Bladder cancer is the most expensive cancer to treat due to the high rate of recurrence. Though white light cystoscopy
is the gold standard for bladder cancer surveillance, the advent of fluorescence biomarkers provides an opportunity to
improve sensitivity for early detection and reduced recurrence resulting from more accurate excision. Ideally,
fluorescence information could be combined with standard reflectance images to provide multimodal views of the
bladder wall. The scanning fiber endoscope (SFE) of 1.2mm in diameter is able to acquire wide-field multimodal video
from a bladder phantom with fluorescence cancer "hot-spots". The SFE generates images by scanning red, green, and
blue (RGB) laser light and detects the backscatter signal for reflectance video of 500-line resolution at 30 frames per
second. We imaged a bladder phantom with painted vessels and mimicked fluorescent lesions by applying green
fluorescent microspheres to the surface. By eliminating the green laser illumination, simultaneous reflectance and
fluorescence images can be acquired at the same field of view, resolution, and frame rate. Moreover, the multimodal
SFE is combined with a robotic steering mechanism and image stitching software as part of a fully automated bladder
surveillance system. Using this system, the SFE can be reliably articulated over the entire 360° bladder surface.
Acquired images can then be stitched into a multimodal 3D panorama of the bladder using software developed in our
laboratory. In each panorama, the fluorescence images are exactly co-registered with RGB reflectance.