1. NOSCAR 2010 Targeted Technology Assessment Imaging & Optics

2. Variable focal length scopes Depth of field of view, full size image rather than cropped or field size image Provide near view and far view Enhance safety and efficacy Incorporate laparoscopic lens system into flexible endoscope (dedicated NOTES endoscope) Zoom function Timeline immediate No obstacles to adoption

3. Imaging & Optics Disassociation of image optics form instrumentation Permits therapeutics beyond the linear axis of the flexible endoscope Multiple angles, panoramic, rear view image Pop-up cameras, implantable tripods, magnetic, etc Benefits of triangulation Separate operators of imaging and therapeutics 1-2 yr timeline Obstacles to adoption Cross camera glare, reflection, disorientation

4. Imaging & Optics Variable stiffness NOTES endoscope Permit stiffening and flexibility Configurational conformity Fixed axis for intervention Smart imaging Beyond HD white light imaging Electronic enhancements (NBI, FICE, MBI) Fluorescence, infrared, thermography

5. Imaging & Optics Lens cleaning systems Adoption of flexible endoscope wash systems to laparoscopes Enhance efficiency Modest cost increase Directing imaging to recesses Illumination and imaging into hidden corners Allow total abdominal imaging Detect metastases Implantable illumination systems

6. Imaging & Optics Guided NOTES trochars Optical, EUS, Mini-scopes, others Permit reliable, reproducible, safe access Applicable to trans-gastric, -colonic, -vaginal 3-D modeling Pre-op CT scanning for organ orientation, guided entry, strategy planning Used in combination with scope guide for real time orientation