US20050143627A1 - Fluorescence endoscopy video systems with no moving parts in the camera - Google Patents

Abstract

A fluorescence endoscopy video system includes a multi-mode light source that produces light for white light and fluorescence imaging modes. Light from the light source is transmitted through an endoscope to the tissue under observation. The system also includes a compact camera for white light and fluorescence imaging, which may be located in the insertion portion of the endoscope, or attached to the portion of the endoscope outside the body. The camera can be utilized for both white light imaging and fluorescence imaging, and in its most compact form, contains no moving parts.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application is a divisional of U.S. patent application Ser. No. 10/050,601, filed Jan. 15, 2002, the benefit of the filing date of which is being claimed under 35 U.S.C. § 120.
FIELD OF THE INVENTION
• The present invention relates to medical imaging systems in general, and in particular to fluorescence endoscopy video systems.
BACKGROUND OF THE INVENTION
• Fluorescence endoscopy utilizes differences in the fluorescence response of normal tissue and tissue suspicious for early cancer as a tool in the detection and localization of such cancer. The fluorescing compounds or fluorophores that are excited during fluorescence endoscopy may be exogenously applied photo-active drugs that accumulate preferentially in suspicious tissues, or they may be the endogenous fluorophores that are present in all tissue. In the latter case, the fluorescence from the tissue is typically referred to as autofluorescence or native fluorescence. Tissue autofluorescence is typically due to fluorophores with absorption bands in the UV and blue portion of the visible spectrum and emission bands in the green to red portions of the visible spectrum. In tissue suspicious for early cancer, the green portion of the autofluorescence spectrum is significantly suppressed. Fluorescence endoscopy that is based on tissue autofluorescence utilizes this spectral difference to distinguish normal from suspicious tissue.
• Since the concentration and/or quantum efficiency of the endogenous fluorophores in tissue is relatively low, the fluorescence emitted by these fluorophores is not typically visible to the naked eye. Fluorescence endoscopy is consequently performed by employing low light image sensors to acquire images of the fluorescing tissue through the endoscope. The images acquired by these sensors are most often encoded as video signals and displayed on a color video monitor. Representative fluorescence endoscopy video systems that image tissue autofluorescence are disclosed in U.S. Pat. No. 5,507,287, issued to Palcic et al.; U.S. Pat. No. 5,590,660, issued to MacAulay et al.; U.S. Pat. No. 5,827,190, issued to Palcic et al., U.S. patent application Ser. No. 09/615,965, and U.S. patent application Ser. No. 09/905,642, all of which are herein incorporated by reference. Each of these is assigned to Xillix Technologies Corp. of Richmond, British Columbia, Canada, the assignee of the present application.
• While the systems disclosed in the above-referenced patents are significant advances in the field of early cancer detection, improvements can be made. In particular, it is desirable to reduce the size, cost, weight, and complexity of the camera described for these systems by eliminating moving parts.
SUMMARY OF THE INVENTION
• A fluorescence endoscopy video system in accordance with the present invention includes an endoscopic light source that is capable of operating in multiple modes to produce either white light, reflectance light, fluorescence excitation light, or fluorescence excitation light with reference reflectance light. An endoscope incorporates a light guide for transmitting light to the tissue under observation and includes either an imaging guide or a camera disposed in the insertion portion of the endoscope for receiving light from the tissue under observation. A compact camera with at least one low light imaging sensor that receives light from the tissue and is capable of operating in multiple imaging modes to acquire color or multi-channel fluorescence and reflectance images. The system further includes an image processor and system controller that digitizes, processes and encodes the image signals produced by the image sensor(s) as a color video signal and a color video monitor that displays the processed video images.
BRIEF DESCRIPTION OF THE DRAWINGS
• The foregoing aspects and many of the attendant advantages of this invention will become more readily appreciated as the same become better understood by reference to the following detailed description, when taken in conjunction with the accompanying drawings, wherein:
• FIGS. 1A-1B are block diagrams of a fluorescence endoscopy video system according to one embodiment of the present invention;
• FIGS. 2A-2B are block diagrams of a multi-mode light source in accordance with different embodiments of the present invention;
• FIG. 3 shows a filter wheel and optical filters for the multi-mode light source;
• FIGS. 4A-4C illustrate a number of alternative embodiments of a camera that can acquire color and/or fluorescence/reflectance images according to one embodiment of the present invention with optional placement for collimation and imaging optics;
• FIGS. 5A-5C illustrate a number of camera beamsplitter configurations;
• FIGS. 6A-6E are graphs illustrating presently preferred transmission characteristics of filters utilized for color imaging and fluorescence/reflectance imaging with the camera embodiments shown inFIGS. 4A-4C;
• FIGS. 7A-7B illustrate additional embodiments of a camera according to the present invention that can acquire color, fluorescence/reflectance, and/or fluorescence/fluorescence images according to an embodiment of the present invention with optional placement for collimation and imaging optics; and
• FIGS. 8A-8F are graphs illustrating presently preferred transmission characteristics of filters for color imaging, fluorescence/fluorescence imaging, and fluorescence/reflectance imaging with the camera embodiment shown inFIGS. 7A-7B.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
• FIG. 1A is a block diagram of a fluorescenceendoscopy video system50 in accordance with one embodiment of the present invention. The system includes amulti-mode light source52 that generates light for obtaining color and fluorescence images. The use of the light source for obtaining different kinds of images will be described in further detail below. Light from thelight source52 is supplied to anillumination guide54 of anendoscope60, which then illuminates atissue sample58 that is to be imaged.
• As shown inFIG. 1A, the system also includes amulti-mode camera100, which is located at the insertion end of theendoscope60. The light from the tissue is directly captured by themulti-mode camera100. With themulti-mode camera100 located at the insertion end of the endoscope, the resultingendoscope60 can be characterized as a fluorescence video endoscope, similar to video endoscopes currently on the market (such as the Olympus CF-240L) in utility, but with the ability to be utilized for fluorescence/reflectance and/or fluorescence/fluorescence imaging, in additional to conventional color imaging. Fluorescence/reflectance and fluorescence/fluorescence imaging will be described in detail below. By locating the camera at the insertion end of the endoscope, the inherent advantages of a video endoscope can be obtained: namely, the light available to form an image and the image resolution are improved compared to the case when the image is transmitted outside the body through an endoscope imaging guide or relay lens system.
• A processor/controller64 controls themulti-mode camera100 and thelight source52, and produces video signals that are displayed on avideo monitor66. The processor/controller64 communicates with themulti-mode camera100 with wires or other signal carrying devices that are routed within the endoscope. Alternatively, communication between the processor/controller64 and thecamera100 can be conducted over a wireless link.
• FIG. 1B is a block diagram of an alternative fluorescenceendoscopy video system50, which differs from that shown inFIG. 1A in thatendoscope60 also incorporates animage guide56 and themulti-mode camera100 is attached to an external portion of the endoscope that is outside the body. The light that is collected from the tissue byendoscope60 is transmitted through theimage guide56 and projected into themulti-mode camera100. Other than the addition of theimage guide56 toendoscope100 and the location of themulti-mode camera100 at the external end of the endoscope, the system ofFIG. 1B is identical to that shown inFIG. 1A.
• FIG. 2A shows the components of thelight source52 in greater detail. Thelight source52 includes anarc lamp70 that is surrounded by areflector72. In the preferred embodiment of the invention, thearc lamp70 is a high pressure mercury arc lamp (such as the Osram VIP R 150/P24). Alternatively, other arc lamps, solid state devices (such as light emitting diodes or diode lasers), or broadband light sources may be used, but a high pressure mercury lamp is currently preferred for its combination of high blue light output, reasonably flat white light spectrum, and small arc size.
• The light from thearc lamp70 is coupled to alight guide54 of theendoscope60 throughappropriate optics74,76, and78 for light collection, spectral filtering and focusing respectively. The light from the arc lamp is spectrally filtered by one of a number ofoptical filters76A,76B,76C . . . that operate to pass or reject desired wavelengths of light in accordance with the operating mode of the system. As used herein, “wavelength” is to be interpreted broadly to include not only a single wavelength, but a range of wavelengths as well.
• Anintensity control80 that adjusts the amount of light transmitted along the light path is positioned at an appropriate location between thearc lamp70 and theendoscope light guide54. Theintensity control80 adjusts the amount of light that is coupled to thelight guide54. In addition, ashutter mechanism82 may be positioned in the same optical path in order to block any of the light from the lamp from reaching the light guide. Acontroller86 operates anactuator77 that moves thefilters76A,76B or76C into and out of the light path. Thecontroller86 also controls the position of theintensity control80 and the operation of theshutter mechanism82.
• The transmission characteristics offilters76A,76B,76C, . . . , the characteristics of theactuator77 mechanism, and the time available for motion of thefilters76A,76B,76C, . . . , into and out of the light path, depend on the mode of operation required for use with the various camera embodiments. The requirements fall into two classes. If the light source shown inFIG. 2A is of the class wherein only one filter is utilized per imaging mode, the appropriate filter is moved in or out of the light path only when the imaging mode is changed. In that case, theactuator77 only need change the filter in a time of approximately 1.0 second. The optical filter characteristics offilters76A,76B . . . are tailored for each imaging mode. For example,optical filter76A, used for color imaging, reduces any spectral peaks and modifies the color temperature of thearc lamp70 so that the output spectrum simulates sunlight.Optical filter76B transmits only fluorescence excitation light for use with the fluorescence/fluorescence imaging mode andoptical filter76C transmits both fluorescence excitation light and reference reflectance light for use with the fluorescence/reflectance imaging mode.
• A light source52A of a second class is illustrated inFIG. 2B; only the differences from the light source shown inFIG. 2A will be elucidated. The light source52A uses multiple filters during each imaging mode. For example, light source filters, which provide red, green, and blue illumination sequentially for periods corresponding to a video frame or field, can be used for the acquisition of a color or a multi-spectral image with a monochrome image sensor, with the different wavelength components of the image each acquired at slightly different times. Such rapid filter changing requires a considerably different actuator than necessitated for thelight source52 ofFIG. 2A. As shown inFIG. 2B, the filters are mounted on afilter wheel79 that is rotated by a motor, which is synchronized to the video field or frame rate. The layout of the blue, red and green filters,79A,79B, and79C respectively, infilter wheel79 are shown inFIG. 3.
• The transmission characteristics of light source filters, the characteristics of the filter actuator mechanism, and the time available for motion of the filters into and out of the light path, for the two different classes of light sources are described in more detail below in the context of the various camera embodiments.
• Because fluorescence endoscopy is generally used in conjunction with white light endoscopy, each of the various embodiments of themulti-mode camera100 described below may be used both for color and fluorescence/reflectance and/or fluorescence/fluorescence imaging. These camera embodiments particularly lend themselves to incorporation within a fluorescence video endoscope due to their compactness and their ability to be implemented with no moving parts.
• In a first embodiment, shown inFIG. 4A, acamera100A receives light from thetissue58, either directly from the tissue in the case of a camera located at the insertion end of an endoscope, as shown inFIG. 1A, or by virtue of anendoscope image guide56, which transmits the light from the tissue to the camera, as shown inFIG. 1B. The light is directed towards amonochrome image sensor102 and a lowlight image sensor104 by a fixedoptical beamsplitter106 that splits the incoming light into two beams. The light beam is split such that a smaller proportion of the light received from thetissue58 is directed towards themonochrome image sensor102 and a larger proportion of the incoming light is directed towards the lowlight image sensor104. In this embodiment, the beamsplitter may be a standard commercially availablesingle plate88,single cube89, orsingle pellicle design90, as shown inFIGS. 5A-5C. It should be noted that, if the optical path between thetissue58 and the image sensors contains an uneven number of reflections (e.g., such as from a single component beamsplitter), the image projected onto the sensor will be left-to-right inverted. The orientation of such images will need to be corrected by image processing.
• InFIG. 4A, lightcollimating optics110 are positioned in front of thebeamsplitter106, andimaging optics112 and114 are positioned immediately preceding themonochrome image sensor102 and the lowlight image sensor104, respectively. Aspectral filter118 is located in the optical path between thebeamsplitter106 and the lowlight image sensor104. Alternatively, thespectral filter118 may be incorporated as an element of thebeamsplitter106.
• FIG. 4B illustrates another embodiment of thecamera100. Acamera100B is the same as thecamera100A described above except that thelight collimating optics110 andimaging optics112 and114 have been eliminated and replaced with a single set ofimaging optics113 located between the tissue andbeamsplitter106. The advantage of this configuration is that all imaging is performed and controlled by thesame imaging optics113. Such a configuration requires all beam paths to have the same optical path length, however, and this restriction must be considered in the design of thebeamsplitter106 andspectral filter118 that is located in the path to the lowlight image sensor104. In addition, the fact that these optical elements are located in a converging beam path must be considered in specifying these elements and in the design of theimaging optics113.
• The lowlight image sensor104 preferably comprises a charge coupled device with charge carrier multiplication (of the same type as the Texas Instruments TC253 or the Marconi Technologies CCD65), electron beam charge coupled device (EBCCD), intensified charge coupled device (ICCD), charge injection device (CID), charge modulation device (CMD), complementary metal oxide semiconductor image sensor (CMOS) or charge coupled device (CCD) type sensor. Themonochrome image sensor102 is preferably a CCD or a CMOS image sensor.
• An alternative configuration of thecamera100B is shown inFIG. 4C. All aspects of this embodiment of thiscamera100C are similar to thecamera100B shown inFIG. 4B except for differences which arise from reducing the width of the camera by mounting bothimage sensors102 and104 perpendicular to the camera front surface. In this alternative configuration, the lowlight image sensor104 and themonochrome image sensor102 are mounted with their image planes perpendicular to the input image plane of the camera. Light received from thetissue58 is projected by imagingoptics113 throughbeamsplitter106 onto theimage sensors102 and104. Thebeamsplitter106 directs a portion of the incoming light in one beam towards one of thesensors102,104. Another portion of the incoming light in a second light beam passes straight through thebeamsplitter106 and is directed by amirror108 towards the other of thesensors102,104. In addition, a second set ofimaging optics115 is utilized to account for the longer optical path to this second sensor. The images projected onto both sensors will be left-to-right inverted and should be inverted by image processing.
• The processor/controller64 as shown inFIGS. 1A and 11B receives the transduced image signals from thecamera100 and digitizes and processes these signals. The processed signals are then encoded in a video format and displayed on acolor video monitor66.
• Based on operator input, the processor/controller64 also provides control functions for the fluorescence endoscopy video system. These control functions include providing control signals that control the camera gain in all imaging modes, coordinating the imaging modes of the camera and light source, and providing a light level control signal for the light source.
• The reason that two separate images in different wavelength bands are acquired in fluorescence imaging modes of the fluorescence endoscopy video systems described herein, and the nature of the fluorescence/reflectance and fluorescence/fluorescence imaging, will now be explained. It is known that the intensity of the autofluorescence at certain wavelengths changes as tissues become increasingly abnormal (i.e. as they progress from normal to frank cancer). When visualizing images formed from such a band of wavelengths of autofluorescence, however, it is not easy to distinguish between those changes in the signal strength that are due to pathology and those that are due to imaging geometry and shadows. A second fluorescence image acquired in a band of wavelengths in which the image signal is not significantly affected by tissue pathology, utilized for fluorescence/fluorescence imaging, or a reflected light image acquired in a band of wavelengths in which the image signal is not significantly affected by tissue pathology consisting of light that has undergone scattering within the tissue (known as diffuse reflectance), utilized for fluorescence/reflectance imaging, may be used as a reference signal with which the signal strength of the first fluorescence image can be “normalized”. Such normalization is described in two patents previously incorporated herein by reference: U.S. Pat. No. 5,507,287, issued to Palcic et al. describes fluorescence/fluorescence imaging and U.S. Pat. No. 5,590,660, issued to MacAulay et al. describes fluorescence/reflectance imaging.
• One technique for performing the normalization is to assign each of the two image signals a different display color, e.g., by supplying the image signals to different color inputs of a color video monitor. When displayed on a color video monitor, the two images are effectively combined to form a single image, the combined color of which represents the relative strengths of the signals from the two images. Since light originating from fluorescence within tissue and diffuse reflectance light which has undergone scattering within the tissue are both emitted from the tissue with a similar spatial distribution of intensities, the color of a combined image is independent of the absolute strength of the separate image signals, and will not change as a result of changes in the distance or angle of theendoscope60 to thetissue sample58, or changes in other imaging geometry factors. If, however, there is a change in the shape of the autofluorescence spectrum of the observed tissue that gives rise to a change in the relative strength of the two image signals, such a change will be represented as a change in the color of the displayed image. Another technique for performing the normalization is to calculate the ratio of the pixel intensities at each location in the two images. A new image can then be created wherein each pixel has an intensity and color related to the ratio computed. The new image can then be displayed by supplying it to a color video monitor.
• The mixture of colors with which normal tissue and tissue suspicious for early cancer are displayed depends on the gain applied to each of the two separate image signals. There is an optimal gain ratio for which tissue suspicious for early cancer in a fluorescence image will appear as a distinctly different color than normal tissue. This gain ratio is said to provide the operator with the best combination of sensitivity (ability to detect suspect tissue) and specificity (ability to discriminate correctly). If the gain applied to the reference image signal is too high compared to the gain applied to the fluorescence image signal, the number of tissue areas that appear suspicious, but whose pathology turns out to be normal, increases. Conversely, if the relative gain applied to the reference image signal is too low, sensitivity decreases and suspect tissue will appear like normal tissue. For optimal system performance, therefore, the ratio of the gains applied to the image signals must be maintained at all times. The control of the gain ratio is described in two patent applications previously incorporated herein by reference: U.S. patent application Ser. No. 09/615,965, and U.S. patent application Ser. No. 09/905,642.
• In vivo spectroscopy has been used to determine which differences in tissue autofluorescence and reflectance spectra have a pathological basis. The properties of these spectra determine the particular wavelength bands of autofluorescence and reflected light required for the fluorescence/reflectance imaging mode, or the particular two wavelength bands of autofluorescence required for fluorescence/fluorescence imaging mode. Since the properties of the spectra depend on the tissue type, the wavelengths of the important autofluorescence band(s) may depend on the type of tissue being imaged. The specifications of the optical filters described below are a consequence of these spectral characteristics, and are chosen to be optimal for the tissues to be imaged.
• As indicated above, the filters in the light source and camera should be optimized for the imaging mode of the camera, the type of tissue to be examined and/or the type of pre-cancerous tissue to be detected. Although all of the filters described below can be made to order using standard, commercially available components, the appropriate wavelength range of transmission and degree of blocking outside of the desired transmission range for the described fluorescence endoscopy images are important to the proper operation of the system. The importance of other issues in the specification of such filters, such as the fluorescence properties of the filter materials and the proper use of anti-reflection coatings, are taken to be understood.
• FIGS. 6A-6E illustrate the preferred filter characteristics for use in a fluorescence endoscopy system having a camera of the type shown inFIGS. 4A-4C and light source as shown inFIG. 2B, that operates in a fluorescence/reflectance imaging mode, or a color imaging mode. There are several possible configurations of fluorescence endoscopy video systems, operating in the fluorescence/reflectance imaging mode including green fluorescence with either red or blue reflectance, and red fluorescence with either green or blue reflectance. The particular configuration utilized depends on the target clinical organ and application. The filter characteristics will now be described for each of these four configurations.
• FIG. 6A illustrates the composition of the light transmitted by a blue filter, such asfilter79A, which is used to produce excitation light in the system light source. This filter transmits light in the wavelength range from 370-460 nm or any subset of wavelengths in this range. Of the light transmitted by this filter, less than 0.001% is in the fluorescence imaging band from 480-750 nm (or whatever desired subsets of this range is within the specified transmission range of the primary and reference fluorescence image filters described below).
• FIG. 6B illustrates the composition of the light transmitted by a red filter, such asfilter79B, which is used to produce red reflectance light in the system light source. This filter transmits light in the wavelength range from 590-750 nm or any subset of wavelengths in this range. Light transmitted outside this range should not exceed 1%.
• FIG. 6C illustrates the composition of the light transmitted by a green filter, such asfilter79C, which is used to produce green reflectance light in the system light source. This filter transmits light in the wavelength range from 480-570 nm or any subset of wavelengths in this range. Light transmitted outside this range should not exceed 1%.
• FIG. 6D shows the composition of the light transmitted by a camera spectral filter, such asfilter118, for defining the primary fluorescence image in the green spectral band. In this configuration, the filter blocks excitation light and red fluorescence light while transmitting green fluorescence light in the wavelength range of 480-570 nm or any subset of wavelengths in this range. When used in a fluorescence endoscopy video system with thelight source filter79A described above, the filter characteristics are such that any light outside of the wavelength range of 480-570 nm, or any desired subset of wavelengths in this range, contributes no more than 0.1% to the light transmitted by the filter.
• FIG. 6E shows the composition of the light transmitted by a camera filter, such asfilter118, for defining the primary fluorescence image in the red spectral band. In this configuration, the filter blocks excitation light and green fluorescence light while transmitting red fluorescence light in the wavelength range of 590-750 nm or any subset of wavelengths in this range. When used in a fluorescence endoscopy video system with thelight source filter79A described above, the filter characteristics are such that any light outside of the wavelength range of 590-750 nm, or any desired subset of wavelengths in this range, contributes no more than 0.1% to the light transmitted by the filter.
• The operation of the preferred embodiment of the fluorescence endoscopy video system will now be described. Thecameras100A as shown inFIGS. 4A and 100B as shown inFIG. 4B or100C as shown inFIG. 4C are capable of operating in color and fluorescence/reflectance imaging modes. A light source of the type shown inFIG. 2B, that provides a different output every video frame or field is required. In the color imaging mode, the processor/controller64 provides a control signal to the multi-modelight source52 that indicates the light source should be operating in the white light mode and provides a synchronizing signal. Thelight source52 sequentially outputs filtered red, green, and blue light, synchronously with the video field or frame of theimage sensors102 and104. The filtered light from thelight source52 is projected into theendoscope light guide54 and is transmitted to the tip of theendoscope60 to illuminate thetissue58.
• The processor/controller64 also protects the sensitive lowlight image sensor104 during color imaging by decreasing the gain of the amplification stage of the sensor. The light reflected by thetissue58 is collected and transmitted by theendoscope image guide56 to the camera where it is projected throughbeamsplitter106 onto themonochrome image sensor102, or the light is directly projected through thecamera beamsplitter106 onto themonochrome image sensor102 if the sensor is located within the insertion portion of the endoscope. The image projected during each of red, green, and blue illuminations is transduced by themonochrome image sensor102 and the resulting image signals are transmitted to the processor/controller64.
• Based on the brightness of the images captured, the processor/controller64 provides a control signal to the multi-modelight source52 to adjust theintensity control80 and thereby adjust the level of light output by theendoscope light guide54. The processor/controller64 may also send a control signal to thecamera100A,100B or100C to adjust the gain of themonochrome image sensor102.
• The processor/controller64 interpolates the images acquired during sequential periods of red, green, and blue illumination to create a complete color image during all time periods, and encodes that color image as video signals. The video signals are connected to color video monitor66 for display of the color image. All of the imaging operations occur at analog video display rates (30 frames per second for NTSC format and 25 frames per second for PAL format).
• When switching to the fluorescence/reflectance imaging mode, the processor/controller64 provides a control signal to the multi-modelight source52 to indicate that it should be operating in fluorescence/reflectance mode. In response to this signal, the lightsource filter wheel79 stops rotating and thelight source52 selects and positions the appropriate blueoptical filter79A continuously into the optical path between thearc lamp70 and theendoscope light guide54. This change from sequentially changing filters to a static filter occurs in a period of approximately one second.Filter79A transmits only those wavelengths of light that will induce thetissue58 under examination to fluoresce. All other wavelengths of light are substantially blocked as described above. The filtered light is then projected into theendoscope light guide54 and transmitted to the tip of theendoscope60 to illuminate thetissue58.
• As part of setting the system in the fluorescence/reflectance mode, the processor/controller64 also increases the gain of the amplification stage of the lowlight image sensor104. The fluorescence emitted and excitation light reflected by thetissue58 are either collected by theendoscope image guide56 and projected through thecamera beamsplitter106 onto the lowlight image sensor104 and theimage sensor102, or are collected and directly projected through thecamera beamsplitter106 onto the lowlight image sensor104 and theimage sensor102 at the insertion tip of theendoscope60.Spectral filter118 limits the light transmitted to the lowlight image sensor104 to either green or red autofluorescence light only and substantially blocks the light in the excitation wavelength band. The autofluorescence image is transduced by the lowlight image sensor104. The reference reflected excitation light image is transduced by themonochrome image sensor102 and the resulting image signals are transmitted to the processor/controller64.
• Based on the brightness of the transduced images, the processor/controller64 may provide a control signal to the multi-modelight source52 to adjust theintensity control80 and thereby adjust the level of light delivered to theendoscope60. The processor/controller64 may also send control signals to thecameras100A,100B or100C to adjust the gains of the lowlight image sensor104 and themonochrome image sensor102, in order to maintain constant image brightness while keeping the relative gain constant.
• After being processed, the images from the two sensors are encoded as video signals by processor/controller64. The fluorescence/reflectance image is displayed by applying the video signals to different color inputs on thecolor video monitor66.
• In order for the combined image to have optimal clinical meaning, for a given proportion of fluorescence to reference light signals emitted by the tissue and received by the system, a consistent proportion must also exist between the processed image signals that are displayed on the video monitor. This implies that the (light) signal response of the fluorescence endoscopy video system is calibrated. The calibration technique is described in two patent applications previously incorporated herein by reference: U.S. patent application Ser. No. 09/615,965, and U.S. patent application Ser. No. 09/905,642.
• Thecameras100A,100B,100C can be operated in a variation of the fluorescence/reflectance mode to simultaneously obtain fluorescence images and reflectance images with red, green, and blue illumination. The operation of the system is similar to that described previously for color imaging, so only the points of difference from the color imaging mode will be described.
• In this variation of the fluorescence/reflectance mode, instead of changing from sequential red, green, and blue illumination to static blue illumination when switching from color imaging to fluorescence/reflectance imaging, the multi-modelight source52 provides the same sequential illumination utilized in the color imaging mode, for all imaging modes. Capture and display of the light reflected by the tissue is similar to that described previously for the color imaging mode. However, in addition to the reflectance images captured in that mode, the gain of the amplification stage of the lowlight image sensor104 is adjusted to a value that makes it possible to capture autofluorescence images during blue illumination. During red and green illumination, the gain of amplification stage of the low light sensor is decreased to protect the sensor while theimage sensor102 captures reflectance images.
• In this modified fluorescence/reflectance mode, the camera captures both reflectance and fluorescence images during the blue illumination period, in addition to reflected light images during the red and green illumination periods. As for the color imaging mode, the reflectance images are interpolated and displayed on the corresponding red, green and blue channels of a color video monitor to produce a color image. Like the previously described fluorescence/reflectance mode, a fluorescence/reflectance image is produced by overlaying the fluorescence image and one or more of the reflectance images displayed in different colors on a color video monitor.
• Since individual reflectance and fluorescence images are concurrently captured, both a color image and a fluorescence/reflectance image can be displayed simultaneously on the color video monitor. In this case, there is no need to utilize a separate color imaging mode. Alternatively, as described for the previous version of fluorescence/reflectance operation, only the fluorescence/reflectance image may be displayed during fluorescence/reflectance imaging and a color image displayed solely in the color imaging mode.
• Yet another embodiment of this invention will now be described. All points of similarity with the first embodiment will be assumed understood and only points that differ will be described.
• In this second embodiment, all aspects of the fluorescence endoscopy video system are similar to those of the first embodiment except for the camera and the light source. Acamera100D for this embodiment of a system is as shown inFIG. 7A. It differs from thecameras100A,100B or100C as described above in that all imaging modes utilize a single, low light color image sensor103 (preferably a color CCD with charge carrier multiplication such as the Texas Instruments TC252) and that no beamsplitter is required. Alternatively, thecolor image sensor103 may be a three-CCD with charge carrier multiplication color image sensor assembly, a color CCD, a three-CCD color image sensor assembly, a color CMOS image sensor, or a three-CMOS color image sensor assembly.
• Each of the pixel elements on the lowlight color sensor103 is covered by an integrated filter, typically red, green or blue. These filters define the wavelength bands of fluorescence and reflectance light that reach the individual pixel elements. Such mosaic filters typically have considerable overlap between the red, green, and blue passbands, which can lead to considerable crosstalk when imaging dim autofluorescence light in the presence of intense reflected excitation light. Therefore, aseparate filter118 is provided to reduce the intensity of reflected excitation light to the same level as that of the autofluorescence light and, at the same time, pass autofluorescence light.
• In this embodiment, the primary fluorescence and reference images are projected onto thesame image sensor103, but, because of the individual filters placed over each pixel, these different images are detected by separate sensor pixels. As a result, individual primary fluorescence and reference image signals can be produced by processor/controller64 from the single CCD image signal.
• InFIG. 7A,light collimating optics110 is positioned between thetissue58 andfilter118 andimaging optics112 is positioned immediately preceding thecolor image sensor103. In an alternative optical configuration,camera100E, as shown inFIG. 7B, eliminates thecollimating optics110 andimaging optics112 and replaces them with asingle imaging optics113 located between thetissue58 andfilter118. The advantage of this configuration is that all imaging is performed and controlled by thesame imaging optics113. The fact thatfilter118 is located in a converging beam path must be considered in specifying that element and in the design of the imaging optics.
• The operation of a system based oncamera100D ofFIG. 7A or100E ofFIG. 7B will now be described. Thecameras100D and100E are capable of operation in the color, fluorescence/fluorescence, and fluorescence/reflectance imaging modes. For a system based oncamera100D or100E, a light source of the type shown inFIG. 2A, provides steady state output in each imaging mode. As described below, the light transmission specifications of the light source filters76A,76B, and76C, thefilter118, and the mosaic color filters integrated with theimage sensor103 are selected such that the intensity of the reflected light and fluorescence light at the color image sensor's active elements results in transduced image signals with good signal-to-noise characteristics and without significant saturation. At the same time these filters have appropriate light transmission specifications for excitation and imaging of the primary fluorescence and for color imaging. The filter transmission characteristics are chosen to provide the desired ratio of relative primary fluorescence to reference light intensity at the image sensor.
• In the color imaging mode, the processor/controller64 provides a control signal to the multimodelight source52 that it should be in white light mode. The light source selects and positions the appropriateoptical filter76A into the optical path between thearc lamp70 andendoscope light guide54. Given the presence offilter118 incameras100D,100E which have reduced transmission for excitation light at blue wavelengths, thelight source filter76A should incorporate reduced transmission at red and green wavelengths to obtain a balanced color image atimage sensor103 with the proper proportions of red, green, and blue components.
• Image signals from the color lowlight sensor103 are processed by processor/controller64. Standard techniques are utilized to produce a color image from a single color sensor: the image signals from pixels having the same filter characteristics are interpolated by processor/controller64 to produce an image signal, related to the pass band of each element of the mosaic filter (e.g. red, green, and blue), at every pixel location. The resulting multiple images, which when combined produce a color image, are encoded by processor/controller64 as video signals. The color image is displayed by connecting the video signals to the appropriate inputs ofcolor video monitor66.
• Processor/controller64 also maintains the overall image brightness at a set level by monitoring the brightness of the image signal at each pixel and adjusting the intensity of the light source output and camera amplifier gains according to a programmed algorithm.
• When switching to the fluorescence/fluorescence imaging mode, processor/controller64 provides a control signal to the multi-modelight source52 to indicate that it should be in fluorescence/fluorescence mode. Thelight source52 moveslight source filter76B into position in the light beam.Filter76B transmits excitation light and blocks the transmission of light at the green and red fluorescence detection wavelengths, as described below. The characteristics of light sourcefluorescence excitation filter76B andexcitation filter118, along with the mosaic filter elements on thecolor sensor103, are such that the intensity of blue light at the color sensor is less than the intensities of red and green autofluorescence at the sensor, and are such that the ratio of the intensity of red autofluorescence to the intensity of green autofluorescence at thecolor sensor103 has the appropriate value for optimal differentiation between normal and abnormal tissue. The fluorescence images are processed, as previously described for color imaging, by processor/controller64 to produce separate images corresponding to each of the pass bands of the mosaic filter (e.g. red, green, and blue). These separate images are encoded as video signals by processor/controller64. A composite fluorescence/fluorescence image is displayed on the color video monitor66 by applying the video signals from red and green pass bands of the mosaic filter to different color inputs of the monitor.
• When switching to the fluorescence/reflectance imaging mode, processor/controller64 provides a control signal to the multi-modelight source52 to indicate that it should be in fluorescence/reflectance mode. Thelight source52 moves light source filter76C into position in the light beam.Filter76C transmits both excitation light and reference light and blocks the transmission of light at fluorescence detection wavelengths, as described below. The characteristics of thelight source filter76C for fluorescence excitation and the reflectance illumination and thecamera filter118, along with the mosaic filter on thecolor sensor103, as detailed below, are such that the intensity of reflected excitation light at the color sensor is comparable to the intensity of autofluorescence at the sensor, and should be such that the ratio of the intensity of autofluorescence to the intensity of reflected reference light at thecolor sensor103 has the appropriate value. The fluorescence and reflectance images are processed, as previously described for color imaging, by processor/controller64 to produce separate images corresponding to each of the pass bands of the mosaic filter (e.g. red, green, and blue). These separate images are encoded as video signals by processor/controller64. A composite fluorescence/reflectance image is displayed on color video monitor66 by applying the video signals from the appropriate mosaic filter pass bands (as discussed below) to different color inputs of the monitor.
• As indicated above, the filters in the light source and camera should be optimized for the imaging mode of the camera, the type of tissue to be examined and/or the type of pre-cancerous tissue to be detected. Although all of the filters described below can be made to order using standard, commercially available components, the appropriate wavelength range of transmission and degree of blocking outside of the desired transmission range for the described fluorescence endoscopy images modes are important to the proper operation of the system. The importance of other issues in the specification of such filters such as the fluorescence properties of the filter materials and the proper use of anti-reflection coatings are taken to be understood.
• As discussed above, the filters in the light source and camera should be optimized for the imaging mode of the camera, the type of tissue to be examined and/or the type of pre-cancerous tissue to be detected, based on in vivo spectroscopy measurements. The preferred filter characteristics for use in the fluorescence endoscopy video systems with a camera of the type shown inFIGS. 7A and 7B, operating in a fluorescence/reflectance imaging mode, or a fluorescence/fluorescence imaging mode, are shown inFIGS. 8A-8F. There are several possible configurations of fluorescence endoscopy video systems, operating in the fluorescence/reflectance imaging mode including green fluorescence with red reflectance, and red fluorescence with green reflectance and red or green fluorescence with blue reflectance. The particular configuration utilized depends on the target clinical organ and application. The filter characteristics will now be described for each of these four configurations.
• FIGS. 8A-8B illustrate a preferred composition of the light transmitted by filters for a color imaging mode.FIG. 8A illustrates the composition of the light transmitted by the light source filter, such asfilter76A, which is used to produce light for color imaging. Thespectral filter118 remains in place during color imaging since there are no moving parts in the present camera embodiment. Accordingly, to achieve correct color rendition during color imaging it is necessary for the transmission of light source filter76A to be modified, compared to the usual white light transmission for color imaging, such that the light received by the highsensitivity color sensor103 is white when a white reflectance standard is viewed with the camera. Therefore, to balance the effect ofspectral filter118, the transmission offilter76A in the red and green spectral bands must be less than the transmission in the blue, and the transmission offilter76A in the blue must extend to a long enough wavelength that there is an overlap with the short wavelength region of appreciable transmission offilter118.Filter76A transmits light in the blue wavelength range from 370-480 nm or any subset of wavelengths in this range at the maximum possible transmission. The transmission ofFilter76A in the green and red wavelength range from 500 nm-750 nm, or any subsets of wavelengths in this range, is preferably reduced by at least a factor of ten compared to the transmission in the blue, in order to achieve a balanced color image at the highsensitivity color sensor103, after taking into account the effect offilter118.
• FIG. 8B shows the composition of the light transmitted by thespectral filter118, which is used for all imaging modes. In this configuration, the filter blocks the blue excitation light in the range 370-450 nm while transmitting red and green light in the wavelength range of 470-750 nm or any subsets of wavelengths in this range. When used in a fluorescence endoscopy video system in combination with thelight source filter76A described above, the filter characteristics are such that the intensity of light captured by highsensitivity color sensor103 in the wavelength bands transmitted by the different regions of the sensor's mosaic filter are comparable, when a white reflectance standard is imaged. When used in a fluorescence endoscopy video system for fluorescence/fluorescence imaging in combination with thelight source filter76B described below, the filter characteristics are such that any light outside of the wavelength range of 470-750 nm (or any desired subset of wavelengths in this range) contributes no more than 0.1% to the light transmitted by the filter.
• FIG. 8C illustrates the composition of the light transmitted by a filter, such asfilter76B, which is used to produce excitation light in the system light source. This filter transmits light in the wavelength range from 370-450 nm or any subset of wavelengths in this range. Of the light transmitted by this filter, preferably less than 0.001% is in the fluorescence imaging band from 470-750 nm (or whatever desired subsets of this range is within the transmission range of the primary and reference fluorescence wavelength bands defined by the transmission of the mosaic filter incorporated in the high sensitivity color sensor103).
• FIG. 8D illustrates the composition of the light transmitted by the light source filter, such asfilter76C, which is used to produce blue excitation light and red reference light for a green fluorescence and red reflectance imaging mode. This filter transmits light in the blue wavelength range from 370-450 nm, or any subset of wavelengths in this range. It also transmits light in the red wavelength range of 590-750 nm, or any subset of wavelengths in this range. The light transmitted in the red wavelength range (or subset of that range) is adjusted, as part of the system design, to be an appropriate fraction of the light transmitted in the blue wavelength range. This fraction is selected to meet the need to match the intensity of the reflected reference light projected on the color image sensor to the requirements of the sensor, at the same time as maintaining sufficient fluorescence excitation. Of the light transmitted by this filter, less than 0.001% is in the green wavelength range of 470-570 nm (or whatever desired subset of this range is specified as the transmission range of the primary fluorescence wavelength band).
• FIG. 8E illustrates the composition of the light transmitted by a light source filter which is used to produce excitation light such asfilter76C described above for a red fluorescence and green reflectance imaging mode. This filter transmits light in the blue wavelength range from 370-450 nm or any subset of wavelengths in this range. It also transmits light in the green wavelength range of 470-570 nm or any subset of wavelengths in this range. The light transmitted in the green wavelength range (or subset of that range) is adjusted, as part of the system design, to be an appropriate fraction of the light transmitted in the blue wavelength range. This fraction is selected to meet the need to match the intensity of the reflected reference light projected on the color image sensor to the requirements of the sensor, at the same time as maintaining sufficient fluorescence excitation. Of the light transmitted by this filter, less than 0.001% is in the red fluorescence imaging wavelength range of 590-750 nm (or whatever desired subset of this range is specified as the transmission range of the primary fluorescence wavelength band).
• FIG. 8F illustrates the composition of the light transmitted by a light source filter which is used to produce excitation light such asfilter76C described above for a red or green fluorescence and blue reflectance imaging mode. This filter transmits light in the blue wavelength range from 370-470 nm or any subset of wavelengths in this range. The light transmitted in the 450-470 nm wavelength range (or subset of that range) is adjusted, as part of the system design, to meet the need to match the intensity of the reflected reference light projected on the color image sensor to the requirements of the sensor and to provide the appropriate ratio of reference reflected light to fluorescence light, at the same time as maintaining sufficient fluorescence excitation. Of the light transmitted by this filter, less than 0.001% is in the fluorescence imaging wavelength range of 490-750 nm (or whatever desired subset of this range is specified as the transmission range of the primary fluorescence wavelength band).
• The fluorescence endoscopy video systems described in the above embodiments have been optimized for imaging endogenous tissue fluorescence. They are not limited to this application, however, and may also be used for photo-dynamic diagnosis (PDD) applications. As mentioned above, PDD applications utilize photo-active drugs that preferentially accumulate in tissues suspicious for early cancer. Since effective versions of such drugs are currently in development stages, this invention does not specify the filter characteristics that are optimized for such drugs. With the appropriate light source and camera filter combinations, however, a fluorescence endoscopy video system operating in either fluorescence/fluorescence or fluorescence/reflectance imaging mode as described herein may be used to image the fluorescence from such drugs.
• As will be appreciated, each of the embodiments of a camera for a fluorescence endoscopy video system described above, due to their simplicity, naturally lend themselves to miniaturization and implementation in a fluorescence video endoscope, with the camera being incorporated into the insertion portion of the endoscope. The cameras can be utilized for both color imaging and fluorescence imaging, and in their most compact form contain no moving parts.

Claims (43)

1. A fluorescence endoscopy video system including:

a multi-mode light source for producing various light outputs, including a number of optical filters that selectively alter the spectral characteristics of the light produced by the light source including:

a light source filter for blue light fluorescence excitation and reflectance imaging at blue wavelengths;

a light source filter for red light reflectance imaging at red wavelengths; and

a light source filter for green light reflectance imaging at green wavelengths, wherein said filters are operable such that the light source can produce sequential red, green and blue light for white light imaging or continuous fluorescence excitation light for fluorescence imaging;

an endoscope for directing the light from the light source into a patient to illuminate a tissue sample and to collect the reflected light and fluorescence light produced by the tissue;

a camera positioned to receive the light collected by the endoscope, the camera including:

an image sensor;

a low light image sensor;

a beamsplitter for splitting the light received from the tissue sample into two beams and projecting the two beams onto the image sensor and low light image sensor;

a filter positioned in front of the low light sensor for selectively transmitting light of desired wavelengths; and

one or more optical imaging components that project images onto both the image sensor and low light image sensor.

an image processor/controller coupled to the camera for digitizing, storing, processing and encoding the image signals received from the image sensor and low light image sensor as video signals; and

a color video monitor that receives the video signals and displays them.

2. The system ofclaim 1, wherein the camera is attached to the portion of the endoscope that remains outside of the body.

3. The system ofclaim 1, wherein the camera is built into the insertion portion of the endoscope.

4. The system ofclaim 2 or3, wherein the beamsplitter directs a greater percentage of light collected by the endoscope to the low light image sensor and a lesser percentage to the image sensor.

5. The system ofclaim 2 or3, wherein the light source optical filter for blue light output transmits blue fluorescence excitation light and blocks light from the light source at wavelengths in a fluorescence detection wavelength band from reaching the camera to the extent that the light received by the camera is substantially composed of light resulting from tissue fluorescence and reflected fluorescence excitation light and minimally composed of light at wavelengths other than those used for fluorescence excitation originating from the light source.

6. The system ofclaim 5, wherein a filter positioned in front of low light image sensor blocks reflected excitation light and transmits primarily fluorescence light to the extent that the light received by the low light image sensor is substantially composed of light resulting from tissue fluorescence and minimally composed of light originating from the light source.

7. The system ofclaim 6, wherein the fluorescence light transmitted by the filter in front of the low light image sensor is green light

8. The system ofclaim 7, wherein the low light sensor has light sensitivity that varies synchronously with the light source output such that the light sensitivity of the low light image sensor is higher during the period of blue light output and lower at other times.

9. The system ofclaim 6, wherein the fluorescence light transmitted by the filter in front of the low light image sensor is red light.

10. The system ofclaim 9, wherein the low light sensor has light sensitivity that varies synchronously with the light source output such that the light sensitivity of the low light sensor is higher during the period of blue light output and lower at other times.

11. The system ofclaim 7, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during blue light excitation and an image created from blue reflectance light acquired by the image sensor, said images being superimposed and displayed in different colors on the color video monitor.

12. The system ofclaim 9, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during blue light excitation and an image created from blue reflectance light acquired by the image sensor, said images being superimposed and displayed in different colors on the color video monitor.

13. The system ofclaim 7, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from red reflectance light acquired by the image sensor during a period of red light illumination, said images being superimposed and displayed in different colors on the color video monitor.

14. The system ofclaim 9, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from red reflectance light acquired by the image sensor during a period of red light illumination, said images being superimposed and displayed in different colors on the color video monitor.

15. The system ofclaim 7, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from green reflectance light acquired by the image sensor during a period of green light illumination, said images being superimposed and displayed in different colors on the color video monitor.

16. The system ofclaim 9, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue light excitation and an image created from green reflectance light acquired by the image sensor during a period of green light illumination, said images being superimposed and displayed in different colors on the color video monitor.

17. The system ofclaim 7, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light, acquired by the low light sensor during a period of blue illumination, and an image created from red reflectance light acquired by the image sensor during a period of red illumination, said images being superimposed and displayed in different colors on the color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed red, green, and blue reflectance light images acquired by the image sensor during periods of red, green, and blue illumination respectively.

18. The system ofclaim 7, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue illumination, and an image created from blue reflectance light acquired by the image sensor during a period of blue illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image consisting of superimposed red, green, and blue reflectance light images acquired by the image sensor during periods of red, green, and blue illumination respectively.

19. The system ofclaim 9, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of light source blue illumination, and an image created from green reflectance light acquired by the image sensor during a period of green illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed red, green, and blue reflectance light images acquired by the image sensor during periods of red, green, and blue illumination respectively.

20. The system ofclaim 9, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue illumination, and an image created from blue reflectance light acquired by the image sensor during a period of blue illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed red, green, and blue reflectance light images acquired by the image sensor during periods of red, green, and blue illumination respectively.

21. A fluorescence endoscopy video system including:

a multi-mode light source;

a number of moveable optical filters including a filter for producing blue excitation and reflectance light, a filter for producing red reflectance light, and a filter for producing green reflectance light;

a mechanism for moving the filters in front of the light source to produce continuous excitation light or sequential red, green and blue reflectance light in synchronism with a video field;

an endoscope for directing the light from the light source into a patient to illuminate a tissue sample and to collect reflected light and fluorescence light produced by the tissue;

a camera positioned to receive the light received from the tissue, the camera including:

an image sensor, the image plane of the image sensor being perpendicular to the image plane of the front of the camera;

a low light image sensor, the image plane of the low light image sensor being perpendicular to the image plane of the front of the camera;

a beamsplitter for splitting the light received from the tissue into two light beams that are directed onto the image sensors;

a mirror for directing one of the two light beams onto one of the image sensors;

a filter positioned in front of the low light sensor for selectively transmitting light of desired wavelengths; and

two or more optical imaging components that project images onto both the image sensors.

an image processor/controller coupled to the image sensors for storing, processing and encoding the image signals received from the sensors as video signals; and

a color video monitor that receives the video signals and displays them.

22. The system ofclaim 21, wherein the camera is attached to the portion of the endoscope that remains outside of the body.

23. The system ofclaim 22, wherein the beamsplitter directs a greater percentage of light collected by the endoscope to the low light image sensor and a lesser percentage to the image sensor.

24. The system ofclaim 21, wherein the camera is built into the insertion portion of the endoscope.

25. The system ofclaim 24, wherein the beamsplitter directs a greater percentage of light collected by the endoscope to the low light image sensor and a lesser percentage to the image sensor.

26. The system ofclaim 22 or24, wherein the light source optical filter for blue light output transmits blue fluorescence excitation light and blocks light from the light source at wavelengths in a fluorescence detection wavelength band from reaching the camera to the extent that the light received by the camera is substantially composed of light resulting from tissue fluorescence and reflected fluorescence excitation light and minimally composed of light at wavelengths other than those used for fluorescence excitation originating from the light source.

27. The system ofclaim 26, wherein a filter in front of low light image sensor blocks reflected excitation light and transmits primarily fluorescence light to the extent that the light received by the low light image sensor is substantially composed of light resulting from tissue fluorescence and minimally composed of light originating from the light source.

28. The system ofclaim 27, wherein the fluorescence light transmitted by the filter in front of the low light image sensor is green light.

29. The system ofclaim 27, wherein the fluorescence light transmitted by the filter in front of the low light image sensor is red light.

30. The system ofclaim 28, wherein the light sensitivity of the low light image sensor varies synchronously with the light source output such that the light sensitivity of the low light image sensor is higher during the period of blue light output and lower at other times.

31. The system ofclaim 29, wherein the light sensitivity of the low light image sensor varies synchronously with the light source output such that the light sensitivity of the low light image sensor is higher during the period of blue light output and lower at other times.

32. The system ofclaim 28, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light by the low light image sensor and an image created from blue reflectance light by the image sensor that are superimposed and displayed in different colors on the color video monitor.

33. The system ofclaim 29, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light by the low light sensor and an image created from blue reflectance light by the image sensor, said images being superimposed and displayed in different colors on the color video monitor.

34. The system ofclaim 28, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from red reflectance light acquired by the image sensor during a period of red light illumination, said images being superimposed and displayed in different colors on the color video monitor.

35. The system ofclaim 29, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from red reflectance light acquired by the image sensor during a period of red light illumination, said images being superimposed and displayed in different colors, on the color video monitor.

36. The system ofclaim 28, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from green reflectance light acquired by the image sensor during a period of green light illumination, said images being superimposed and displayed in different colors, on the color video monitor.

37. The system ofclaim 29, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue light excitation, and an image created from green reflectance light acquired by the image sensor during a period of green light illumination, said images being superimposed and displayed in different colors, on the color video monitor.

38. The system ofclaim 28, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue illumination, and an image created from red reflectance light acquired by the image sensor during a period of red illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed images created from red, green, and blue reflectance light images acquired by the image sensor during periods of red, green, and blue illumination respectively.

39. The system ofclaim 28, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from green fluorescence light acquired by the low light sensor during a period of blue illumination, and an image created from blue reflectance light acquired by the image sensor during a period of blue illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed images created from red, green, and blue reflectance light images acquired by the image sensor during periods of red, green, and blue illumination respectively.

40. The system ofclaim 29, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue illumination, and an image created from green reflectance light acquired by the image sensor during a period of green illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed images created from red, green, and blue reflectance light acquired by the image sensor during periods of red, green, and blue illumination respectively.

41. The system ofclaim 29, wherein the image processor/controller creates a composite fluorescence/reflectance image comprising an image created from red fluorescence light acquired by the low light sensor during a period of blue illumination, and an image created from blue reflectance light acquired by the image sensor during a period of blue illumination, said images being superimposed and displayed in different colors on a color video monitor, wherein said composite fluorescence/reflectance image is displayed simultaneously with a composite color image, consisting of superimposed images created from red, green, and blue reflectance light acquired by the image sensor during periods of red, green, and blue illumination respectively.

42. A system for producing white light and/or autofluorescence images at video frame rates, comprising:

a light source that produces sequential blue, red and green light, wherein the blue light can produce tissue autofluorescence;

an endoscope for delivering light from the light source to an in-vivo tissue sample;

a camera positioned at the distal tip of the endoscope; the camera including:

an image sensor;

a low light image sensor;

a filter that substantially blocks reflected blue light from reaching the low light image sensor; and

a beamsplitter for directing a percentage of light received from the tissue to the low light image sensor and a lesser percentage of light received from the tissue to the image sensor; and

an image processor/controller coupled to the image sensors that stores images created from red, green and blue reflectance light acquired by the image sensor and autofluorescence images created from autofluorescence light acquired by the low light sensor in response to blue light,

wherein said processor selectively outputs images created from red, green, blue reflectance light and/or an image created from the autofluorescence light to a display for white light or fluorescence/reflectance imaging.

43. A camera for use in a video endoscope, including:

a low light image sensor;

an image sensor;

a fixed beam splitter that directs a percentage of light to the low light image sensor and a lessor percentage of light to the image sensor;

a filter that limits the amount of reflected excitation light that reaches the low light sensor; and

imaging optics to focus light on the low light and image sensors,

wherein said low light image sensor and image sensor can simultaneously produce an autofluorescence and a reflectance image when positioned to receive autofluorescence light and reflected excitation light.

Images