THE ANATOMICAL RECORD 298:1125–1134 (2015)

Application and Limitations of Endoscopy in Anthropological and Archaeological Research RONALD G. BECKETT* Bioanthropology Research Institute, College of Health Sciences, Quinnipiac University, Arizona, USA

ABSTRACT The use of endoscopy in anthropological and archaeological research was been well documented in the literature. This article explores the varied settings in which endoscopy is beneficial in gathering visual data for interpretation related to cultural remains and artifacts. Endoscopic data may be used to assist in the pursuit of answering such bioanthropological questions as sex, age at death, presence of paleopathologies, dental conditions, and cultural practices. Endoscopy is often used to guide and document biopsy procedures as well as the retrieval of artifacts from within poorly accessible locations such as body cavities, coffins, or tombs. In addition, endoscopic data is used to examine such archaeological features as tomb structure and design. A contrast between the medical and anthropological approach is described. Endoscopic research is enhanced when applied in conjunction with additional varied imaging modalities. While invasive, endoscopy is a nondestructive methodological approach. As with all methods, endoscopy has application and interpretational limitations, which can be described as limitations resulting from instrumentation, and those arising from personnel less familiar with the various approaches to endoscopy in both field and laboratory settings. Anat Rec, C 2015 Wiley Periodicals, Inc. 298:1125–1134, 2015. V

Key words: mummies; endoscopy; anthroplogy; archaeology; nondestructive

Endoscopy is a method that “looks inside” bodies or objects. Typically, endoscopy is employed via an endoscope in a variety of medical procedures for both diagnostic and therapeutic purposes. The images allow access to and visualization of body organs or cavities with air space. The nature of the application of endoscopy is such that, unlike other imaging modalities, the instrument is passed directly into the target structure. There are multiple technological variations that are important to consider regarding the application and limitations of this method. Of these variations, diameter of the insertion tube, lens variability, and portability are the greatest considerations. There is a very wide variety of endoscopic instrumentation available. The two broad categories are medical and industrial endoscopes (Fig. 1). Both medical and industrial endoscopes have been used in research projects involving mummies, ancient artifacts, and archaeoC 2015 WILEY PERIODICALS, INC. V

logical excavations. Biopsies or artifact retrieval are often conducted with endoscopy. Within these two broad categories of endoscopic instrumentation are multiple variations making the endoscope an increasingly versatile instrument for data collection in the anthropological and archaeological settings. Instrument diameter, rigidity, length, lens variations, portability, and biopsy channel configurations are some of the technological

*Correspondence to: Ronald G. Beckett, Bioanthropology Research Institute West, Quinnipiac University 8775 N. Maya Court Tucson, AZ 85742. E-mail: Ronald.beckett@quinnipiac. edu (or) [email protected] Received 16 January 2015; Accepted 30 January 2015. DOI 10.1002/ar.23145 Published online in Wiley Online Library (wileyonlinelibrary. com).

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variations that need to be considered and matched to the research objectives. Endoscopy is a visualization method that uses a flexible or rigid insertion tube. The flexible instruments can be directed toward target organs or objects using directional controls, much like a joy-stick, at the proximal end of the instrument. As the instrument is passed into enclosed spaces, lighting is accomplished by either directing light through the distal end of the endoscope’s optical glass fibers, or by using light emitting diodes at the distal tip. The distal tip may also use a fixed or interchangeable lens system to visualize the target. The lens can either direct the image to an eye-piece or camera affixed to the distal end of the endocsope. Newer endoscopes use image capturing systems that are miniature video cameras associated directly with the lens at the distal tip. A wide variety of lens options are available and can provide various views ranging from near focus, far focus, and wide angle, to 3-D images captured using stereoscopic lenses (Fig. 2). Images are captured on a variety of digital media for documentation and later review. These images can be both video formats and captured still-frames. Alternate light sources can also be used via endoscopy to differentiate among tissue types and other structures. Varied diameter endoscopes are available and can be as small as less than a millimeter. These smallest endoscopes are referred to as “fiberscopes.” Industrial endo-

Fig. 1. An example of medical and industrial endoscopes.

scopes are available that are 18 m (60 feet) in length and longer with obvious archaeological applicability. Biopsies or artifact retrieval are often conducted with endoscopy. Transcutaneous endoscopic guided biopsies have been conducted as well as fluoroscopic guided endoscopic biopsies (Fig 3). Because the endoscope is seeing “what cannot be seen” within an enclosed body cavity or space, the method is best used in conjunction with other imaging modalities (Kim et al., 2006). In fieldwork (Fig. 4), x-ray systems work well in concert with endoscopy (Beckett et al., 1998). In laboratory settings, advanced imaging such as CT scanning (Fig. 5) and fluoroscopy are complementary to endoscopic applications (Posh and Beckett, 2000; Beckett and Conlogue, 2010).

RATIONALE AND USE IN ANTHROPOLOGY AND ARCHAEOLOGY Research conducted to collect and evaluate data within an anthropological and/or archaeological context relies extensively on macroscopic analysis of objects of antiquity and mummified human remains. This direct observational method provides a great deal of information yet does not allow the researchers to see within human remains or objects. Destructive methods such as unwrapping or full autopsies are often used to see what lies beyond the surface (Aufderheide and RodriguezMartin, 1998). Endoscopy is a tool that can image data from within enclosed body cavities or objects and extend the researchers ability to collect valuable data without altering or destroying the object. While endoscopy is invasive, when applied correctly it can be a powerful non-destructive method for data collection within the context of anthropological and archaeological research (Aufderheide, 2003). Endoscopic methods have been used in anthropological and archaeological research settings since the development of the flexible fiberoptic endoscope (Tapp et al., 1984; Beckett et al., 2000). Endoscopy has been used to gather images from mummified and skeletal remains, artifacts within tombs or associated with mummies, biopsies and artifact retrieval, as well as in preexcavation tomb analysis. More recently, an increased variety of applications for endoscopic technology have been realized. Endoscopy has been used to assist in data collection for a variety of anthropological research questions. Among these are

Fig. 2. Endoscopes can be used in conjunction with a wide variety of lens options.

Fig. 3. Fluoroscopic guided biopsy.

Fig. 4. X-ray and endoscopic image of ceramic within the thorax of a pre-Columbian Chiribaya mummy, Ilo, Peru.

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Fig. 5. Endoscopy used in conjunction with CT scan.

assisting in the determination of age at the time of death (Beckett et al., 1999a; Duclos et al., 2000), imaging biomechanical stress (Fig. 6; Bravo et al., 2003a, 2003b, assessment of paleopathological conditions (Fig. 7; Beckett et al., 1999b, 2003; Conlogue et al., 2008b), analysis of burial practices and mummification technique (Fig. 8; Nelson et al., 2007; Conlogue et al., 2008a), dentition analysis (Fig. 9), and soft tissue or bony biopsy for histological and pathological determinations (Fig. 10; Ventura et al., 2002). Additionally, biopsy or material collection for chemical analysis or radiocarbon dating, as well as artifact analysis of objects

wrapped within mummy bundles have been accomplished using endoscopy. Endoscopy has been used in extreme field settings and in pre-excavation tomb evaluation (Fig. 11; Beckett and Conlogure, 2010). Endoscopy has also been used in conjunction with light reflectance/ absorption methods (Fig. 12; Beckett et al., 2007a). Newer applications for endoscopy continue to be developed. The major advantages of endoscopy applied to anthropology and archaeology is its’ technological flexibility of application and portability. When used in conjunction with varied imaging technologies, the endoscope can

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increasing our understanding of the journey of human life on earth.

LIMITATIONS OF METHOD As with any technology, endoscopic application in anthropology and archaeology has it is limitations. The limitations can be broken into two broad categories: limitations inherent to the instrumentation and limitations associated with the personnel applying endoscopic methods.

TECHNOLOGIC LIMITATIONS ASSOCIATED WITH ENDOSCOPY

Fig. 6. Endoscopic image of severe biomechanical stress (arthritis).

Fig. 7. Endoscopic image of pulmonary adhesions in a late 19th century side-show arsenic mummy.

assist with the collection of otherwise unavailable data. Further, the endoscope helps alleviate the need to autopsy mummified human remains, which, in turn, helps preserve the remains for future research and maintain appropriate respect for the deceased while

As previously described, endoscopy requires and route of access into the body cavity, object, mummy wrapping, or other target space. While endoscopes do come in a wide variety of diameters and lengths, at times an access route does not present itself. Often another paleoimaging modality such as x-ray or CT has identified an area of special interest within the mummy or artifact. This may be a unique ceramic or metallic burial inclusion or a calcified lymph node. No matter the case, the decision to create an entry route for the introduction of an endoscope should be weighed carefully. A risk to benefit analysis should be conducted to assure that the potential information gained would be worth making an access route (Beckett and Conlogue, 2010). In addition, a high probability of successful biopsy or retrieval should be assured. If the decision is made to move forward and create an opening, we have been successful in using a flap like opening (Fig. 13) that can be closed following the procedure (Woodward et al., 2011). The smallest diameter endoscope should be selected and the most direct route should be chosen that would have the greatest possibility of success. The procedure should be well documented and directed by alternate imaging methods as indicated. Careful notation and or identification of the modification needs to be made both on the surface of the mummy or object as well as in the interior of the object using pre and post procedure radiographic documentation. Even if there is access to internal body cavities or archaeological objects, another limitation of the endoscopic method is the potential lack of maneuverability. The space entered by the endoscope may be so narrow that the only view is that which is directly in front of the lens. While imaging data can still be collected, this lack of maneuverability can be a major limitation of this method. Another major limitation to the images derived from endoscopy is the interpretability of the data. The data obtained from endoscopic methods is descriptive rather than qualitative (Fig. 14). In desiccated human remains, the internal organs are often not in their typical anatomical position. Thoracic cavity contents can be found in the abdominal or pelvic cavities. Depending on the degree of taphonomic change, the morphologic features of organs, tissues and other anatomic structures can be very different from those seen in a well-preserved mummy and certainly different from living or recently dead humans or animals. The characteristics of desiccated tissues and organs, as well as their potential

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Fig. 8. Endoscopic image of route of excerebration in an Egyptian mummy describing techniques associated with mummification.

Fig. 9. Endoscopy used in analysis of dentition in wrapped, mummified remains.

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Fig. 10. Endoscopic biopsy procedure of a renal stone in a crypt mummy in Popoli, Italy.

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for any cross-contamination potential in this endoscopic application. It is important to realize that even though the endoscopic procedures are non-destructive, they are invasive. Any time an instrument is introduced into a body or artifact, there is a great risk of destructing some material. Typically, this is due to “scope drag.” Scope drag occurs when the operator does not protect the entry route on insertion and subsequent manipulation of the endoscope. The endoscope may also become destructive internally if the operator is too aggressive when trying to access deeper body regions or maneuver the distal end of the endoscope within the body or artifact. Care must be taken to avoid this limitation by taking care to protect the access point (Fig. 15) and to be certain not to force the endoscope into spaces within the body or artifact that it will not “flow” into naturally or with dependent manipulation. Since internal anatomic landmarks may not be as reliable in a desiccated mummified body, it is often difficult for the endoscopist to be certain as to their regional or exact endoscopic location within that body. Location verification via x-ray, CT, or fluoroscopy is essential prior to recording images produced with the endoscope in a given position. Position verification adds validity to the image description attained from the endoscope. A major archaeological concern with the use of endoscopic methods is that of illumination limitations within a large enclosure such as a coffin, tomb, or room. Standard endoscopes, both medical and industrial, do not have illumination capacities to accommodate a larger hollow space. The endoscopist must be prepared and develop slave lighting strategies for these circumstances (Fig. 16).

LIMITATIONS OF PERSONNEL

Fig. 11. An example of pre-excavation tomb analysis in Ilo, Peru.

morphologic appearance must be well understood by those who are conducting the study. If the endoscope is to be used to collect tissue samples for histological or DNA analysis, an additional limitation is that of potential contamination of the sample. Even with the most careful adherence to sample collection protocol, this limitation poses a great risk to the success of such procedures. Great care must be taken to control

Perhaps the greatest limitation to endoscopic methods used in anthropology and archaeology is that of adequate knowledge regarding instrumentation variability. Medical personnel conducting endoscopic research in mummified remains or artifacts will be well versed in the application of a wide variety of medical endoscopes and supportive technologies, but may not be aware of the many variations of industrial endoscopic instrumentation and supportive technologies that are available. This lack of knowledge of instrumentation variation can greatly limit any given research effort and impede the data collection process from this method. Another major human limitation is that of minimal experience with both the instrumentation associated with endoscopic methods, as well as the limitations associated with the interpretation of data collected by this method. Experience is critical in the reliability of the technique selected and the resultant images. Medical personnel are accustomed to viewing anatomical structures and anomalies within the given context of living or recently dead humans. In this context, anatomy is in a reasonable morphologic state and position within the body. This is not the case in mummified remains. Given that the internal environment of desiccated bodies, tissues, and organs may present with marked variation in morphology and in anatomical positions, lack of experience in this imaging modality in this setting can lead to dramatic interpretational errors. These interpretational errors may render the data and quality of the study

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Fig. 12. Endoscopic guided light reflectance method.

Fig. 13. A “flap” entry used for biopsy access in a late 19th century mummy. Fig. 14. Internal organic remains are often difficult to identify.

questionable. Those wishing to employ endoscopic methods would do well to train with a seasoned research team familiar with its use and in the interpretation of data from these anthropological and archaeological applications. Finally, another human limitation to this method is in the reporting of not only the results from an endoscopic

study, but from the technique and instrumentation used (Beckett, 2007b; Beckett and Conlogue, 2010). If endoscopy use in anthropologic and archaeological research is to continue to advance, reproducible studies must be reported. The report should include minimally the

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ing our understanding of the human experience. While endoscopic methods have both technological and operational limitation potentials, with appropriate experience, critical thinking, and laboratory experimentation, many of these limitations can be overcome or at the very least, minimized. Newer endoscopic applications continue to be developed and the contribution of this method to anthropological and archaeological research will continue to grow.

LITERATURE CITED

Fig. 15. Method to protect endoscopic entry route from insertion tube “drag.”

Fig. 16. Establishing “slave” illumination strategies for large target cavities or tombs.

instrument used by name/type, diameter and length, light source, lens, image capture system, access route, body cavity or artifact examined, and major findings. The report should also include supporting photographs of the procedure as well as radiographic verification of endoscope position within the remains or object (Beckett and Conlogue, 2010).

SUMMARY The many and varied applications of endoscopic methodology in anthropological and archaeological research along with the derived data justifies the inclusion of endoscopic approaches to data collection in these settings. The strength of the endoscopic method rests in its’ portability and technologic flexibility. Varied instrumentation configurations allow the endoscope to be applied in a wide variety of settings allowing otherwise unobtainable data and images to be realized, thereby enhanc-

Aufderheide AC, Conrado R-M. 1998. The Cambridge Encyclopedia of Human Paleopathology. United Kingdom: Cambridge University Press. Aufderheide AC. 2003. The Scientific Study of Mummies. United Kingdom: Cambridge University Press. Beckett RG, Gerald C. 1998. Video Enhanced Fiberoptic Examination of Skeletal Material and Artifacts with Radiologic Correlation. Papers on Paleopathology presented at the 25th Annual Meeting, March 31-April 1, 1998. Supplement to Paleopathology Newsletter, No. 102, June issue. Beckett RG, Gerald C, Roger C. 1999a. Endoscopic Evaluation of Segmented Sternum with Radiographic Correlation in a Peruvian Infant: Implications for Aging of the Individual. Papers on Paleopathology presented at the 26th Annual Meeting, April 27-28, 1999, Supplement to Paleopathology Newsletter, No. 106, June issue, ISSN 0148-4737. Beckett RG, Michael M, Janet M. 1999b. Endoscopic Evidence of Lymphadenopathy in a Mummified Peruvian Woman from Pachacamac. Papers on Paleopathology presented at the 26th Annual Meeting, April 27-28, 1999, Supplement to Paleopathology Newsletter, No. 106, June issue, ISSN 0148-4737. Beckett RG, Sonia G. 2000. Field Videoendoscopy - A Pilot Project at Centro Mallqui, El Algarrobal, Peru. Papers on Paleopathology presented at the 27th Annual Meeting, April 11 &12, 2000. Supplement to Paleopathology Newsletter, No. 110, June issue. Beckett RG, Anthony B, Gerald C, Sonia G. 2003. Dead Men Breathing: The Prevalence of Intrathoracic and Extrathoracic Pulmonary Paleopathologies Among 83 Chachapoya Mummies, Leymebamba, Peru. Papers on Paleopatholpgy presented at the 30th Annual Paleopathology Association Meeting, Tempe, Arizona, April. Supplement to Paleopathology Newsletter, June issue. Beckett R, Gerald C, David H. 2007a. Light Reflectance Signatures Among Mummified Organs with Endoscopic Guidance and Radiographic Correlation – A Preliminary Study. Paper presented at the 34th Annual North American Paleopathology Association Meeting, April, in Philadelphia, Pennsylvania. Beckett R. 2007b. Paleoimaging - Standards for Endoscopic and Reflectance Applications in Anthropological Studies. Paper presented in live video conference with Forensic Anthropology & Bioarchaeology Graduate Program, October, for Pontifica Universidad Catolica del Peru. Lima, Peru. Beckett RG, Conlogue GJ. 2010. Paleoimaging: Field Applications for Cultural Remains and Artifacts. CRC Press (Taylor & Francis). Boca Raton, Florida, USA. ISBN – 10: 1420090712, ISBN – 13: 978-1420090710 Bravo A, Gerald C, Ronald B, Andrew S, Larry E, Sarah M. 2003a. A Paleopathological Examination of Eighteen Mummies from the Church of the Dead, Urbania, Italy. Papers on Paleopathology presented at the 30th Annual Paleopathology Association Meeting Tempe, Arizona April. Supplement to Paleopathology Newsletter, June issue. Bravo A, Gerald C, Ronald B, Larry E. 2003b. Exploring the Myth and Paleopathologies of Mummies From a Turkish Tomb, Amasya, Turkey. Papers on Paleopathology presented at the 30th Annual Paleopathology Association Meeting, Tempe, Arizona, April. Supplement to Paleopathology Newsletter, June issue. Conlogue G, Ronald B, John P, Yvette B, David H, Gary D, Thomas K. 2008a. Paleoimaging: the use of radiography, magnetic

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resonance and endoscopy to examine mummified remains. J Rad Nursing 27:5–13. Conlogue G, Ronald B, Yvette B, Jiazi L. 2008b. A Preliminary Radiographic and Endoscopic Examination of 21 Mummies at the “Museo De Las Momias” in Guanajuato, Mexico and the Importance of a Team Approach to Image Interpretation. Paper presented at the 35th Annual Meeting of the Paleopathology Association, April 8-9, in Columbus, Ohio. Duclos L, Ronald B, Sonia G, Gerald C. 2000. Endoscopy as an adjunct to determining age at death in mummified remains. Papers on Paleopathology presented at the 27th Annual Meeting, April 11-12, 2000. Supplement to Paleopathology Newsletter, No. 110, June issue. Kim SB, Shin JE, Park SS, Bok GD, Chang YP, Kim J, Chung YH, Yi YS, Shin MH, Chang BS, Shin DH, Kim MJ. 2006. Endoscopic investigation of the internal organs of a 15th-century child mummy from Yangju, Korea. J Anat 209:681–688. Nelson A, Gerald C, Ronald B, John P, Rethey C, Edwin W, James R. 2007. Multi-Modality Analysis of Variability in Transnasal Craniotomy Lesions in Egyptian Mummies. Paper presented at the

34th Annual North American Paleopathology Association Meeting, April. Philadelphia, Pennsylvania. Posh J, Ronald B. 2000. A comparison of two nondestructive techniques for the evaluation of endocranial features - videoendoscopy and virtual fly through computed tomography. Papers on Paleopathology presented at the 27th Annual Meeting, April 11-12. Supplement to Paleopathology Newsletter, No. 110, June issue. Tapp E, Stanworth P, Wildsmith K. 1984. The Endoscope in Mummy Research. In Evidence Embalmed. In: David R, Tapp E, editor. Manchester, UK: Manchester University Press. p 65–77. Ventura L, Paula L, Ronald B, Gerald C, Sindici G, Calabrese A, Di Giandomenico V, Gino F. 2002. The Natural Mummies of Popoli. A new site in the inner Abruzzo Region (Central Italy). Anthropol Portuguese 19:1–2. ISSN 0870-0990 Pub. Spring. Woodward J, Gaither C, Gonzalez R, Beckett RG, Conlogue GJ, Cool C, Groshong S. 2011. Re-thinking Anthracosis: A Critical Reexamination of a Diagnostic Trend. (Case Study from a 19th Century West Virginian Mummy). 7th World Congress on Mummy Studies, San Diego, California. June 12-16, 2011.

Application and limitations of endoscopy in anthropological and archaeological research.

The use of endoscopy in anthropological and archaeological research was been well documented in the literature. This article explores the varied setti...
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