Non-Linear Image Distortions in Flexible Fiberoptic Endoscopes and their Effects on Calibrated Horizontal Measurements Using High-Speed Videoendoscopy.

Laryngeal images obtained via high-speed videoendoscopy are an invaluable source of information for the advancement of voice science because they can capture the true cycle-to-cycle vibratory characteristics of the vocal folds in addition to the transient behaviors of the phonatory mechanism, such as onset, offset, and breaks. This information is obtained through relating the spatial and temporal features from acquired images using objective measurements or subjective assessments. While these images are calibrated temporally, a great challenge is the lack of spatial calibration. Recently, a laser-projection system allowing for spatial calibration was developed. However, various sources of optical distortions deviate the images from reflecting the reality. The main purpose of this study was to evaluate the effect of the fiberoptic flexible endoscope distortions on the calibration of images acquired by the laser-projection system. Specifically, it is shown that two sources of nonlinear distortions could deviate captured images from reality. The first distortion stems from the wide-angle lens used in flexible endoscopes. It is shown that endoscopic images have a significantly higher spatial resolution in the center of the field of view than in its periphery. The difference between the two could lead to as high as 26.4% error in calibrated horizontal measurements. The second distortion stems from variation in the imaging angle. It is shown that the disparity between spatial resolution in the center and periphery of endoscopic images increases as the imaging angle deviates from the perpendicular position. Furthermore, it is shown that when the imaging angle varies, the symmetry of the distortion is also affected significantly. The combined distortions could lead to calibrated horizontal measurement errors as high as 65.7%. The implications of the findings on objective measurements and subjective visual assessments are discussed. These findings can contribute to the refinement of the methods for clinical assessment of voice disorders. Considering that the studied phenomena are due to optical principles, the findings of this study, especially those related to the effects of the imaging angle, can provide further insights regarding other endoscopic instruments (eg, distal-chip and rigid endoscopes) and procedures (eg, gastroendoscopy and colonoscopy).