most common tools used by otolaryngologists to view the upper respiratory system is an endoscope.
  • endoscopes are used by surgeons and physicians in many fields of medicine, such as in pulmonary, and urology, in order to view parts of the human body internally for examination, diagnosis, and treatment.
  • Endoscopes are also used in the gastrointestinal tract.
  • the endoscope was an optical instrument.
  • the endoscope can have a rigid or flexible tube and provide an image for visual inspection and photography.
  • the rigid endoscope while originally hollow, typically includes a series of glass rods at intermittent distances from each other sheathed in a tube, with an accompanying fiber-optic light bundle to direct a light upon the object under examination.
  • the flexible endoscope replaces the series of glass rods with tiny fiber-optic glass rods which simply transmit an image from the distal tip to an eye piece.
  • certain flexible endoscopes replace the series of optical glass rods sheathed in a tube, with a solid state camera located at the distal end of the flexible endoscopic tube.
  • the solid state camera can be a self-scanning solid state imaging device such as a charge coupled device (CCD) or a complementary metal-oxide semi-conductor
  • CMOS complementary metal-oxide-semiconductor
  • An objective or image forming lens can be provided in front of the solid state camera. The lens is arranged to focus an image upon the CCD.
  • a pre-amplifier is coupled to the output of the CCD.
  • a line carrying the signal from the pre-amplifier extends through the flexible tube to the proximal end of the endoscope for coupling to a remote image processor.
  • Color image sensors typically utilize one of various means of determining color, such as a color filter array.
  • An external light source is typically provided to illuminate the organ or object under inspection.
  • the light source typically provides light directed via the optical fiber system extending through the tube.
  • the endoscope can also enable taking biopsies and retrieval of foreign objects.
  • the tube can provide for an additional channel to allow entry of medical instruments or manipulators.
  • endoscopes included only an eyepiece, through which the physician could view the area being examined and/or treated.
  • Later systems included video adapters to couple a camera head to the eyepiece.
  • the camera head coupled the eyepiece to a video system.
  • the video system was coupled to a monitor.
  • the image as viewed from the eyepiece could now be more easily seen on the monitor.
  • additional equipment must be acquired such as a tape recorder, optical media device, and a printer. All of this equipment is typically stored on a cart.
  • the cart typically includes wheels for mobility and is coupled to the endoscope via the various cables.
  • the camera control unit and accompanying computer and viewing screen are bulky, heavy, and not easily transported to different locations.
  • the systems currently available can range in cost from $ 10,000 or more for just the camera and camera control unit.
  • the endoscope, and typically a light source must be purchased.
  • Manufacturers have attempted to produce digital archiving platforms to allow easy integration into the digital age by integrating disc burners and hard drives into the endoscopy units so that exams can be stored directly onto removable media. These alternatives, however, limit editing of the images and are not very dynamic.
  • Other manufacturers have attempted to produce endoscopy units that capture the images directly into a proprietary computer system designed for the specific function of video capturing and archiving. These systems provide better data manipulation, but can cost more than $ 20,000, and thus not affordable for a small or cost-limited practice.
  • Yarush et al discloses a fixed lens tube which receives a variety of apparently custom probes and, in certain embodiments, further requires one of several adapters to receive certain probes. Additionally, this aforementioned patent is not readily adapted to the standard fittings of the eyepiece of endoscopes used in medical practices.
  • U.S. Patent Publication No. 2007/0276183 discloses a portable battery operated hand-held endoscopy system adapted for interchangeable use with a variety of endoscopes, and is incorporated herein by reference.
  • the endoscopy system includes a portable battery operated hand-held camera unit having a liquid crystal display (LCD).
  • the camera unit couples to the eyepiece of an endoscope.
  • a typically external light source couples to the endoscope.
  • the present invention merges data acquisition with storage and management in a novel, web application, allowing practitioner to patient sharing, synchronization of patient folders, and sending an image or video by a secured connection to a referring practitioner, anytime, anywhere.
  • FIG. 1 is a perspective view of a prior art endoscope having a flexible insertion tube and tubing for the light source and suction;
  • FIG. 2 is a perspective view of one embodiment of an endoscopic imaging system having a flexible insertion tube, with a distal image sensor and a proximal image processor, in accordance with the present disclosure
  • FIG. 3 is a perspective view of another embodiment of an endoscopic imaging system having a flexible insertion tube, with a distal image sensor, and a removable proximal image processor and display, in accordance with the present disclosure
  • FIG. 4 is a diagram showing an exemplary medical imaging system
  • FIG. 5 is a block diagram of an exemplary unified imaging platform according to the disclosure
  • FIG. 6 is a block diagram of an exemplary endoscopic system having a rigid or flexible image collection end and a proximate image sensor
  • FIG. 7 is a block diagram of an exemplary endoscopic system having a distal image sensor and an electrically coupled display unit;
  • FIG. 8 is a block diagram of an exemplary system having a distal image sensor and wirelessly coupled display unit
  • FIG. 9 is a block diagram of a display unit coupled to an endoscopic imaging cart system
  • FIG. 10 is a block diagram of a display unit coupled with a docking station
  • FIG. 11 is a block diagram of a software system architecture in accordance with the present disclosure.
  • FIG. 12 is a block diagram showing integration between an exemplary imaging system in accordance with the present disclosure and a healthcare information system
  • FIG. 13 is an exemplary screenshot of a remote image system web application user interface
  • FIG. 14 is a flowchart showing an exemplary workflow using an imaging system in accordance with the present disclosure.
  • FIG. 15 illustrates an exemplary HD camera medical imaging system in accordance with the present disclosure.
  • FIG. 1 A prior art endoscope 10 is shown in FIG. 1.
  • the endoscope 10 is shown to include a flexible insertion tube 12 and tubing 14 which conveys light from a light source and suction to the insertion tube 12.
  • the endoscope 10 includes two stacked wheels 16 to provide four basic degrees of movement, e.g., up/down and left/right, of the insertion tube 12, such as used in pulmonary endoscopes and gastroscopes.
  • Endoscopes having flexible insertion tubes and being designed for use in otolaryngology, urology, and gynecology typically have a single wheel or lever to provide two degrees of movement, e.g., up and down.
  • An additional channel 18 is provided for entry of medical instruments or manipulators.
  • a connector 20 is provided at the end of the tubing 14.
  • the connector 20 is adapted for connection to a remote light source (not shown) and suction source (not shown), and further includes a connection 22 for coupling to a remote video system (not shown).
  • a distal image sensor 24 and related components are located at the distal tip of the flexible insertion tube 12.
  • a wire or line (not shown) extends from the distal image sensor 24 through the length of the flexible insertion tube 12 and continues through the tubing 14 to the connector 20.
  • FIG. 2 is a perspective view of one embodiment of an endoscopic imaging system 30 in accordance with the present invention.
  • the endoscopic imaging system 30 includes an endoscope 32 having a flexible insertion tube 34, with a distal image sensor 24 and related components (not shown in FIG. 2) located at the distal end of the insertion tube 34.
  • a wire or line extends from the distal image sensor 24 through the length of the flexible insertion tube 12 to the proximal end of the endoscope 32.
  • a viewing screen or video display unit 36 is shown coupled to the endoscope 32.
  • the video display unit 36 may include a video display such as a liquid crystal display (LCD), light emitting diode (LED) display, plasma display or the like, for example.
  • the endoscope 32 is shown to include a rotating ring 38 which rotates about the longitudinal axis of the endoscope 32.
  • the rotation ring 38 includes a neck portion 40.
  • the video display unit 36 is shown to include a stem portion 42 rotatably coupled to the neck portion 40 of the rotating ring 38.
  • the video display unit 36 is movable with the rotation of the rotating ring 38 about the longitudinal axis of the endoscope 32, as well as pivotal about the longitudinal axis of the stem portion 42.
  • the video display unit 36 is removable.
  • FIG. 2 shows that video display unit 36 is removable from the endoscope 32.
  • a display holder 44 is coupled to the stem portion 42.
  • the holder 44 similar to the video display unit 64, is thus capable of the same axial rotation about the stem portion 42 as well as the rotation about the axis of the endoscope 32.
  • the display holder 44 is adapted to receive the removable video display 36.
  • the removable video display unit 36 is coupled to the electronics of the endoscope 32 via a connector (not shown) located at the bottom of the video display unit 36 and a mating connector (not shown) located within the interior cavity formed by the holder 44. It is also anticipated that the video display unit 36 may include a wireless interface for wireless communication with a corresponding wireless interface coupled to the electronics in the endoscope 32.
  • the video display unit 36 includes an analog-to-digital (AfD) converter having an input coupled to the connector of the video display unit 36. An output of the A/D converter is coupled to an image processor also located in the video display unit 36.
  • the video display unit 36 further includes a controller coupled to the image processor and to the connector of the video display unit 36.
  • the video display unit further includes various memory and various external interfaces coupled to the image processor and controller.
  • the image processor is proximally located.
  • the endoscope 32 includes two stacked wheels 16 to provide four basic degrees of movement, e.g., up/down and left/right, of the flexible insertion tube 34.
  • the endoscope 32 further includes a plurality of user input control switches or buttons 50.
  • the switches or buttons 50 are connected to the connector of the endoscope 32, or display holder 44 or in the case of a removable video display unit 36. Thus, the switches or buttons 50 may be connected to the internal components of the video display unit 36.
  • the plurality of user input control switches or buttons 50 include direction button 52, mode button 54, and menu button 54.
  • Direction button 52 is preferably a digital joystick, normally spring biased to remain in a central, vertical orientation, which may be momentarily rocked into forward, reverse, left and right orientations, relative to its central orientation.
  • One of the functions of direction button 53 is to select a digital zoom level for image viewing and capture.
  • Movement of direction button to the forward or reverse orientation causes an associated positive or negative change in the digital zoom level of the image to be viewed and the still or motion video image to be captured.
  • a zoom level of up to 4X digital magnification may be selected using direction button 52.
  • Mode button 54 and menu button 56 are preferably pushbutton, momentary switches.
  • Direction button 52 performs several additional functions, in conjunction with mode button 54, menu button 56, and an on-screen menu presented to the physician using video display unit 36, under control of the microprocessor, or digital signal processor, contained within the endoscope 32.
  • the physician can play back video clips and select from amongst still images for viewing, view an index of "thumbnail" images of such recordings and still images, fast forward, fast reverse, and stop playing video clips, select a video/still capture image resolution mode of 1 , 3 or 6 mega-pixels, record audio voice clips, turn image date stamping on and off, enable and disable automatic image stabilization, adjust the white balance setting of captured images, turn image histogram displays on and off, choose from amongst natural color, black and white, and sepia toned image capture, manually adjust the image exposure level, activate a 10-second electronic shutter self-timer, enable/disable on screen display icons, select the video output resolution (i.e., 640x480 or 320x240 pixels), and
  • the on-screen menu can also be employed to delete images and video clips, view a "slide show" of previously captured images, and to print images directly to an attached, PICTBRIDGE®-compatible printer.
  • the on-screen menu can be used to set an internal date and time, enable/disable audio beep sounds, set the display flicker frequency to 50Hz or 60Hz, set the direct, analog TV output of the high speed I/O data port to either NTSC or PAL video formats, set the brightness of video display unit 36, format the internal and removable storage media; turn automatic shutoff on and off, set the language for the on screen display, and set a mode of operation of the USB port (depending upon the setting, when connected to a personal computer via the high speed USB port, the on screen display will either display a menu permitting the physician to select a desired connection mode, will automatically connect in "removable disk” mode, or will automatically enter printer mode).
  • a high speed I/O data transfer port (not shown) on the video display unit 36 permits both digital data transfers to an external computer, such as a personal desktop or laptop computer, via a conventional Universal Serial Bus (USB) interface, as well as analog video output to a conventional video display monitor, via an appropriate accessory AV cable.
  • Data transfer port when coupled to a PICTBRIDGE®-compatible USB printer, permits still images captured by the endoscopic camera to be printed directly, without the need for an intermediate external computer.
  • a power-on switch (not shown) is disposed on the endoscope 32.
  • a snap fit battery door (not shown), removable with the aid of a plurality of gripping ribs, permit access to a portion of the interior of endoscope 32, to permit removal and replacement of a rechargeable battery powering the endoscope 32, as well as the insertion and removal of a flash memory card storing captured motion video and/or still images.
  • a functional block diagram (not shown) of one embodiment of the present invention includes an endoscope 32 having an image acquisition device which may be a CCD chip 110, for example.
  • the image acquisition device is connected to the input of a preamplifier which provides an output coupled to an electrical line extending through the flexible insertion tube 34 and to the connector card at the holder 44.
  • the endoscope 32 further includes the fiber light source extending through the flexible insertion tube 34 and to the connector 20.
  • the plurality of user input control switches or buttons 50 each have a circuit which extends to a connector card at the holder 44.
  • the video display unit 36 includes an analog-to-digital converter coupled to the connector of the video display unit 36.
  • the image processor is coupled to the A/D converter.
  • the image processor is also coupled to the controller, various memory, and various optional external interfaces.
  • the controller is also coupled to various memory and optional external interfaces, as well as the user input control switches or buttons 50.
  • the optional external interfaces can include a high speed data transfer port 142, an analog output, such as audio S for coupling to an external device, and removable flash memory.
  • On board flash memory can also be provided in the display unit 36.
  • Additional internal components of the endoscopic system include a battery, removable flash memory card, primary printed circuit board, secondary printed circuit boards.
  • the battery is preferably a conventional lithium-ion type battery, which can be removed for recharging in a separate charging unit by first removing battery door from the main body portion or proximal end of the endoscope 32.
  • a battery recharging jack can be disposed on the main body portion, and a suitable recharging cradle or stand supplied, to permit the battery to be recharged in situ.
  • Removable flash memory card preferably comprises an industry standard Secure Digital (SD) card, Mini SD card with SD card adapter, or MultiMedia card (MMC).
  • SD Secure Digital
  • MMC MultiMedia card
  • Memory card is releasable and is retained within an associated card slot, and can be removed from within the camera housing upon removal of the battery door.
  • Primary printed circuit board can include much of the circuitry, including A/D converter, digital signal processor or microprocessor, controller, and on-board flash memory. Secondary printed circuit board may carry direction button, mode button, and menu button. Secondary printed circuit board may carry redundant video record button and redundant still photograph shutter button.
  • Main body portion may further contain a miniature microphone (not shown), also coupled to primary printed circuit board.
  • the microphone permits the physician to record sound clips, such as voice annotations, to the internal flash memory storage or the removable flash memory card, and to transfer such sound/voice clips to an external personal computer.
  • FIG. 3 shows another embodiment of the endoscopic system of the present invention.
  • FIG. 3 shows an endoscopic imaging system 60 which includes an endoscope 32 having a flexible insertion tube 34, with a distal image sensor 24 and related components (not shown in FIG. 3) located at the distal end of the insertion tube 34.
  • a wire or line extends from the distal image sensor 24 through the length of the flexible insertion tube 12 to the proximal end or main body portion of the endoscope 32.
  • a removable viewing screen or video display unit 36 is shown coupled to the endoscope 32.
  • the system 60 of FIG. 3 is very similar to the system 30 of FIG. 2, with the exception that the majority of the electronics are located outside of the main body portion or proximal end of the endoscope 32. For example, as described in connection with FIG. 2, the majority of the electronic components are located in the removable video display unit 36.
  • a cord 80 extends from the removable video display unit 46 to a removable adaptor 70.
  • the removable adaptor 70 may include the user switches or buttons 50.
  • the adaptor 70 is removably attachable to the endoscope 32, together with the cord 80 and removable video unit 36 to accommodate cleaning of the endoscope 32.
  • the majority of the electronics reside in the adaptor 70.
  • the A/D converter, image processor and controller are located in the adaptor 70 and are coupled to the video display unit 36 via the cord 80.
  • the two axis control 90 provides control of the distal end of the flexible insertion tube 34 as is known in the art.
  • video compression in DV quality is performed using MPEG-4 video compression. Stills are compressed using a JPEG compression algorithm: both are industry standard methods for data compression. After use, images can be transported from the removable flash RAM drive (SD RAM) or transmitted via USB-2 to another computing device. Image viewing can also be performed live via the USB- 2 cable to a computing device or via the AV output to a compatible video monitor. Voice recordings can also be captured while recording to annotate clinical findings.
  • SD RAM removable flash RAM drive
  • Voice recordings can also be captured while recording to annotate clinical findings.
  • FIG. 4 illustrates one embodiment of the present invention.
  • information is captured via a video capture device 402 such as an endoscopic imaging system.
  • This information is uploaded via upload 416 to a computer 404 via a wired or wireless connection.
  • upload 416 can be USB, WiFi, Bluetooth or the like.
  • Computer 404 can import information from a plurality of video capture devices.
  • computer 404 can import files such as DICOM files.
  • DICOM Digital Imaging and Communications in Medicine standard for distributing and viewing any kind of medical image regardless of the origin.
  • Storage system 406 communicates with computer 404 via communicator 418.
  • Communicator 418 can be XMPP (Extensible Messaging and Presence Protocol) or DICOM for example.
  • storage system 406 is web based, is a connection and presence manager and provides video relay and buffer. The system passes on pre-recorded video streams in DICOM format and converts live video to formats that will stream on various devices. Illustrative devices depicted include an iPhone® 408, second computer 410, web browser 412 and other devices 428.
  • Storage system 406 communicates with iPhone® via iPhone® communicator 420, iPhone® communicator can encompass for example SMS (short message service), Email, XMPP, DICOM, and H.264 (a standard for video compression).
  • Storage system 406 communicates with second computer via second computer communicator 422, second computer communicator can encompass for example Email, XMPP, DICOM, and H.264.
  • Storage system 406 communicates with web browser via web browser communicator 424, web browser communicator can encompass for example Email, HTTP, and FLV (flash video).
  • iPhone® 408 can include a DICOM viewer.
  • Second computer 410 can include a DICOM viewer and can 'export DICOM files to other EMR (electronic medical record) software.
  • Web browser 412 can include a FLV viewer and can be web based.
  • a network of medical data communications is contemplated.
  • such network is obtained by connecting a palm held endoscopic imaging system to personal computers and mobile devices.
  • such network further includes multiple medical devices connected to a myriad of health information transmission systems. Examples of contemplated medical devices include but are not limited to bronchoscope, laryngoscope, gastroscope and the like.
  • a first use scenario applies to the situation where both sender and receiver use a transmission software application.
  • a Data Sender is a practitioner at a first hospital or care center, who evaluates a patient.
  • the Data Receiver is a practitioner at the same first hospital or care center, who is presently attending to other patients. At least one other practitioner is off site ("Offsite Practitioner")-
  • the Data Sender begins an examination such as an EGD endoscopy and selects the Data Receiver and the Offsite Practitioner as recipients of the related data. Both the Data Receiver and the Offsite Practitioner are instantly notified that the examination is starting.
  • the Data Receiver and Offsite Practitioner receive live streaming video on their data compliant devices (mobile phone, PC, or other device) and can watch the video in progress without being present.
  • This feature allows the Data Sender to see that the Data Receiver and the Offsite Practitioner are watching the video in transmission. Further, the Data Receiver and Offsite Practitioner can point to areas under evaluation for the Data Sender to navigate and inspect more closely. [0069] Based upon the transmitted video, the Data Sender can request opinions from the Data Receiver and Offsite Practitioner. Further, should a recipient such as the Data Receiver and/or Offsite Practitioner have a time conflict during the examination and/or subsequent procedures the video can be saved and reviewed at a later date/time.
  • a second use example applies to the situation where only the sender has access to use the transmission software/application.
  • the Data Sender can be, for example a physician in a rural setting.
  • the Data Sender practitioner performs an examination/evaluation with a data transmission compliant examination device.
  • a portable endoscopic camera is data transmission compliant.
  • the Data Sender records the video of the examination/evaluation to the device.
  • a component of the device is connected to an office computer via a wired or wireless connection such as USB, WiFi, Bluetooth or the like.
  • the Data Sender can then contact a Consulting Practitioner to provide a password and send a text message having a secure link to view the video.
  • the Consulting Practitioner can view the video from any location with a Web browser.
  • the consulting Practitioner is also texted and emailed instructions on how to deactivate (ban) access to the video by clicking a specific link
  • the point of care system disclosed herein combines portable imaging with web based image and video storage in a secure, HIPAA compliant environment.
  • the system comprises a camera, web services and desktop application.
  • a hand held, portable endoscopic imaging system comprises a high definition camera with a universal scope coupler, a removable video display unit such as a liquid crystal display touch screen with multimedia playback, and a USB docking station used for battery charging and data transfer.
  • An online data storage and collaborative site is further provided.
  • the user can upload, store, manage, manipulate, and share exam findings such as endoscopic examinations.
  • Using the disclosed system with its desktop companion allows data to be shared via an automated push and pull of imaging data streamlines workflow.
  • Features of the disclosed system can include: filing exams based on patient demographics, annotation of exams, search capabilities, report generation, editing of video, frame by frame analysis of video, and secure online sharing of endoscopic images and video.
  • FIG. 5 is a block diagram of an exemplary unified imaging platform according to the disclosure.
  • a unified imaging platform 500 includes a display 502, one or more processors 504, a network interface 506, a storage 508, a medical device interface 510 and a user interface 512.
  • digital image data from a medical imaging device is received via the medical device interface 510.
  • the medical device interface 510 forms an interface between the unified imaging platform 500 and a medical imaging device such as an endoscope.
  • the medical device interface can be a wired or wireless interface.
  • the digital image data can be processed by one or more of the processors 504 and displayed on the display 502 and/or stored in the storage 508.
  • the processors 504 can include one or more of a microprocessor, a digital signal processor, a microcontroller, a programmable logic device, or any now known or later developed processing device suitable for use in the unified imaging platform 500.
  • the display can include an LCD display, an LED display, a plasma display, a cathode ray tube (CRT) display, or any now known or later developed display suitable for use in the unified imaging platform 500.
  • the storage 508 can include an electronic data storage device (e.g., SDRAM, ROM, EEPROM, Flash, or the like), a magnetic data storage device (e.g., a hard disk drive), an optical data storage device (e.g., a CD or DVD drive), or any now known or later developed data storage device suitable for use in the unified imaging platform 500 to store digital image, digital video and/or associated data.
  • an electronic data storage device e.g., SDRAM, ROM, EEPROM, Flash, or the like
  • a magnetic data storage device e.g., a hard disk drive
  • an optical data storage device e.g., a CD or DVD drive
  • any now known or later developed data storage device suitable for use in the unified imaging platform 500 to store digital image, digital video and/or associated data.
  • the unified imaging platform 500 can be controlled by a user via the user interface 512, which can include one or more of a switch, a button, a position sensing device (joystick, mouse, trackball, or the like), a touch screen, a keyboard, or any now known or later developed user interface element suitable for use in the unified imaging platform 500.
  • a switch can include one or more of a switch, a button, a position sensing device (joystick, mouse, trackball, or the like), a touch screen, a keyboard, or any now known or later developed user interface element suitable for use in the unified imaging platform 500.
  • the unified imaging platform 500 can communicate with external networks or systems via the network interface 506 which can include a wired or wireless network interface.
  • FIG. 6 is a block diagram of an exemplary endoscopic system having a rigid or flexible image collection end and a proximate image sensor.
  • an endoscopic system 600 includes a display unit 602, an endoscope 604, a proximate image sensor 606 and a rigid or flexible optical insertion tube 608.
  • proximate image sensor 606 In operation, light is transmitted from a distal end of the insertion tube 608 to the proximate image sensor 606, which produces an analog or digital image signal.
  • the proximate image sensor transmits the image signal to the endoscope 604 and, in turn, to the display unit 602, which can be a unified imaging platform similar to that shown in FIG. 5.
  • An image, generated from the image signal, can be viewed on the display unit 602.
  • the image can also be edited, stored or transmitted to another system by the display unit 602.
  • the display unit 602 can be removed from the endoscope 604.
  • FIG. 7 is a block diagram of an exemplary endoscopic system having a distal image sensor and an electrically coupled display unit.
  • an endoscopic system 700 includes a display unit 702, an endoscope 704, an electrical link in a flexible insertion tube 706 and a distal image sensor 708.
  • the distal image sensor 708 produces an analog or digital image signal, which is transmitted via the electrical link 706 to the endoscope 704 and, in turn to the display unit 702, which can be a unified imaging platform similar to that shown in FIG. 5.
  • An image, generated from the image signal, can be viewed on the display unit 702.
  • the image can also be edited, stored or transmitted to another system by the display unit 702.
  • the display unit 702 can be removed from the endoscope 704.
  • FIG. 8 is a block diagram of an exemplary system having a distal image sensor and a wirelessly coupled display unit.
  • an endoscopic system 800 includes a display unit 802, a wireless link 804, an endoscope body 806, an electrical link in a flexible insertion tube 808 and a distal image sensor 810.
  • the distal image sensor 810 produces an analog or digital image signal, which is transmitted via the electrical link 808 to the endoscope body 806 and, in turn to the display unit 802 via the wireless link 804.
  • the display unit 802 can be a unified imaging platform similar to that shown in FIG. 5.
  • An image, generated from the image signal, can be viewed on the display unit 802.
  • the image can also be edited, stored or transmitted to another system by the display unit 802.
  • the display unit 802 can be removed from the endoscope body 806.
  • FIG. 9 is a block diagram of a display unit coupled to an endoscopic imaging cart system.
  • a medical imaging system 900 includes a display unit 902 coupled to a medical imaging system 904.
  • the display unit 902 can be a unified imaging platform similar to that shown in FIG. 5.
  • An image can be viewed on the display unit 902.
  • the image can also be edited, stored or transmitted to another system by the display unit 902.
  • FIG. 10 is a block diagram of a display unit coupled with a docking station.
  • a medical imaging system 1000 includes a display unit 1002 coupled to a docking station 1004 that can include a link 1006 to an external system or network.
  • the display unit 1002 can be placed in the docking station 1004 for battery recharging and/or data transfer. Data transfer between the display unit 1002 and external systems can occur via the docking station 1004 and the link 1006.
  • FIG. 11 illustrates software system architecture.
  • the system 110 includes a medical imaging device 1102 (e.g., a device similar to that shown in FIGS. 6-9).
  • the system also includes a mass storage 1106.
  • the medical imaging device 1102 and the mass storage device are coupled to a plugin API 1110 via links 1104 and 1108, respectively.
  • the plugin API is also coupled to a health information system 1112 via an HL7 link.
  • the health information system 1112 is also coupled to a web services API 1116 via an interface 11 14 (e.g., an XML/REST interface).
  • the system 110 also includes an imaging management station 1118, a mobile device 1122 and a remote system 1126 respectively coupled to the web services API 1116 via XML/REST interface links 1120, 1124, 1128.
  • a local cache storage 1130 is also coupled to the remote system 1126.
  • the web services API 1116 is also coupled to a web services system 1132 via an XML/REST interface link 1134.
  • the web services system is coupled to a patient records database 1138 and a cloud storage 1140 via interfaces 1136 and 1144, respectively.
  • the cloud storage 1140 is coupled to the web services API 1116 via a streaming media interface 1142.
  • the system can include a web based storage system for images and video such as endoscopic images and video.
  • a number of web based services can be utilized via a REST style interface. All communication between clients and the web server is done over HTTPS using 256 bit AES encryption.
  • three clients are implemented: a web application, an iPhone native application, and a desktop application.
  • the system is highly decoupled and makes use of open standards making it very flexible.
  • the web server is composed of a pair of Amazon EC2 instances: the main server and a secondary server that acts as a database read slave and can function as a fail-over server in case the master server instance were to go down.
  • Storage of images and video is handled for example by Amazon S3.
  • Amazon EC2 and S3 are high performance, highly scalable and very secure.
  • a single server is estimated to handle approximately 200-300 simultaneous users. Additional users can be supported by adding a load balancer and creating additional master-slave server instances.
  • Hourly snapshots of server and database state are saved to Amazon EBS. Data is continuously backed up and new server instances can be brought online in minutes. A random back-up is selected each week and a complete recovery is performed on a new server instance (separate from the production server) to simulate a disaster recovery.
  • Access to the web services requires a software systems account, an authenticated user within that account, and authorization to perform a particular action on a particular resource by that user. Authentication and authorization are handled by the server.
  • Each account has its own URL and its own separate database within the system. Inside of each account there may exist any number of user accounts. Users can be given coarse grained access controls. Users marked as "admin" have complete control over their account. Users not marked as admin must be assigned permission to read, create, update or delete patients, files, procedures or other users.
  • FIG. 12 illustrates integration with EMR.
  • the system 1200 includes a medical imaging device 1214 coupled to a plugin API 1216 via link 1220.
  • An imaging management station 1218 is coupled to the plugin API 1216 via link 1222 and coupled to a web services API 1224 via link 1226 (e.g., an XML/REST interface).
  • the plugin API 1216 is coupled to an integration engine 1212 via an interface 1228 (e.g., HL7).
  • the integration engine 1212 is also coupled to the web services API 1224 via an interface 1230 (e.g., an XML/REST interface).
  • the integration engine 1212 is coupled to a message transformer 1210, which is coupled to a message router 1208 and another message transformer 1206.
  • the message transformer 1206 is coupled to an EMR/HIS 1202 via a link 1204 (e.g., an HL7 interface).
  • an integration engine is used to coordinate traffic between the EMR, the web services, and the application (and by proxy, the LCD).
  • An exemplary integration engine is MirthConnect. (http://www.mirthcorp. com/community/overview).
  • a listener in implemented in Mirth that receives orders (ORM) for endoscopic procedures from AllMeds.
  • ORM orders for endoscopic procedures from AllMeds.
  • An exemplary ORM is provided below:
  • a web service request is constructed using REST API, which then stores the order in our database.
  • the user docks their LCD into the docking station. This will cause the Application to go through the process outlined above, additionally pulling the order ID down and storing it with the patient folder on the LCD. Alternatively, the doctor may simply enter the patient chart number on the LCD and skip this initial docking process. The doctor then proceeds to perform the examinations.
  • the application copies all data from the eGo and begins uploading the image and video data. Once an image or video is uploaded, the application will look locally for the procedure ID.
  • the web service will query the web service to try and find a procedure that matches the patient chart number (as entered on the LCD) and the capture date of the image. If a procedure ID is found, the application will construct an ORU message containing OBX segments that reference the image and video data. The references are pre-authenticated URLs that point to the image and video data. The ORU is sent to Mirth where it will finally be forwarded to the EMR.
  • 31276 A Nasal/Sinus Endoscopy, Surgical w/Frontal Sinus Exploration, w/wo
  • This ORU will contain as many OBX segments as there were images or videos for the exam.
  • the links are stored with the patient record as external documents.
  • the default web browser is opened pointing to the file.
  • the EMR must support the ability to handle an external web link.
  • the link is a direct link to the media data and should display in most browsers.
  • One option is for the EMR to simply launch the default browser on the system and have it pointing at the file.
  • the server When an authorized user requests a pre-authenticated link, the server generates a digital signature for that link.
  • the pre-authenticated nature of the link means that neither the email recipient nor the EMR needs to know the credentials of the user that created the link in order to access the resource.
  • the signature in the link is only valid for a specific resource and for a specific access method, and optionally, for a specific period of time. It is not possible for someone to simply point the link to a new resource and gain unauthorized access.
  • the server authorizes the request by computing a signature using procedure such as: canonical request: HTTP_method ⁇ n (GET, PUT, POST, DELETE, HEAD, etc) timestamp ⁇ n expiration ⁇ n (expiration is optional) request url hmac: HMAC-SHAl (canonical request, secret code) signature: base64(hmac)
  • FIG. 13 provides a screen shot illustrating a web application front end.
  • the web application is built using Microsoft Silverlight 3 and runs in Firefox, Internet Explorer, and Safari web browsers on Windows and Mac OS X. It provides a user friendly front end for managing patients, images and video, editing video, sharing images and video via secure link, side by side comparison of images and video and report generation.
  • the application is installed on the user's computer. It runs natively on Windows and Mac OS X. Exemplary tasks include identifying docketing of LCD unit into the docking station, copy data to and from the LCD unit, and communicate with the web services and heath information systems.
  • a Python based plugin system is contemplated as one means for the system to be extensible by end users.
  • the application requires the user to log in and also communicates over HTTPS.
  • FIG. 14 shows a flowchart of an exemplary workflow within the system which includes: a user performing examination(s) 1404; user docking the LCD display unit (e.g., unified imaging platform) with a docking station 1406; application software recognizes LCD and copies all data from the LCD to the PC 1408; application queries web services for patient schedule and populates LCD with folders representing the patients (folder name is patient first initial, first 4 letters of last name) 1410; application releases the LCD 1412, LCD is now ready for additional exams.
  • the application is uploading images and videos to web service and forwarding information to integration engine 1414.
  • FIG. 15 provides an example of a high definition camera medical imaging system having a removable display device.
  • This specific example comprises a camera unit, a video display unit and a docking station.
  • Capabilities and elements of the system disclosed herein can include for example, an on-board image processor, capability for high definition video and six megapixel photos, liquid crystal display viewing screen, touch screen for data input, onboard memory for archiving images, removable memory for transferring data to various personal computing and memory devices, high speed digital data transfer for live image viewing via a traditional monitor or on a personal computing device, and virtual Repository of endoscopic images and videos.
  • system capabilities and elements can include for example, the ability to capture images such as endoscopic images with a hand held device, the ability to obtain high definition images and videos, a removable touch screen liquid crystal display, a sophisticated user interface, mobile multimedia play back, light source optimization technology, user specified light balances which may be optimized to work with Halogen, LED, Halide, or Xenon light sources, manual white balance, and automatic white balance.
  • system capabilities and elements can include for example, high definition images and video that can be uploaded and stored on a secure data management system, the ability to store information automatically in a secure HL7 format, the ability to easily store and transfer electronic medical records, the ability to extract a still image from a video, trim the video, capability for one touch download, and side by side comparison of videos, photos, and CT images.
  • system capabilities and elements can include for example, ability for practitioners to share images/ exams at the point of care with the removable liquid crystal display monitor, dual image comparison allowing practitioners to demonstrate patient's normal and abnormal pathology, ability to automatically upload data to streamline workflows by eliminating redundant capture, tag, record, export, and import tasks normally associated with moving data such as endoscopic data; and a web based storage solution that sends a secure link to email allowing practitioners to reach and or send data anytime, anywhere without restrictions of video file size.
  • a camera unit weighs about 410 grams, is about 6.5" long, 7.5" tall without LCD, 10" tall with LCD, provides 1280x720 resolution HD video (MPEG4 compression, AVI format), provides five mega pixel still image (JPEG format), and comprises a CMOS image sensor, universal C-mount endoscope coupler, HDMI digital video output, Composite analog video output, removable, rechargeable lithium- ion battery, hot keys for still/video capture and zoom in/out, and a rugged, powder- coated magnesium shell.
  • the video display unit weighs about 100 grams, is about 3.75" x 3.25" x 1.125", and comprises a 3.5" touch screen (as measured on the diagonal), an removable SD card, a multimedia playback, a non-removable, and a rechargeable lithium-ion battery.
  • the docking station is 4.5" x 2.25" x 4.5"and comprises a 50 pin port for the LCD unit, charging ports for lithium-ion batteries, wall power port (DC 5V at 3A), and USB 2.0 mini port.
  • the docking station in one embodiment implements mass storage driver for data transfer (USBSTOR on Windows).
  • Administrative, physical and technical safeguards consistent with HIPAA Security Standards are envisioned to protect the confidentiality, integrity and availability of data. These safeguards include housing servers in physically secure, geographically disperse data centers, protecting servers with firewalls, securing remote connections to servers via encryption means such as 256 bit AES encryption, providing each user with a unique id and password which is required to access the system, maintaining system backups, providing redundant systems for fail-over, and logging all access attempts and system activity.
  • System design features related to HIPAA compliance include file names are anonym zed and stored separately from patient data, minimal patient data is stored in web database relying instead on EMRs and other HIT systems to store more comprehensive demographics.
  • the server compares the computed signature with the signature in the query string. If any part of the request is different from the original, the signatures will not match and so the request is denied.
  • the secret code is unique for each account and known only to the server.
  • the optional expiration parameter allows the sender to deny access to the resource after a specific period of time. This does not prevent the receiver from downloading the resource before that expiration period and obtaining a local copy, however this is not the intended purpose of the expiration parameter. It is assumed that the receiver is a trusted party and that there is no issue with their obtaining a local copy of the resource. However, when sending a link to an external party, certain security aspects can be out of the control of the sender.
  • the link may be stored on an unsecured machine in plain-text, the link may be sent or received over an unsecured channel, the link may be inadvertently sent to the wrong party.
  • the expiration parameter provides a mechanism to limit the amount of time a particular resource is vulnerable to these types of unintended exposures in the wild.
  • Links stored in the EMR do not typically have an expiration parameter since the communication channels between the application, Mirth and the EMR are assumed to be secure. Also, the links within the EMR are assumed to be protected by the EMRs own security systems.
  • An important aspect of the pre-authenticated links is that they contain no identifying patient information. However, there is no mechanism in the system to determine whether or not there is patient information embedded in the file that the link points to. For example, the patient's name may be spoken in the audio track of a video, or their name and date of birth may be embedded in a CT image. In all cases, it is the responsibility of the user to redact any potentially sensitive information before a file or link to a file is transmitted to another party.
  • the viewing screen on the camera may be a commercially available twin LCD display having a backlight and a system LSI (large-scale integrated circuit) chip between two LCD screens, allowing both sides of the display to work at the same time.
  • the system may include an audio input for accommodating stroboscopic analysis.

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Abstract

L'invention porte sur une plateforme d'imagerie unifiée. La plateforme d'imagerie unifiée peut être adaptée pour une utilisation avec une diversité de dispositifs d'imagerie médicale. La plateforme d'imagerie médicale unifiée peut comprendre un dispositif d'affichage, un processeur, un dispositif de stockage de données et une ou plusieurs interfaces externes. La plateforme d'imagerie unifiée peut être couplée de façon amovible à un dispositif d'imagerie médicale tel qu'un endoscope. La plateforme d'imagerie unifiée peut être couplée au dispositif d'imagerie médicale par l'intermédiaire d'une liaison câblée ou sans fil. A l'aide de services Internet, la plateforme d'imagerie unifiée peut également transférer des données d'image à d'autres dispositifs comprenant un système d'ordinateur de bureau local, un dispositif mobile et/ou un système distant.
EP10767617A 2009-04-20 2010-04-20 Système d'imagerie Withdrawn EP2421425A4 (fr)

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CN106725248A (zh) * 2016-12-30 2017-05-31 广州华友明康光电科技有限公司 一种手持式医疗电子内窥镜多屏显示系统
CN110461211A (zh) 2017-03-24 2019-11-15 柯惠有限合伙公司 内窥镜和治疗方法
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WO2010123858A2 (fr) 2010-10-28
CN102458217A (zh) 2012-05-16
EP2421425A4 (fr) 2012-09-19
WO2010123858A3 (fr) 2011-01-20
JP2012523944A (ja) 2012-10-11
KR20120008059A (ko) 2012-01-25

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