From THE NEW YORK TIMES, SUNDAY, APRIL 14, 1996

THE NEW YORK TIMES, SUNDAY, APRIL 14, 1996

From Stony Brook, a New Way to Examine Colons, Externally

By ADAM L. PENENBERG

Technology invented by Dr. Arie Kaufman allows a three-dimensional image of a colon. Dr. Kaufman at a computer.

        FLYING through a virtual colon Dr. Arie Kaufman said, is a lot like playing a "Star Wars" video game. Dr. Kaufman , a professor of computer science at the State University at Stony Brook , should know. He has invented a technology that may soon supplant colonoscopy, the procedure that uses a flexible fiber- optic tube called a colonoscope to help detect problems in the colon like polyps and cancer.
        "This technology costs significantly less than a regular colonoscopy and is a lot more convenient for the patient," said Dr. Kaufman, who is known for his work in a computer graphics technology called volume visualization. "It frees up doctors to do other things, since you use technician time, not experienced- doctor time."
        By using information from a computer-assisted tomography scan, or CAT scan, of the colon taken from outside the abdomen Dr. Kaufman produces clear computerized images that he can "fly through," search for bumps and other abnormalities, sample tissues and delve beneath the surfaces of polyps.
        Much like virtual-reality programs that let people walk

An examination takes a page from virtual reality.

through houses, labyrinths, caves and other fantasy scenarios, three-dimensional colonoscopy permits examinations without the patient's even having to be present.
        Colonoscopy, with rectal entry, and barium enemas are the usual methods to detect problems, but each has drawbacks. Colonoscopy can, in rare instances, lead to perforation of the colon walls, may require sedation, can cost Sl,100 to $1,900 and take 40 to 60 minutes to carry out. Barium enemas, which are less expensive, do not afford full views and are often less accurate. In contrast, Dr. Kaufman estimates that his three-dimensional colonoscopy will cost about $350 and take iust a few minutes.
        "Dr. Kaufman's technique will allow us to do pretty much anything a regular colonoscopy let's us do, but without all that patient discomfort," a radiologist at University Hospital in Stony Brook, Dr. Mark Wax, said. "A gastroenterologist, by having a scope inside the patient,can only see the surfaces. But this technique will make it possible for us to be able to take data from the walls of the intestines, actually peel layers off the wall and peer inside the surfaces of polyps. I see it as a very viable technique."
        As with conventional examinations, patients prepare by cleansing the bowel. In the radiology area the physician pumps air into the colon to inflate it. Then a machine scans thin cross- sections of the whole lower abdomen and pelvis. The examiners send the digitized images to Dr. Kaufman's laboratory for analysis, where they compare the results of the techniques. The three- dimension al technique is now being used in addition to, not in place of, conventional colonoscopies.
        Dr. Kaufman said he came up with the idea for the new approach two years ago. "I was talking to a gastroenterologist," he said, "and we were discussing the fact that everyone over the age of 50 should have colonoscopic procedure, which is not an exciting prospect. I wondered if we could use a computer instead of doctor, and he said, 'No, I'll go out of business.'"
        As an outgrowth of his volume visualization work, Dr. Kaufman takes two-dimensional data from CAT scans, magnetic- resonance imaging or X-rays and renders them as three-dimensional images. "Volvis" users can, on a screen, peel the layers of a representation of the brain, heart or lungs.
        Volume visualization relies on mathematical formulas that simulate how particles emit, absorb, bend or refract light. The system takes an object that has been traditionally represented in two-dimensional triangles and translates them into voxels, small cubes that have been identified as belonging to an object, in much the same way that pixels make up images on the screen of a television set. An image is drawn when imaginary rays are fired. As each ray passes through each voxel, data accumulated and displayed as a graphic image.
        After tests on a plastic pipe, Dr. Kaufman compiled data from the visible human project, a reference set of digital information about male and female cadavers in M.R.I., CAT scan and anatomical modes on the Internet from the National Institutes of Health (http://www.nlm.nih.gov).
        "We showed it to the G.I.'s and radiologists on staff here," Dr. Kaufman said, "and they were impressed, a real-smash success. Now we have begun testing it on patients at Stony Brook University Hospital." Other researchers, too, are working on three-dimensional colonoscopy.
        At the General Electric research center in Schenectady, Bill Lorensen, has also been working on virtual reality approaches. "But while Dr. Kaufman is using a volumetric system," Mr. Lorensen said, "we're using a surface-based system, which is better for today's hardware and software. We can use off-the -shelf software, while he has to create his own."
        Dr. Kaufman said his technology was a blend of surface and volume methods and could be operated on any Silicon Graphics computer. Eventually, he said, common desk top computers would be able to use the technique.
        "If I want to go into the surface of a polyp I can," Dr. Kaufman said. "But Bill Lorensen can't. To him it's just a surface. But I can go in and actually test it."
        At the Bowman Gray School of Medicine at Wake Forest University in Winston-Salem, N.C., research focuses on improving techniques for telling the difference "between potentially cancerous polyps and last night's dinner," a radiologist, Dr. David Vining, said.
        "We're working on developing contrasting agents to help with this, and also to be able to detect flat lesions," Dr. Vining said. "Not all cancers project mossy masses like a stock of broccoli. Some of them are flat lesions, which, If you're just flying through, you won't see."
        One advantage of conventional colonoscopies is that polyps can be immediately removed with snips at the end of the tube, although Dr. Vining said, 90 percent of the cases do not require polyp removal.
        Col. Richard Satava, a doctor in the Army Advanced Research Projects Administration, said within 20 years Dr. Kaufman's technology might be used on the battlefield.
        "CT, M.R.I., ultrasound or what ever new imaging modality that will exist in the future might be able to immediately acquire a 3-D image of the casualty," Dr. Satava, an expert in telesurgery, said. "Just like virtual colonoscopy flies through 3-D images, a surgeon could completely visualize the internal wounds, including flying through them a la 'Fantastic Voyage,' to completely understand how badly wounded a patient is and, if there is time, to actually practice different approaches or procedures before actually operating."
        Dr. Kaufman said that he planned to make the technology available for the asking and that he had applied for a patent on behalf of the university. He has 13 patents, on volume visualization, flight simulation, volume-rendering hardware and eye track, a technology that he developed that enables quadriplegics to operate a computer by moving their eyes. In eight years, Dr. Kaufman has raised S4 million in royalties and research grants for Stony Brook.
        "We hope in a year, maybe a year and a half, to make 3D virtual colonoscopy available to the public," he said. "But first F.D.A. approval is needed. But since it's basically a 10 minute CT scan, it shouldn't take long."

THE NEW YORK TIMES, SUNDAY, APRIL 14, 1996

From Stony Brook, a New Way to Examine Colons, Externally
By ADAM L. PENENBERG


Technology invented by Dr. Arie Kaufman allows a three-dimensional image of a colon. Dr. Kaufman at a computer.

FLYING through a virtual colon Dr. Arie Kaufman said, is a lot like playing a "Star Wars" video game. Dr. Kaufman , a professor of computer science at the State University at Stony Brook , should know. He has invented a technology that may soon supplant colonoscopy, the procedure that uses a flexible fiber- optic tube called a colonoscope to help detect problems in the colon like polyps and cancer. "This technology costs significantly less than a regular colonoscopy and is a lot more convenient for the patient," said Dr. Kaufman, who is known for his work in a computer graphics technology called volume visualization. "It frees up doctors to do other things, since you use technician time, not experienced- doctor time." By using information from a computer-assisted tomography scan, or CAT scan, of the colon taken from outside the abdomen Dr. Kaufman produces clear computerized images that he can "fly through," search for bumps and other abnormalities, sample tissues and delve beneath the surfaces of polyps. Much like virtual-reality programs that let people walk

An examination takes a page from virtual reality.

through houses, labyrinths, caves and other fantasy scenarios, three-dimensional colonoscopy permits examinations without the patient's even having to be present. Colonoscopy, with rectal entry, and barium enemas are the usual methods to detect problems, but each has drawbacks. Colonoscopy can, in rare instances, lead to perforation of the colon walls, may require sedation, can cost Sl,100 to $1,900 and take 40 to 60 minutes to carry out. Barium enemas, which are less expensive, do not afford full views and are often less accurate. In contrast, Dr. Kaufman estimates that his three-dimensional colonoscopy will cost about $350 and take iust a few minutes. "Dr. Kaufman's technique will allow us to do pretty much anything a regular colonoscopy let's us do, but without all that patient discomfort," a radiologist at University Hospital in Stony Brook, Dr. Mark Wax, said. "A gastroenterologist, by having a scope inside the patient,can only see the surfaces. But this technique will make it possible for us to be able to take data from the walls of the intestines, actually peel layers off the wall and peer inside the surfaces of polyps. I see it as a very viable technique." As with conventional examinations, patients prepare by cleansing the bowel. In the radiology area the physician pumps air into the colon to inflate it. Then a machine scans thin cross- sections of the whole lower abdomen and pelvis. The examiners send the digitized images to Dr. Kaufman's laboratory for analysis, where they compare the results of the techniques. The three- dimension al technique is now being used in addition to, not in place of, conventional colonoscopies. Dr. Kaufman said he came up with the idea for the new approach two years ago. "I was talking to a gastroenterologist," he said, "and we were discussing the fact that everyone over the age of 50 should have colonoscopic procedure, which is not an exciting prospect. I wondered if we could use a computer instead of doctor, and he said, 'No, I'll go out of business.'" As an outgrowth of his volume visualization work, Dr. Kaufman takes two-dimensional data from CAT scans, magnetic- resonance imaging or X-rays and renders them as three-dimensional images. "Volvis" users can, on a screen, peel the layers of a representation of the brain, heart or lungs. Volume visualization relies on mathematical formulas that simulate how particles emit, absorb, bend or refract light. The system takes an object that has been traditionally represented in two-dimensional triangles and translates them into voxels, small cubes that have been identified as belonging to an object, in much the same way that pixels make up images on the screen of a television set. An image is drawn when imaginary rays are fired. As each ray passes through each voxel, data accumulated and displayed as a graphic image. After tests on a plastic pipe, Dr. Kaufman compiled data from the visible human project, a reference set of digital information about male and female cadavers in M.R.I., CAT scan and anatomical modes on the Internet from the National Institutes of Health (http://www.nlm.nih.gov). "We showed it to the G.I.'s and radiologists on staff here," Dr. Kaufman said, "and they were impressed, a real-smash success. Now we have begun testing it on patients at Stony Brook University Hospital." Other researchers, too, are working on three-dimensional colonoscopy. At the General Electric research center in Schenectady, Bill Lorensen, has also been working on virtual reality approaches. "But while Dr. Kaufman is using a volumetric system," Mr. Lorensen said, "we're using a surface-based system, which is better for today's hardware and software. We can use off-the -shelf software, while he has to create his own." Dr. Kaufman said his technology was a blend of surface and volume methods and could be operated on any Silicon Graphics computer. Eventually, he said, common desk top computers would be able to use the technique. "If I want to go into the surface of a polyp I can," Dr. Kaufman said. "But Bill Lorensen can't. To him it's just a surface. But I can go in and actually test it." At the Bowman Gray School of Medicine at Wake Forest University in Winston-Salem, N.C., research focuses on improving techniques for telling the difference "between potentially cancerous polyps and last night's dinner," a radiologist, Dr. David Vining, said. "We're working on developing contrasting agents to help with this, and also to be able to detect flat lesions," Dr. Vining said. "Not all cancers project mossy masses like a stock of broccoli. Some of them are flat lesions, which, If you're just flying through, you won't see." One advantage of conventional colonoscopies is that polyps can be immediately removed with snips at the end of the tube, although Dr. Vining said, 90 percent of the cases do not require polyp removal. Col. Richard Satava, a doctor in the Army Advanced Research Projects Administration, said within 20 years Dr. Kaufman's technology might be used on the battlefield. "CT, M.R.I., ultrasound or what ever new imaging modality that will exist in the future might be able to immediately acquire a 3-D image of the casualty," Dr. Satava, an expert in telesurgery, said. "Just like virtual colonoscopy flies through 3-D images, a surgeon could completely visualize the internal wounds, including flying through them a la 'Fantastic Voyage,' to completely understand how badly wounded a patient is and, if there is time, to actually practice different approaches or procedures before actually operating." Dr. Kaufman said that he planned to make the technology available for the asking and that he had applied for a patent on behalf of the university. He has 13 patents, on volume visualization, flight simulation, volume-rendering hardware and eye track, a technology that he developed that enables quadriplegics to operate a computer by moving their eyes. In eight years, Dr. Kaufman has raised S4 million in royalties and research grants for Stony Brook. "We hope in a year, maybe a year and a half, to make 3D virtual colonoscopy available to the public," he said. "But first F.D.A. approval is needed. But since it's basically a 10 minute CT scan, it shouldn't take long."