Medford/Somerville, MA, USA. There is a basic problem with colonoscopy: when the endoscope is inserted into the colon during routine screening, its tip can impinge against the colon wall and stall the procedure as an endoscopist navigates the scope through bends and turns in the colon.

Colonoscopy is regarded as the most thorough way to screen for colon cancer but the potentially life-saving procedure can also be painful. Scientists and engineers continually research new ways to reduce patient discomfort while ensuring the exam's accuracy.

Modern devices for colonoscopy use fiber optics to guide the endoscope during routine screenings. The technology uses sensors and digital electronics that display the 'scopes forward view and position on a video monitor. A new device has entered this market, the Tufts endoscopic fiber optic shape tracker (EFOST), with a backward view, which could lower costs, increase patient comfort, and broaden the number of doctors qualified to provide such examinations.



Colorectal cancer growths can appear in the appendix, colon (the longest part of the large intestine), rectum, and (in some definitions) the anus.

Commonly known as bowel cancer, colorectal cancer is the third leading cause of cancer-related deaths in the world. In 2008, an estimated 1.23 million new cases were diagnosed that killed more than 600,000 people.

The American Cancer Society (ACS) estimates that 102,900 new cases were diagnosed in the United States (2010), of which 39,670 were rectal (51,370 for colon and rectal combined).

Colon cancer has a high cure rate when detected early. Most men and women are advised to start periodic colonoscopies at age 50.

The National Cancer Institute (NCI) has several informative resources on its website to help with Understanding Colon and Rectal Cancer.The technology is a possible solution to a basic problem when the endoscope is inserted into the colon during routine screening. As an endoscopist navigates through the bends and turns in the colon, the tip of the scope can impinge against the colon wall.

When this happens, the tip becomes stationary and unable to move forward. As the physician applies more pressure, a loop can form in the length of scope behind the tip. Because the traditional endoscope provides only a frontal view during the procedure, the doctor cannot see the loop, nor easily maneuver the scope to remove it. Not surprisingly, looping can be a major source of pain during a colonoscopy.

The new system outfits an endoscope with fiber optic bend sensors and digital electronics that display its position and shape on a video monitor, coverting the traditional mechanical device into a more advanced visual navigation tool.

Associate Professor of Mechanical Engineering Caroline G.L. Cao, Ph.D. at the Tufts University School of Engineering led the development effort. "Doctors will have a way to see in real-time how the scope is moving inside the patient's body," says Cao.

"If the scope begins to loop, they will see it instantaneously and then be able to make adjustments to straighten it out." Cao and Tufts Research Associate Professor Peter Y. Wong, Ph.D, describe their concept in a paper that appears in the journal Optical Engineering.

Bend Sensors to Create a Visual Image

Using a prototype, the Tufts engineers embedded quantum dots — nano-sized crystals of semiconductor material — circumferentially at intervals along the length of an optical fiber. The researchers stretched the fiber around a metal cylinder to create a bending effect. They then injected a laser light beam into the fiber's inner core from one end.

The fiber's core released light as it is bent. This activated the quantum dots. Instantly, the dots reemitted light signals of varying intensity to a spectrometer. With this data, the researchers were able to measure the degree of curvature in the fiber. From the position of the activated dots, the researchers were also able to calculate the direction of the bend. "The greater the bend, the more intense the light emissions," says Cao.

In a separate experiment, the team used an inanimate model colon made of polyurethane foam.. They inserted the modified fiber inside an endoscope and then threaded the device into the model. The researchers were able to produce a video image by sending the data through a digital processor which created a real-time image of the scope in the model colon.

Cao notes, "Physicians can use the image on the monitor to guide them. They'll know exactly where the end of the point is, as well as the shape of the scope inside the colon."

The commercialization of EFOST is being managed by Tufts University's Office for Technology Licensing and Industrial Collaboration. There are currently patents pending in the USA, Canada, Europe, Japan and Australia. The next step, Cao says, is to acquire funding to launch a start-up company and then move on to further development of the technology, including eventual clinical trials.

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