Tiresias - The Panoptic View

“Now is the winter of our discontent

Made glorious summer by this sun of York;

And all the clouds that lower'd upon our house

In the deep bosom of the ocean buried.”

William Shakespeare

My friends

Ahh, The Bard, The Bard! Tiresias sees.

In the last few posts Tiresias has discussed some specific applications of Optiscan’s confocal in-vivo endomicroscopy, and how they will be introduced, specifically in neurosurgery, oral cancer and breast cancer. Today he would like to step back a little, and look at the big picture, panoptic or panoramic view, if you like. Perhaps even a little philosophical.

As you, my friends, may have gathered, Tiresias is a student of medical history. Today he would like to look at our company, refracted through history, and through two concepts; macro-imaging versus micro-imaging; and the in vivo versus ex vivo imaging. Tiresias is not going to insult your intelligence by explaining what each of these means, but just to remind you that in vivo means examining tissue in the living organism and ex vivo is examining the tissue, taken from the organism, and examined in the external environment. Ex vivo examination of biopsies and excised tissue is conventional histopathology. Until now it has not been possible to do microscopic examination in the living organism. But, of course, you all know this!

Now to the history. Modern medicine begins in the renaissance, in the 15th and 16th century, with the anatomist, with the understanding of the macroscopic naked eye structure of the human body. Andreas Vesalius, Leonardo da Vinci, and many many others, dissected cadavers and worked out the structure of the human body. This led to other important discoveries in in the understanding of function of organs based on the macroscopic structure. This was physiology, and the greatest of the early discoveries, based on the understanding of the structure, was William Harvey’s understanding of the circulation and function of the heart. Without these advances modern medicine and surgery is inconceivable. Tiresias will call this ex vivo macro. In other words, examination of not the living body or in vivo, but cadaveric post-mortem tissue with the naked eye.

The next step was the invention of the light microscope. This enabled examination of the structure of tissue at the microscopic level, beyond the resolution of the naked eye, but outside the organism. This led to the next great revolution the understanding the microscopic structure of the body, the understanding the structure of tissues, and discovery of cells, and discovery of germs, and how they cause disease. This can be considered as ex vivo micro.

In 1895, Wilhelm Rontgen discovered X-rays. This was the start of medical imaging. Plain X-rays were an enormous leap forward. For the first time in history inaccessible structure of the body, could be seen, in the living body. Though useful, plain X-rays, by our standards today, were obviously very limited. The next big advance to macroscopic in vivo imaging was the invention of the digital computer, which led to CT scanner, and then to ultra-sound imaging, echocardiography, MRI scanning, PET scanning any and interventional radiology at interventional neuro radiology. Roentgen could not have imagined any of this when his saw the first flickering shadows of his own skeleton in his laboratory. Nobody could have. Tiresias will call this in vivo macro imaging. Seeing inside the living body, at the naked eye level.

The final step in this history, closing of the circle, is invivo micro imaging. In other words, to be able to examine living tissues and living cells physiological in life, inside the living body, at the microscopic level. This is Optiscan. Tiresias has touched on some obvious early applications, but like Roentgen, we cannot even grasp the what other applications of this will arise and how it will change medicine and surgery. In vivo microscopy, has arrived.

Ah the Bard..…….The clouds are certainly being removed from our house and blue sky is beckoning.