External Validity of Calibrated Measurements from a Laser-Projection Transnasal Fiberoptic High-Speed Videoendoscopy System

Objective. Evidence-based practice and precision medicine can significantly benefit from the ability to perform calibrated spatial measurements (eg, mm) from endoscopic images. However, calibrated measurements are not readily available from laryngeal images. Laser-projection endoscopes can provide the required information for performing calibrated spatial measurements, but their applications require a process known as calibration. During calibration, a set of benchtop recordings are used to determine the effect of confounding factors of spatial measurements, and also to learn their proper compensation strategies. Calibration benchtop recordings are acquired from flat surfaces and at a perpendicular imaging angle which is significantly different from in-vivo situations, where a three-dimensional (3D) surface gets recorded at a semi-unknown imaging angle. The aim of this study was to quantify changes in calibrated vertical and horizontal measurement accuracies as we move from the controlled condition of calibration to more realistic and uncontrolled settings. Method. A flat surface was positioned in front of a calibrated laser-projection transnasal fiberoptic endoscope at different working distances and imaging angles. Calibrated vertical and horizontal measurement errors were computed from each condition. Multiple linear regression analyses were used to quantify the dependence of vertical and horizontal measurement errors on the imaging angle and working distance. Next, a 3D-printed surface was positioned in front of the laser-projection endoscope at different working distances. Calibrated vertical and horizontal measurement errors were computed from each condition and then they were compared to measurement errors from a flat surface positioned at comparable working distances. Results. The outcome of analyses supported a significant effect of imaging angle on calibrated vertical measurement accuracy, while no significant effect of imaging angle on calibrated horizontal measurement accuracy was established. Additionally, the result of multiple linear regression analyses showed that the coefficient of imaging angle was two times larger than the working distance, which further highlights the significant effect of imaging angle on vertical measurement accuracy. Comparing the magnitude of calibrated vertical and horizontal measurement errors between the 3D surface and a flat surface suggested a significant effect of surface topology on calibrated measurement accuracies. Conclusions. The mean percent magnitude of error of vertical and horizontal measurement errors from the 3D surface were respectively around 6% and 11%, at most working distances, which are acceptable for many applications. However, the significant effect of imaging angle and surface topology on measurement errors highlights the need for further research on these confounding factors. It also suggests that significant improvements in measurement accuracies may be achieved if these factors are properly accounted for during the calibration process. Last but not least, this study highlights the need for the evaluation of laser-projection endoscopes in uncontrolled and more realistic settings. Specifically, evaluations of laser-projection endoscopes in very controlled settings could significantly overestimate their accuracies and hence it will not represent their actual performances during in-vivo data acquisitions.