Cystoscopy

What it does

Cystoscopy reads a recorded examination of the bladder, as video or as the stills captured during it. Cystoscopy is the core test in the work-up of haematuria and in follow-up after bladder cancer treatment, and the lesions most often overlooked are small papillary tumours and flat areas of carcinoma in situ.

The run follows the recording frame by frame, detects papillary tumours and suspicious flat lesions, and tracks each one across the frames in which it appears so it is reported once. Every lesion comes with a best key frame, the first and last timestamp at which it is visible, and its place in a lesion map of the bladder that the urologist can use to plan resection or biopsy.

Intended use

Decision support after the procedure: a second look at a surveillance or diagnostic cystoscopy, especially for less-experienced operators, and a key-frame record of what was seen for the patient file and for comparison at the next visit.

Who it is for

Urologists, urology residents and nurse cystoscopists, and units that keep cystoscopy recordings for surveillance programmes. Developers use the run to attach structured lesion findings and key frames to a urology reporting system.

Accepted input

• Video: flexible or rigid cystoscopy recordings as MP4, MOV or MKV (H.264/H.265), or as DICOM Video Endoscopic Image.
• Stills: JPEG/PNG images or DICOM VL Endoscopic Image saved during the examination.
• Clips and full examinations are both read; a full examination gives the most complete lesion map.

Requirements

Requirement	Why
Filled, rinsed bladder in view	Folds, debris and blood hide flat lesions and small tumours
Systematic survey of all walls	A lesion can only be mapped if the recording shows it
Frame rate in the video file	Lesion timestamps and tracks depend on it
Steady views of each suspicious area	Flat lesions are judged on close, stable frames

Optional context

The indication (visible or non-visible haematuria, surveillance after resection, intravesical therapy) and prior tumour history can be passed in clinical_context; the guidance and draft report use them.

The result

Section	Content
Bladder tumours	Papillary tumours and suspicious flat lesions, each with a track, key frame, first and last timestamp and position in the lesion map
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Findings, key frames and the timeline arrive in one JSON result, with each lesion linked to the frames it was detected on.

Standards

• DICOM: key frames as VL Endoscopic Image, annotated clips as Video Endoscopic Image, the key-frame selection as a Key Object Selection document, lesion findings in SR TID 1500, the report as Encapsulated PDF.
• Interoperability: FHIR R4 Procedure, DiagnosticReport and Observation; SNOMED CT coding of procedure, finding and site.