Endoscope auxiliary device for gastrointestinal polyp measurement

Abstract

An endoscope auxiliary device for measuring gastrointestinal polyps mainly comprises a polyp measuring scale, a pushing tube and an operating handle, overcomes estimation errors caused by distortion and zooming of a fisheye lens of an endoscope in the prior art, and fills the technical blank of accurate physical measurement of polyp forms. Meanwhile, the device can be used for physically measuring the size of the polyp in the digestive tract under the endoscope, and can also be combined with an endoscope administration tube to realize clinical functions of polyp measurement, lavage, liquid medicine spraying and radiography.

Description

Technical Field

[0001] The present application relates to an endoscopic auxiliary device for measuring gastrointestinal polyps, which is a medical device used in conjunction with endoscopic diagnosis and treatment. Background Art

[0002] In the early detection of digestive tract tumors and minimally invasive surgeries such as polypectomy, the use of gastroscopy or colonoscopy for diagnosis and treatment has the advantages of simplicity, efficiency, minimal damage, and a short recovery period. Polyps in the digestive tract are important markers for the early development of tumors. Medical research has confirmed that early detection of digestive tract polyps through endoscopic examination and early endoscopic resection are effective means to prevent the occurrence and development of digestive tract cancer and reduce the incidence and mortality of digestive tract cancer.

[0003] The European Society of Gastrointestinal Endoscopy (ESGE) Guidelines for Colorectal Polypectomy (2017 Edition) states in the "Definition and Classification of Polyps" that polyps should be described and reported according to their location, size (in mm) and morphology during endoscopic examination. In addition, the guidelines further clarify in the "Definition of Polypectomy and Mucosal Resection" that different surgical methods should be selected according to the size of the polyp. For example, cold snare polypectomy is recommended for the removal of tiny polyps (≤5mm) or small polyps (6-9mm), hot snare polypectomy (HSP) is recommended for the removal of (10-19mm) flat and sessile polyps, and conventional (based on diathermy) endoscopic mucosal resection (EMR) is recommended for the removal of large (≥20mm) sessile adenomatous polyps. It can be seen that polyp size is a key clinical indicator in endoscopic examination or polypectomy. However, due to the limitations of endoscopic technology (such as the fisheye lens distortion effect, changes in polyp size caused by zoom, etc.), endoscopes do not have the function of measuring polyp size. The measurement of polyp size is highly dependent on the endoscopist's estimation and is highly subjective. According to a study conducted by the Department of Gastroenterology at Centro Hospitalar de Leilia in Portugal that included 573 polyps, the difference between the polyp size reported by endoscopists and their pathological measurements was studied. The results showed that the error rate of polyp estimation was as high as 62.1%, and the size of polyps tended to be overestimated by endoscopists.

[0004] Accurately measuring the size of polyps is crucial for assessing the risk of digestive tract cancer and choosing surgical methods. Inaccurate size estimation may lead to misdiagnosis, unnecessary medical operations, or the wrong surgical method. In view of the shortcomings of the existing technology, this application proposes a technical solution that can accurately calculate the size of polyps during endoscopic diagnosis or surgery to meet the urgent clinical needs. Summary of the invention

[0005] An endoscope auxiliary device for measuring gastrointestinal polyps mainly comprises a polyp measuring ruler, a pushing tube and an operating handle.

[0006] The polyp ruler is a micro-scale ruler made of shape memory material. The polyp ruler can be folded or contracted in the endoscope instrument channel or the sheath lumen, and can quickly return to the original stereotyped shape after being released.

[0007] The shape memory materials used in preparing the polyp scale include but are not limited to shape memory alloys (SMA) or shape memory polymers (SMP). For example, nickel-titanium-based memory alloys, copper-based memory alloys, iron-based memory alloys and other memory alloys in the shape memory alloy series are used; or silicone rubber, thermoplastic polyester elastomers, thermoplastic polystyrene-butadiene elastomers, thermoplastic polyurethane elastomers and thermoplastic plastics with cross-linked structures in the shape memory polymer series are used.

[0008] The external structure of the polyp measuring ruler adopts the regular structural shape of a universal measuring tool, including a circular, elliptical, semicircular, triangular, square or ruler structure.

[0009] The surface of the polyp measuring ruler is provided with scale indication, and the interior of the polyp measuring ruler is transparent or hollow.

[0010] The minimum indication of the polyp scale is 1mm, and the measuring range is between 5mm and 20mm. For example, the polyp scale is prepared in four specifications with a measuring range of 5mm, 10mm, 15mm, and 20mm, and the minimum indication of the measuring scale is 1mm. In clinical practice, doctors can choose an appropriate polyp scale specification based on the size of the polyp visually observed under the endoscope.

[0011] Preferably, the polyp measuring ruler is made of a wire-shaped shape memory alloy material, the outer diameter of the wire-shaped material is between 0.1mm and 0.3mm, and is prepared into a circular coil structure. The model specifications are divided into four ranges of 5mm, 10mm, 15mm, and 20mm, and the minimum indication of the measuring scale is 1mm.

[0012] In one embodiment, a height scale is also provided on the polyp scale, and the height scale intersects the polyp scale vertically, and the minimum scale of the height scale is 1 mm. For example, the height scale is arranged on the periphery of the polyp scale and intersects the periphery of the polyp scale vertically. The height scale can be formed integrally with the polyp scale, or can be formed by welding.

[0013] In actual production, in order to prevent the polyp scale or height gauge from losing accuracy due to pressure deformation during storage and transportation, a protective cap is also provided on the periphery of the polyp scale and the height indication. The outer shape of the protective cap is not limited, and the internal protective cavity is consistent with the size and shape of the polyp scale and height gauge. The protective cap is made of medical polymer materials or metal materials, for example, the protective cap is made of medical polyvinyl chloride or polypropylene plastic, or aluminum alloy.

[0014] The push tube is a slender tube that folds or compresses the polyp ruler and sends it into the endoscope instrument channel, and controls the polyp ruler to measure on the surface of the polyp. The polyp ruler is firmly assembled on the head of the push tube.

[0015] According to the applicable patient objects (such as children and adults) and the endoscopic diagnosis and treatment sites (such as gastroscopy or colonoscopy), the length of the push tube is between 900mm and 2500mm and is divided into multiple models. According to the different inner diameters of the endoscope instrument channels, the outer diameter of the push tube is between 1mm and 3.6mm and is divided into multiple specifications. The material of the push tube is not limited, and metal guide wires, nylon tubes, etc. can be used. In order to enhance the passing performance in the endoscope instrument channel, the push tube is required to have a smooth surface, elasticity and a certain degree of rigidity.

[0016] In one embodiment, the combined part of the polyp ruler and the push tube is used as a height ruler. Specifically, a measuring scale is set at the head of the push tube, and the head of the push tube and the outer periphery of the polyp ruler are vertically intersected and combined. The intersection point of the intersection combination is marked as the 0mm value of the height value. From the 0mm value upward, the height indication of 1mm to 20mm is marked on the head of the push tube to form a height ruler for measuring the height of the polyp.

[0017] In another embodiment, the polyp scale is integrally formed with the push tube, for example, a shape memory alloy material is processed into a guide wire, the head of the guide wire is processed into a polyp scale and can meet the technical requirements of folding or compression, and the rear end guide wire can meet the requirements of the push tube.

[0018] The operating handle is an operating control device for the polyp scale and the push tube to advance or withdraw in the endoscope instrument channel, and the operating handle is arranged at the end of the push tube. The structure and shape of the operating handle are not limited, and the structure and size that can be easily grasped and manipulated are suitable to meet ergonomic requirements.

[0019] Furthermore, in order to prevent the polyp ruler from being worn or deformed due to heat caused by friction during its movement in the endoscope instrument channel, which may affect the accuracy of the polyp ruler, a sheath is also provided on the outer periphery of the push tube. The sheath is a flexible pipeline formed by extrusion of medical polymer materials and provided with a push tube and a polyp ruler inlet and outlet channel. After the polyp ruler is folded or compressed, it is pushed into the cavity of the sheath head for temporary storage. After the sheath reaches the polyp site through the auxiliary channel of the endoscope, the operating handle controls the push tube and the polyp ruler to move forward toward the end of the endoscope head, and releases the polyp ruler from the sheath head.

[0020] The length and inner diameter of the sheath should correspond to and be matched with the corresponding sizes of the push tube and polyp scale, so that the polyp scale and push tube can move in and out of the sheath freely.

[0021] In order to improve the combination capability of endoscopic instruments, it is convenient for medical staff to conveniently perform various clinical operations such as polyp measurement, coloring or medication. In another embodiment, the push tube, polyp ruler and endoscope medication tube are combined, and the polyp ruler is folded or compressed and pushed into the inner cavity of the endoscope medication tube, and the polyp ruler is temporarily stored in the cavity of the head of the endoscope medication tube, forming an endoscopic instrument with multiple functions including polyp measurement and irrigation, spraying of drug solution and imaging.

[0022] Preferably, the endoscopic drug delivery tube is prepared as a double-lumen catheter, in which one lumen is used for endoscopic drug delivery, and the other lumen is used to place a polyp ruler and a push tube. The polyp ruler is temporarily stored in the lumen at the head of the endoscopic drug delivery tube, and the operating handle of the push tube is exposed 5mm to 20mm from the tail end of the endoscopic drug delivery tube.

[0023] After the endoscopic drug delivery tube is delivered to the polyp site through the endoscope auxiliary channel, the polyp scale is released from the head of the endoscopic drug delivery tube by controlling the push tube and the polyp scale to move forward toward the end of the endoscope.

[0024] The clinical use of the present application is to be used for the physical measurement of the size of polyps in the digestive tract under endoscopy. It can also be combined with an endoscopic drug delivery tube to achieve clinical functions including polyp measurement, irrigation, spraying of drug solution and angiography.

[0025] The beneficial effect of the present application is that a foldable or compressible polyp ruler is prepared using shape memory material. After the polyp ruler is pushed to the periphery of the polyp, the polyp ruler is released and stretches or recovers to its original fixed shape. The polyp ruler is placed on the periphery of the polyp or horizontally above the polyp to physically measure the size of the polyp. Moreover, a height scale is also provided on the periphery of the polyp ruler, which can simultaneously physically measure the height of the polyp to form more abundant polyp size data, overcoming the estimation error caused by the distortion and zoom of the fisheye lens of the endoscope in the prior art, and filling the technical gap of accurate physical measurement of polyp morphology.

[0026] Furthermore, with the increasing popularity of the development and application of medical decision-making support software or mathematical calculation applets, for example, the image information formed by the polyp ruler and the polyp on the same surface taken during measurement is used, virtual auxiliary lines are added to the polyp image, and the scale of the polyp ruler is used as a reference to overcome the distortion caused by fisheye lens or zoom. General mathematical or geometric calculation formulas are used to calculate richer polyp morphological information, including the maximum length, minimum length, outer circumference and surface area of ​​the polyp.

[0027] The present invention has low preparation cost, simple operation, safety and reliability, and is worthy of clinical promotion and use. BRIEF DESCRIPTION OF THE DRAWINGS

[0028] Figure 1 This is a schematic diagram of the overall structure of an embodiment of the present application. Figure 2 This is an enlarged close-up view of a circular polyp measuring ruler with a height ruler according to an embodiment of the present application. Figure 3 This is a schematic diagram of an embodiment of the polyp measuring ruler, push tube and sheath tube combination of the present application. Figure 4 This is a schematic diagram of the polyp scale of the present application after it is released from the front end of the sheath tube Figure 5 This is a schematic diagram of an embodiment of the combination of the push tube, polyp measuring ruler and endoscope drug delivery tube of the present application. Figure 6 This is an example of a method for measuring polyp size in clinical practice. Figure 7 Schematic diagram of the combination of the push tube, polyp measuring ruler and double-lumen endoscope drug delivery tube of the present application As shown in the figure: polyp scale 10, scale indication 101, height scale 103, push tube 20, operating handle 30, sheath tube 40, endoscope drug delivery tube 50, drug delivery port sealing joint 501, drug delivery cavity 502, polyp 60 DETAILED DESCRIPTION

[0029] The present application is described in detail below with reference to the accompanying drawings and embodiments.

[0030] 1. Example 1: Preparation of a circular polyp measuring ruler 10 with a measuring range of 20 mm 1.1 Technical requirements for circular polyp ruler 10: circumference 62.8mm (calculated based on the inner circumference of the circle), diameter 20mm, and the minimum scale indication 101 is 1mm.

[0031] 1.2 Material: The nickel-titanium alloy (Ni-Ti) guide wire with shape memory properties is used as the material. The outer diameter of the guide wire is 0.1 mm, and the cross-section of the nickel-titanium alloy guide wire is circular.

[0032] 1.3 Design of winding forming mold: Design and prepare the winding forming mold of the polyp measuring ruler 10. The mold is required to be a standard cylinder with an outer circumference of 62.8 mm and a diameter of 20 mm; a diameter wire groove with a width of 0.13 mm and a length of 20 mm is set in the center of the cylinder (i.e., the diameter wire of the cylinder cross section).

[0033] 1.4 Molding of Polyp Gauge 10: Insert the nickel-titanium alloy guide wire into the diameter groove, and make the head end of the nickel-titanium alloy guide wire flush with the outer circumference of the cylinder. Wrap the nickel-titanium alloy guide wire around the outer circumference of the cylinder in a clockwise direction, and apply a pre-tightening tension, and send it into a tubular low-temperature heating furnace for heat treatment. The temperature of the low-temperature heating furnace is set between 350℃ and 450℃, and the holding time is 3 minutes. Annealing, immerse in cold water for rapid cooling and shaping, the round polyp gauge 10 after shaping should meet Figure 2 requirements.

[0034] 1.5 Use precision screen printing equipment to print scale on the outer periphery of the polyp scale 10 and the diameter line of the polyp scale 10. The scale indication 101 is 1mm, and the scale must be clearly discernible with the naked eye or after magnification 1-2 times.

[0035] 1.6 After preparation, use a precision vernier caliper to measure the measurement accuracy of the circular polyp ruler 10. The outer circumference, diameter and scale indication 101 should meet the design requirements.

[0036] It should be noted that other circular polyp rulers 10 with different measuring ranges (5mm, 10mm, 15mm) can be implemented with reference to the above technical solution; the processes of square or triangular polyp rulers 10 only differ in the shape of the winding forming mold in item 1.3, and the technical solutions are the same, which will not be described one by one.

[0037] 2. Example 2: Preparation of an endoscopic drug delivery tube 50 with gastrointestinal polyp measurement function 2.1 Mould design and manufacturing 2.1.1 As Figure 5 The structure shown is designed to manufacture the extrusion molds of the push tube 20 and the drug delivery tube, and the injection molds of the operating handle 30, the protective cap and the drug delivery port closing joint 501.

[0038] 2.1.2 The extrusion die of the push tube 20 is suitable for extrusion molding of nylon tubes with an outer diameter of 1.5 mm.

[0039] 2.1.3 The extrusion die for the dosing tube is suitable for the extrusion molding of soft polyvinyl chloride tubes. The extruded dosing tube has an outer diameter of 2.6 mm and an inner diameter of 1.8 mm.

[0040] 2.1.4 The injection mold of the operating handle 30 is suitable for injection molding of polyvinyl chloride materials. The operating handle 30 is a cylindrical handle with a length of 100 mm and an outer diameter of 30 mm. A mounting hole with an inner diameter of 1.6 mm and a depth of 8 mm is provided at the center of the head of the operating handle 30, and an irregular concave-convex anti-slip structure is provided on the periphery of the operating handle 30.

[0041] 2.1.5 The injection mold of the protective cap is suitable for injection molding of medical polypropylene material, and is required to be able to completely enclose the polyp ruler 10 and the head of the push tube 20 inside, and to prevent the polyp ruler 10 and the head of the push tube 20 from being impacted by external pressure.

[0042] 2.1.6 The injection mold of the drug delivery port closed joint 501 is suitable for injection molding of polyvinyl chloride materials. The inner diameter of the head end of the drug delivery port closed joint 501 is 2.7 mm, and a matching sealing plug is provided at the tail end.

[0043] 2.2 Material production 2.2.1 Use nylon 1010 material and extrusion equipment to extrude the push tube 20, which is cut into sections of 1500mm each.

[0044] 2.2.2 Use medical soft polyvinyl chloride particles, use extrusion equipment to extrude them into drug delivery tubes, and cut them into sections of 1300mm each.

[0045] 2.2.3 Use medical polyvinyl chloride particles and injection molding equipment to prepare an operating handle 30.

[0046] 2.2.4 Use medical polypropylene material particles and injection molding equipment to prepare the protective cap.

[0047] 2.2.5 Use medical polyvinyl chloride particles and injection molding equipment to prepare a drug delivery port sealing joint 501.

[0048] 2.3 Assembling pre-packaging 2.3.1 Use medical glue to glue the tail of the cut push tube 20 into the mounting hole of the head of the operating handle 30, and the tensile strength is required to be no less than 10N.

[0049] 2.3.2 Use high-frequency welding equipment to weld the circular polyp ruler 10 prepared in Example 1 to the head end of the push tube 20. The push tube 20 and the circular polyp ruler 10 are required to form a 90-degree structural layout, such as Figure 2 .

[0050] 2.4 With the intersection of the push tube 20 and the circular polyp measuring ruler 10 as the height value of 0 mm, a precision screen printing device is used to print and mark the height indication of 0 mm to 20 mm on the head of the push tube 20 to form a height ruler 103 for measuring the height of the polyp 60.

[0051] 2.5 After the circular polyp measuring ruler 10 and the outer periphery of the head of the pushing tube 20 are assembled with protective caps, they are placed together with the endoscope medication tube 50 in a medical outer packaging bag, sealed and packaged, sterilized, and after passing the inspection, they are ready for use.

[0052] Since the double-lumen drug delivery tube belongs to the conventional technology of multi-lumen catheter preparation, please refer to Figure 7 The structure is produced by conventional extrusion technology and will not be described in detail in this description.

[0053] 3. Example 3: Clinical application of the present application in the measurement of colorectal polyps 60 3.1 After the endoscope enters the colorectum and detects the target polyp 60, the medical staff first estimates the size of the polyp 60 and selects the appropriate size of the polyp ruler 10. For example, if the polyp 60 is visually estimated to be about 6-8mm, a 10mm polyp ruler 10 can be used; if the polyp 60 is visually estimated to be larger than 10mm, a 15mm or 20mm polyp ruler 10 can be used.

[0054] 3.2 Open the 10 mm product prepared in Example 2 and remove the protective cap. Figure 5 As shown, the polyp ruler 10 is retracted or folded into the inner cavity of the head of the endoscope drug delivery tube 50 until the front end of the polyp ruler 10 is flush with the head of the endoscope drug delivery tube 50.

[0055] 3.3 Insert the endoscope drug delivery tube 50 into the endoscope instrument channel, push the push tube 20 forward by operating the handle 30, release the polyp ruler 10 and the height ruler 103 from the head of the endoscope drug delivery tube 50, and restore the polyp ruler 10 to a perfect circular shape, so that the plane size and height of the polyp 60 can be measured. Figure 4 shown.

[0056] Specific measurement methods include, for example, Figure 6 As shown, after the inner wall of the intersection of the polyp ruler 10 and the height ruler 103 is placed close to point A on the periphery of the polyp 60, the polyp ruler 10 is encircled on the periphery of the target polyp 60. Even through visual inspection, medical staff can accurately determine the surgical method to be used for the target polyp 60 in accordance with the ESGE colorectal polyp 60 resection guidelines. The judgment basis is that the diameter of the polyp ruler 10 is 10 mm, Figure 6 The target polyp 60 is completely covered by the inner circumference of the polyp scale 10, and the maximum length of the polyp 60 (from point A to point C) is visually estimated to be about 8 mm, which is a small polyp 60 (6-9 mm) as specified in the guidelines, and cold snare polypectomy is recommended for removal.

[0057] Then, the target polyp trapped by the polyp ruler 10 is photographed through the endoscope, and the polyp 60 photo is imported into the computer. Through the medical decision-making assistance software or image processing software, the scale of the polyp ruler 10 is used as a reference to accurately calculate the length of the polyp 60 from point A to point C and the width of the polyp 60 from point B to point D, with an accuracy error of no more than 1 mm. Furthermore, the auxiliary line tools of the computer software (such as length and width auxiliary lines, height auxiliary lines, etc.) can be used to accurately calculate the height, perimeter, area and other more abundant morphological information of the polyp 60, thereby eliminating the erroneous diagnosis and treatment results caused by estimation.

[0058] During this period, if it is necessary to spray drugs or dyes on the target polyp 60 through the endoscopic drug delivery tube 50, the push tube 20 can be easily pulled outward to retract the polyp measuring ruler 10 and then pulled out. Furthermore, if a double-lumen endoscopic drug delivery tube 50 is used, the drug delivery operation can be performed simultaneously through the other lumen of the drug delivery tube.

[0059] The above drawings and embodiments are only used to illustrate the technical solution of the present application and are not intended to limit it. Although the present application is described in detail with reference to the preferred embodiments, a person skilled in the art should understand that the technical solution of the present application can be modified or replaced by equivalents without departing from the purpose and scope of the technical solution of the present application, which should be included in the scope of the claims of the present application. It does not constitute any limitation on the scope of protection of the present application.

Claims

1. An endoscopic auxiliary device for measuring gastrointestinal polyps, mainly comprising a polyp measuring ruler (10), a push tube (20) and an operating handle (30); in: The polyp ruler (10) is a micro-scale ruler made of shape memory material. The push tube (20) is a slender tube that is used to fold or compress the polyp ruler (10) and send it into the endoscope instrument channel, and manipulate the polyp ruler (10) to measure the surface of the polyp (60). The polyp ruler (10) is firmly combined with the head of the push tube (20); the operating handle (30) is an operating control device for the polyp ruler (10) and the push tube (20) to advance or withdraw in the endoscope instrument channel, and the operating handle (30) is arranged at the end of the push tube (20); the polyp ruler (10) is characterized in that: the polyp ruler (10) can be folded or contracted in the endoscope instrument channel or the inner cavity of the sheath tube (40), and can quickly return to the original fixed shape after being released; the surface of the polyp ruler (10) is provided with a scale indication (101), and the inside of the polyp ruler (10) is transparent or hollow.

2. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: The external structure of the polyp measuring ruler (10) adopts the regular structural shape of a universal measuring tool, including a circular, elliptical, semicircular, triangular, square or ruler structure.

3. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: The minimum indication value of the polyp measuring ruler (10) is 1 mm, and the measuring range is between 5 mm and 20 mm.

4. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: The polyp measuring ruler (10) is also provided with a height ruler (103), the height ruler (103) intersects the polyp measuring ruler (10) vertically, and the minimum scale of the height ruler (103) is 1 mm.

5. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: The head of the push tube (20) is provided with a measuring scale, and the head of the push tube (20) and the outer periphery of the polyp measuring ruler (10) are vertically intersected and combined, and the intersection point of the intersection combination is marked as the 0mm value of the height value. From the 0mm value upward, the height indication values ​​of 1mm to 20mm are marked in sequence on the head of the push tube (20), forming a height ruler (103) for measuring the height of the polyp (60).

6. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: A sheath tube (40) is also provided on the outer periphery of the pushing tube (20); after the polyp measuring ruler (10) is folded or compressed, it is pushed into the cavity of the head of the sheath tube (40) for temporary storage.

7. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: The push tube (20), the polyp measuring ruler (10) and the endoscope drug delivery tube (50) are combined to form an endoscope instrument with multiple functions including polyp (60) measurement and irrigation, drug spraying and angiography.

8. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: The endoscopic drug delivery tube (50) is prepared as a double-lumen catheter, wherein one lumen is used for endoscopic drug delivery, and the other lumen is used to place a polyp scale (10) and a push tube (20). The polyp scale (10) is temporarily stored in the lumen at the head of the endoscopic drug delivery tube (50), and the operating handle (30) of the push tube (20) is exposed 5 mm to 20 mm from the tail end of the endoscopic drug delivery tube (50).

9. An endoscopic auxiliary device for measuring gastrointestinal polyps according to claim 1, Its characteristics are: It is used for physical measurement of the size of polyps (60) in the digestive tract under endoscopy, and can also be combined with an endoscope drug delivery tube (50) to achieve clinical functions including polyp (60) measurement, irrigation, spraying of drug solution and imaging.

Images