Abstract:
A cavity illumination system according to the present disclosure may include one or more illumination elements composed of a transparent or semi-transparent, biocompatible sterilizable polymer and one or more illumination sources. The sterilizable polymer operates as a waveguide. An illumination element may incorporate micro structured optical components such as for example gratings, prisms and or diffusers to operate as precision optics for customized delivery of the light energy. The micro structured optical components may also be used to polarize and/or filter the light energy entering or exiting the illumination element.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    The present application is a continuation of U.S. patent application Ser. No. 11/432,898 (Attorney Docket No. 40556-707.201, now U.S. Pat. No. ______), filed May 12, 2006, which claims priority from U.S. Provisional Patent Application No. 60/681,074 (Attorney Docket No. 40556-707.101), filed May 13, 2005; U.S. Provisional Patent Application No. 60/681,119 (Attorney Docket No. 40556-708.101), filed May 13, 2005; and U.S. Provisional Patent Application No. 60/681,089 (Attorney Docket No. 40556-709.101), filed May 13, 2005, the full disclosures of which are incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The inventions described below relate to the field of medicine and more specifically, to providing body cavity illumination for use by doctors and dentists during medical and dental procedures. 
         [0004]    2. Background of the Invention 
         [0005]    Various illuminating means have been employed in the past to illuminate natural cavities within the human body in order to facilitate examination and performance of medical procedures by medical professionals. Illumination devices currently on the market employ projected, directional light. Some devices such as commercially available specula have their lighting means disposed on the lower blades of the specula where a heavy discharge, e.g., a vaginal discharge, can pool and obscure the light source. Other devices employ projected directional light, however, these illumination means merely provide illumination in a capacity limited to the area directly in front of the device or the optical fiber. These drawbacks make it difficult for medical personnel to perform examinations or procedures because their ability to see is diminished due to poor illumination. 
         [0006]    Conventional methods of illumination in dentistry primarily consist of the use of overhead lighting or the use of head mounted lighting by dental professionals. Although these methods have been used for many years, they have many drawbacks. During dental examinations and procedures, dentists are often positioned between the light source and the patient&#39;s mouth, which blocks the light and creates shadows in the patient&#39;s mouth making it difficult to see. 
         [0007]    It is frequently necessary in medical procedures to insert an endotracheal tube into the trachea of a patient for the purpose of performing diagnostic tests or for the introduction of some means of ventilation, oxygenation, and/or airway protection. Even in the best situations, intubation is often difficult and can give rise to complications. In many patients, establishment of the airway is particularly difficult due to morphologic anomalies such as a large tongue, excessive pharyngeal or laryngeal soft tissue, or tracheal displacement, as well as physiologic events such as laryngospasm, regurgitation of gastric materials, bleeding, or foreign bodies aspiration. These morphologic anomalies and/or events make it difficult to visualize the posterior pharyngeal area and larynx with conventional laryngoscopic maneuvers. In emergency situations, attempts to intubate such patients are difficult and time consuming. Inability to expeditiously intubate the patient and protect the airway can lead to significant hypoxemia, myocardial ischemia, and brain injury. Cases of death have also been related to complications caused by the inability to quickly and clearly see the larynx and trachea. Proper illumination is critical to safely and quickly insert an endotracheal tube into a patient. 
         [0008]    Conventional laryngoscopes are often only able to provide illumination to the area directly in front of the blade or the optical fiber. These drawbacks make it difficult for medical personnel to perform intubations because their ability to see is diminished due to poor field of illumination. 
         [0009]    Anoscopes are used to view the anal cavity and lower rectum. Illumination is provided with a fiber optic light pipe that provides only a spot of light that must be moved around to view the cavity. Some anoscopes are provided with fiber optic fibers arranged in a ring around the tip of the device. Such devices are very expensive to manufacture and only provide a ring of light due to the small divergence angle of the fiber optic light output, thereby poorly illuminating the cavity walls. 
         [0010]    An inefficient waveguide in conventional devices may experience significant light loss; typically 60% of light may be lost from input to output. Such a light guide would require a high power LED to provide sufficient light. A high power LED requires a lot of power and generates significant heat, thereby requiring large batteries and bulky and inconvenient heat sinking devices and methods that add to the size and increase the difficulty of using such a device. Other high power light sources often require noisy fans, which may disturb the medical personnel conducting a surgery or medical exam. 
         [0011]    What is needed is a more effective, simple and inexpensive means of illuminating body cavities. 
       BRIEF SUMMARY OF THE INVENTION 
       [0012]    A cavity illumination system according to the present disclosure may comprise one or more illumination elements composed of a transparent or semi-transparent, biocompatible sterilizable polymer and one or more illumination sources. The sterilizable polymer operates as a waveguide. An illumination element may incorporate micro structured optical components such as for example gratings, prisms and or diffusers to operate as precision optics for customized delivery of the light energy. The micro structured optical components may also be used to polarize and/or filter the light energy entering or exiting the illumination element. 
         [0013]    For example, a dental retractor may have a substantially U-shaped waveguide to confine and guide a propagating electromagnetic wave. When in use, the light source in the dental retractor provides an electromagnetic wave, which is confined and guided by the polymer resulting in the illumination of the oral cavity. 
         [0014]    Alternatively, an external reusable light source may be attached to the disposable dental retractor to provide a source of light, said light being guided by the waveguide to optical structures specifically designed to illuminate particular areas of the oral cavity. Other similar dental devices may be so configured to provide illumination of the oral cavity, for example, cheek retractors, cheek expanders, combination lip and cheek retractors, tongue shields, bite blocks, intra-oral mirrors used in photography, and the like. 
         [0015]    In an alternate example, an illuminated laryngoscope may include a disposable blade comprising a biocompatible sterilizable polymer. When in use, the light source in the blade, or in optical communication with the blade provides an electromagnetic wave, which is confined and guided by the polymer resulting in the illumination of the trachea of the patient. 
         [0016]    In modern practice, a non-disposable metal blade is often preferred due to the forces applied during use. In an alternate configuration, a disposable waveguide may be attached to the metal blade or inserted into a groove in the metal blade. When in use, the light source in the waveguide, or in optical communication with the waveguide provides light that is confined and guided in the waveguide until it reaches optical structures for directing the outgoing light to selected areas to be illuminated. 
         [0017]    In another example, a speculum illumination system may comprise a gynecological speculum having detachable blades comprising a biocompatible sterilizable polymer. The illumination source is in optical communication with the blades the sterilizable polymer functions as a waveguide. 
         [0018]    A body cavity illumination system waveguide is designed and fabricated to optimize light transfer from the light source or fiber optic input cable and minimize light loss from the waveguide in order to provide an efficient light transmission system. Efficiency is particularly important for LED and other light sources, e.g., tungsten or xenon lamps, because it directly determines the required brightness of the LED. An efficient waveguide, one in which light loss is typically less than 30%, allows a much lower power LED or other light source to be used, thereby significantly reducing or eliminating the need for special heat sinking devices and methods and improving the usability of the device. The design of an efficient body cavity illumination waveguide may involve special design of the light input portion of the waveguide to efficiently capture the incoming light, design and fabrication of the light reflecting walls of the waveguide to maintain surface finish to maximize reflection and reduce light lost through refraction, the use of reflective or dampening coatings, the design of light directing optical structures that direct the light toward the light output optical structures while minimizing light loss through refraction, and/or the design of light output optical structures that maximize light exiting the waveguide through refraction, particularly refraction of light in certain directions, while minimizing light lost through reflection. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]      FIG. 1  is a front view of a patient&#39;s oral cavity during a dental examination using a cavity illumination system according to the present disclosure. 
           [0020]      FIG. 2  is a side view of an alternate cavity illumination configuration. 
           [0021]      FIG. 3  is a top view of an alternate cavity illumination configuration as a dental retractor with a handle. 
           [0022]      FIG. 4  is a top view of an alternate dental retractor cavity illuminator. 
           [0023]      FIG. 5  is a top view of a dental retractor cavity illuminator with light directing structures. 
           [0024]      FIG. 6  is a top view of a dental retractor cavity illuminator with light directing structures in the handle. 
           [0025]      FIG. 7  is a cutaway view of the dental retractor cavity illuminator of  FIG. 6 . 
           [0026]      FIG. 8  is a top view of a cheek retractor cavity illuminator according to the present disclosure. 
           [0027]      FIG. 9  is a side view of a laryngoscope cavity illuminator in use. 
           [0028]      FIG. 10  illustrates a laryngoscope illumination system with an illumination source in the blade. 
           [0029]      FIG. 11  illustrates a laryngoscope illumination system with an illumination source in the handle. 
           [0030]      FIG. 12  is a side view of an alternate laryngoscope illuminator according to the present disclosure. 
           [0031]      FIG. 13  is a side view of a metal blade laryngoscope including an illuminator waveguide engaging the blade. 
           [0032]      FIG. 14  is a cutaway view of the laryngoscope cavity illuminator of  FIG. 13  taken along B-B. 
           [0033]      FIG. 15  is a side view of a laryngoscope cavity illuminator waveguide. 
           [0034]      FIG. 16  illustrates the Speculum Illumination System. 
           [0035]      FIG. 17  is a side view of the cavity illumination system of Figure with the handles closed. 
           [0036]      FIG. 18  is a side view of an alternate cavity illumination system with the illumination source in the handle. 
           [0037]      FIG. 19  is a side view of another alternate cavity illumination system. 
           [0038]      FIG. 19A  is a cutaway view of the blade of cavity illumination system of  FIG. 19  taken along C-C. 
           [0039]      FIG. 19B  is a cutaway view of an alternate blade of cavity illumination system of  FIG. 19  taken along C-C. 
           [0040]      FIG. 20  is a side view of still another alternate cavity illumination system. 
           [0041]      FIG. 21  is a top view of yet another cavity illumination system according to the present disclosure. 
           [0042]      FIG. 22  is a cutaway view of the cavity illumination system of  FIG. 21  taken along D-D. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0043]      FIG. 1  illustrates a patient&#39;s oral cavity  1  during a dental examination. The patient&#39;s mouth is opened with a cheek or dental retractor, exposing the patient&#39;s teeth  2 . The dental retractor comprises biocompatible sterilizable polymer that acts as a waveguide and further comprises an illumination source  3 . The illumination source comprises an LED (light emitting diode)  4 , battery  5 , a conductor  6  electrically connecting the battery and the LED, and an LED control circuit  7  and switch  8 . The switch may have pressure sensor causing a connection between the battery and the LED when the patient&#39;s lips or cheeks press against the retractor and resulting in illumination. The LED is preferably a white-light LED, which provides a bright, white light. The battery may be provided in any form, but is preferably a lithium ion polymer battery provided in small, conformal case. The control circuit, including a switch, is provided in the case or any convenient location. 
         [0044]    Dental illumination system  53  of  FIG. 2  is integrated into a dental mirror. An illumination source is integrated into handle  55 . The illumination source includes switch  56 , battery  57 , any suitable switching and drive circuit such as circuit  58  and a suitable light element such as LED  54 , preferably a bright white LED. The battery may be of any suitable type, preferably a lithium ion polymer battery. Light is conducted into the cavity using waveguide  59  with an input portion  60  positioned next to the LED to capture the light emitted from the LED. The waveguide exits the handle and forms a frame  61  for mirror  62 . 
         [0045]    Alternatively, top face  61   t  of the waveguide may be coated with a mirror finish to implement the mirror. Output optical structures such as structures  63  may be located where the waveguide exits the handle portion to shine light into the mirror that is then reflected to the anatomical structures to be viewed. Alternatively, output optical structures such as structures  64  may be situated on top waveguide surface  61   t  along the periphery of the mirror. Light emanating from these structures is directed upwards to illuminate the anatomical structures viewed in the mirror. These structures may be specially designed to reduce the light directed toward the user and/or maximize the light directed toward the anatomical structures to be viewed. 
         [0046]    The bottom side of the waveguide frame, surface  61   b , may also contain output optical structures such as structures  65  to illuminate anatomical structures when the mirror is reversed and used as a retractor. Output optical structures  65  on the bottom surface of the waveguide frame may be placed along the periphery, along a portion of the waveguide frame face, and/or across the entire area of the bottom surface. The waveguide frame may also include light directing structures to direct light from the input portion to the output portion of the waveguide frame. Light output structures may be combined, such as structures  63  for use with the mirror and structures  65  for use as a retractor, or structures  64  for use with the mirror and structures  65  for use as a retractor. Waveguide frame  59  is designed to maximize light transmission efficiency to enable use of a lower power LED, thereby allowing a smaller heat sink and smaller batteries that then allow the handle to be smaller in size and easier to manipulate by a user. 
         [0047]    Waveguide  59  may also be modified to direct light while the handle/waveguide assembly is secured to a dental drill, thereby providing illumination during drilling. Alternatively, the drill itself may be modified to include a fiber optic bundle in the drill cable and allow a disposable waveguide to be connected to this light source for drilling, then disposing of the waveguide after the procedure is finished. 
         [0048]      FIG. 3  illustrates a cavity illumination system for dental procedures using a dental retractor  16  with a U-portion  17  and a handle portion  18 . The dental cavity illumination system comprises retractor  16  with an illumination source comprising an LED  20 , battery  21 , LED control  22  circuit, and switch  23  secured within handle  18 . In this figure, the LED is mounted on the handle portion of the retractor and the illumination source further comprises an optical fiber  24  communicating from the LED to the U-shaped portion of the retractor. The U-shaped portion of the retractor acts as a waveguide and the optical output of the optical fiber travels through the U-shaped portion. The optical fiber is secured in a channel provided in the retractor. The handle portion of this retractor may serve as a heat sink for dissipating the heat generated by the LED, and additional heat sinks structures may be added. The handle portion assembly may also be manufactured and provided separately from the U-shaped portion of the retractor. This way, the U-shaped portion may be packaged separately from the handle portion to enable disposable use of the U-shaped portion with a non-disposable handle portion. The assembly may also be integrated into the retractor, and provided in sterile packaging in kits of retractors assembled to support dental procedures. Depending on the type of retractor, the waveguide may be designed to include channels for suction and irrigation, thereby providing an integrated dental device. 
         [0049]      FIG. 4  shows a lip retractor waveguide  66  with a connector  67  at the handle end for connecting the waveguide to a fiber optic cable such as cable  68 , which is connected to a suitable light source such as source  69 . Handle portion  66   h  of the waveguide is designed and constructed to support total internal reflection of the light entering the waveguide from the fiber optic cable. Light travels down the handle where it spreads into U-shaped portion  70  and exits the waveguide through output optical structures  71  specifically designed to direct the light at particular locations, e.g., as spots or bands of light along the gum line or as a more diffuse light illuminating the gum line and teeth for a particular number of teeth or as a diffuse light illuminating the oral cavity, or some combination thereof. 
         [0050]    Waveguide  66  may also include a light directing structure  72 , in this case a prism that may be formed of a cutout or by insert molding a material of suitably different refractive index relative to the waveguide material, such structure serving to direct light toward the output optical structures located at the ends of the curved retracting portion to illuminate specific areas of the oral cavity. 
         [0051]    Waveguide  75  of  FIG. 5  includes light directing structures  76  on outer surface  77  of handle  78  or along the transition  79  of the handle to the U-shaped portion  80  or along the U-shaped portion that serve to efficiently direct the light into and along the U-shaped portion to maximize the amount of light  81  exiting the output optical structures  82  located along a substantial length of the curved retracting portion to illuminate a broad area while minimizing light loss in the waveguide. 
         [0052]    Cavity illuminator  85  of  FIGS. 6 and 7  includes output optical structures  86  located in handle portion  85   h  or the transition portion  87  between the handle and curved retracting portion  88 . The location of output structures  86  as illustrated, serving to illuminate the front teeth, gums or other anatomical structures toward the front of the mouth. In an alternate configuration, optical output structures in the handle or transition portion may be combined with one or more light directing structure, e.g., a prism, and optical output structures along the curved retracting portion to direct light both at or from the front of the oral cavity as well as the sides of the oral cavity to illuminate oral anatomical structures for examination or treatment. 
         [0053]      FIG. 8  illustrates a cavity illumination system using a cheek retractor. The cavity illumination system comprises a cheek retractor  25  manufactured from a biocompatible sterilizable polymer that is transparent or semi-transparent and acts as a waveguide. The retractor has an illumination source disposed therein. The illumination source comprises an LED  26  or other light source, a battery  27 , a LED control circuit  28 , and a switch  29 . When in use, the light source in the cheek retractor provides an electromagnetic wave that propagates through the polymer resulting in the illumination of an oral cavity. 
         [0054]    A cheek retractor cavity illuminator may also include a connector portion that allows connection to an external light source either directly or through a suitable light conduit, for example, a fiber optic cable. Light entering the connector portion may be propagated through the waveguide via total internal reflection to optical output structures located on a suitable surface. Light directing structures may be located on the external wall of the cheek retractor waveguide or within the body of the waveguide. 
         [0055]      FIG. 9  illustrates a laryngoscope illumination system in use on a patient  30 . The laryngoscope  31  includes a handle  32  and a blade  33 . The handle  32  allows for grasping the laryngoscope  31 . The blade  33  is rigid and is attached to and extending from the handle. The blade comprises biocompatible sterilizable polymer that acts as a waveguide and further comprises an illumination source. The blade is for inserting into the mouth  34  of a patient to allow viewing of a portion of the mouth, the pharynx, and the larynx of the patient  30 . The blade is used to depress the tongue  35  and mandible in order to prevent the tongue  35  of the patient  30  from obstructing the view of the medical professional during examination. When the illumination source is illuminated, electromagnetic waves (light) are able to propagate through the blade and illuminate the mouth and trachea of the patient. 
         [0056]      FIG. 10  illustrates the laryngoscope  31  of the laryngoscope illumination system in further detail. The laryngoscope  31  includes a handle  32  and a blade  33 . The blade comprises a biocompatible sterilizable polymer that acts as a waveguide. The blade may have an illumination source disposed therein. The polymer may be transparent or semi-transparent. The illumination source disposed within the blade comprises one or more LEDS  36  (light emitting diodes), battery  37 , a conductor  38  electrically connecting the battery and the LED, and an LED control circuit  39  and switch  40 . The LED is preferably a white-light LED, which provides a bright, white light. The battery may be provided in any form, but is preferably a lithium ion polymer battery. The blade may also be detachable from the handle and disposable. The illumination source is in optical communication with the blade. When the illumination source is illuminated, light from the illumination source propagates through the blade illuminating the blade. 
         [0057]      FIG. 11  illustrates an alternate laryngoscope illumination system with the illumination source in the handle of the laryngoscope  31 . The laryngoscope  31  includes a handle  32  and a blade  33 . The blade comprises a biocompatible sterilizable polymer that acts as a waveguide. The handle has an illumination source disposed therein. The polymer in the blade may be transparent or semi-transparent. The illumination source disposed within the handle comprises one or more LEDs  36  (light emitting diodes), battery  37 , a conductor  38  electrically connecting the battery  37  and the LED  36 , an LED control circuit  39 , a switch  40  and an optical fiber  41  in optical communication between the LED  36  and the blade  33 . 
         [0058]    The light output  90  of the optical fiber travels to one or more light directing surfaces such as surface  91  where it is directed toward output optical structures  92  on any suitable surface of the blade. Output optical structures  92  may direct illumination to particular anatomical areas through refraction while minimizing reflection that contributes to loss of light. The LED is preferably a white-light LED, which provides a bright, white light. The battery may be provided in any form, but is preferably a lithium ion polymer battery. The optical fiber  41  is secured in a channel provided in the laryngoscope  31 . LED  36  may be positioned in closer proximity to blade  33  such that light from LED  36  is captured directly by blade  33 , perhaps using optical structures on the light input portion of blade  33  that efficiently capture light from LED  36 , thereby obviating the need for optical fiber  41 . The handle  32  of this laryngoscope may serve as a heat sink for dissipating the heat generated by the LED, and additional heat sinks structures may be added. The handle may also be manufactured and provided separately from the blade of the laryngoscope  31 . This way, the blade  33  may be packaged separately from the handle to enable disposable use of the blade  33  with a non-disposable handle  32 . When the illumination source is illuminated, light from the illumination source propagates through the optical fiber to the blade illuminating the blade  33 . This in turn can illuminate the mouth and trachea of a patient. 
         [0059]    Cavity illuminator  93  of  FIG. 12  includes a waveguide insert  94  attached to blade  95 . The waveguide insert may be attached to the blade surface, e.g., with a suitable adhesive or other attachment means, or may be inserted into a channel formed in the blade to receive and hold the insert. The blade and handle may be separate pieces or integrated as a single device. In this embodiment, light from optical fiber  41  injects light into waveguide insert  94 , said light traveling along the waveguide insert to exit at one or more optical output structures positioned at one or more designated areas of the waveguide insert. Optical fiber  41  may be replaced by any other suitable light conduit, such as a rigid or flexible light pipe or waveguide. 
         [0060]    Referring now to  FIGS. 13 and 14 , cavity illumination system  96  including waveguide insert  97 , the waveguide insert having an input connector  98  to couple light into the waveguide insert from an external light source, such as a fiber optic cable connected to xenon or tungsten light source as shown in  FIG. 4 . waveguide insert  97  may engage a channel  95   c  in the blade. The channel is designed to engage the insert. The waveguide insert may be made from a suitable hard plastic, such as polycarbonate or acrylic. The waveguide may also be made from a flexible optical material, such as silicone, and may be supplied with a stiffening member to make it easier to insert the flexible waveguide into the channel in the blade. The waveguide may be made to be single use disposable or made to be suitable for multiple uses. The light source contained in the blade injects light into the waveguide insert, said light then is contained in the waveguide and travels to output optical structures in the waveguide insert that direct light to particular anatomic areas. 
         [0061]    Waveguide insert  97  as shown in  FIG. 15  may include output optical structures such as structures  101  in one or more suitable locations to direct light to any appropriate anatomical areas. Output optical structures  101 , here, stair stepped facets, running a portion of the length of the top surface of the waveguide insert, each of said facets causing a portion of the light  102  to exit the waveguide insert in a predetermined direction while minimizing light lost due to reflection at these structures in order to maintain high transmission efficiency. If the output optical structures abruptly end at an end face, light will shine out of this end face. However, the light that exits the end face may not serve as useful illumination and, hence, may be considered lost light that lessens the efficiency of the waveguide insert. To improve efficiency, one or more optical structures  104  may be arranged on bottom surface  100   b  of to direct light out of the corresponding top surface loot, which may have microstructured optical components to diffuse or further direct the light  103 . Combining the bottom face output optical output structures  104  with the top face output optical structures  101  increases the transmission efficiency of the waveguide insert. 
         [0062]      FIG. 16  illustrates the speculum illumination system. Gynecological speculum  42  includes a first handle  43 , a second handle  44 , an upper blade  45  and lower blade  46 . The upper blade  45  and lower blade  46  comprise a biocompatible sterilizable polymer that functions as a waveguide. The polymer may have holographic or complex prismatic properties and is designed to maximize light transmission efficiency to allow the use of lower power light sources. Each blade may engage an illumination source or have an illumination source disposed therein. The polymer may be transparent or semi-transparent. The illumination source disposed within the blades comprises one or more LEDs  47  (light emitting diodes), battery  48 , a conductor  49  electrically connecting the battery and the LED, and an LED control circuit  50  and switch  51 . The LED  47  is preferably a white-light LED, which provides a bright, white light. The battery may be provided in any form, but is preferably a lithium ion polymer battery. The blades may also be detachable from the handle and disposable. The illumination source is in optical communication with the respective blade. When the illumination source is illuminated, light from the illumination source propagates through the blade providing illumination from appropriate areas of the blade. 
         [0063]    Referring now to  FIG. 17 , handles  43  and  44  are closed to separate blades  45  and  46 . In this orientation, blades  45  and  46  may direct light into the cavity in which the device is engaged. Any suitable structure, or structures such as coating  53 , facets  54  and or micro optical structures  55  may be incorporated into blades  45  and or  46  to control and direct illumination, however, such structure or structures must be specifically designed to maximize light transmission efficiency and minimize light loss and must be specifically designed to direct light to specific anatomic structures. For example, structures  54  may designed to direct more diffuse light to illuminate a substantial portion of the vaginal wall, or may be designed to direct more focused light to illuminate the cervix at the end of the vaginal cavity, or may be designed to provide both types of illumination. Single or multiple refractive and/or reflective structures, which may be combined with microstructured optical components, may be used to maximize light transmission efficiency to allow lower power light sources to be used, thereby reducing heat generation and the need to provide cumbersome heat management devices and methods. 
         [0064]      FIG. 18  illustrates an alternate cavity illumination system with the illumination source in the handles  43  and  44  of the speculum  42 . The speculum  42  includes a first handle  43 , a second handle  44 , an upper blade  45  and lower blade  46 . The blades  45  and  46  comprise a biocompatible sterilizable polymer that functions as a waveguide. The polymer may have holographic or complex prismatic properties and is designed to maximize light transmission efficiency to allow the use of lower power light sources. The handles have an illumination source disposed therein. The polymer in the blade may be transparent or semi-transparent. The illumination source disposed within one or both handles comprises one or more LEDs  47  (light emitting diodes), battery  48 , a conductor  49  electrically connecting the battery and the LED, an LED control circuit  50 , a switch  51  and an optical fiber  52  in optical communication with the LED and a blade. The optical output of the optical fiber  52  travels through the blade illuminating the anatomical area(s) of interest. The LED is preferably a white-light LED, which provides a bright, white light. The battery may be provided in any form, but is preferably a lithium ion polymer battery. The optical fiber is secured in a channel provided in the speculum. The handles of this speculum may serve as a heat sink for dissipating the heat generated by the LED, and additional heat sinks structures may be added. The handles may also be manufactured and provided separately from the blades of the speculum. This way, the blades may be packaged separately from the handle to enable disposable use of the blade with a non-disposable handle. When the illumination source is illuminated, light from the illumination source propagates through the optical fiber to the blades illuminating the upper blade and lower blade. This in turn can illuminate the vaginal cavity a patient. 
         [0065]    Speculums with metal blades continue to be used. If a metal speculum is preferred, then a disposable waveguide insert, similar to that shown in  FIG. 19  or  FIG. 20 , may be provided. 
         [0066]    Speculum  110  of  FIG. 19  may be a disposable speculum comprised of an illuminating bottom blade  111  (waveguide blade) and a non-illuminating top blade  112 . Waveguide blade  110  has an input connector  113  for a suitable light source, such as a fiber optic cable  115  connected to an external xenon light source  114 . Light  116  enters the connector portion of the waveguide blade and travels up the handle portion to a light directing structure  117 , which directs the light 90 degrees toward the output optical structures  118  and  119  located along the bottom blade portion. 
         [0067]    If bottom blade  111  has a solid cross-section as shown in  FIG. 19A , output optical structures such as structures  118  and  119  may extend the full width  120  of blade  111  as well. If the bottom blade has a cup-shaped cross-section as shown in  FIG. 19B , separate output optical structures may be located on edge faces  121  and  122  as well as on concave surface  123 . The output optical structures direct light to specific anatomic areas and such light may be more diffuse, more focused, or a combination of each. The waveguide blade may be fabricated with suitable waveguide material as an optical element co-molded or over-molded with a suitable non-optical material as a structural element. The waveguide blade is normally designed to maximize light transmission efficiency. 
         [0068]    Cavity illumination system  130  of  FIG. 20  may include two waveguide blades,  111  and  125 . The bottom waveguide  111  is as described for  FIG. 19 . Top waveguide blade  125  may include a connector  128  for a separate light source or both the top and bottom waveguide blades may be connected to the same light source  126 . Top waveguide blade  125  may not need internal light directing structures, such as structure  117  in blade  111 , because its normal geometry may provide suitable reflecting surfaces for directing light  131  toward the output optical structures  125   a  and  125   b . Top waveguide blade may have a similar output optical structure as the bottom waveguide blade. Together, the two blades provide even illumination of the entire cavity wall. Each waveguide blade may be designed to maximize light transmission efficiency. Alternatively, each blade may have different output optical characteristics to provide complimentary illumination, each blade illuminating different areas or anatomy. 
         [0069]      FIG. 21  illustrates a side view of an illuminating anoscope waveguide  140  with a proximal end  141  and a distal end  142  that is inserted into a patient&#39;s natural cavity such as the anal cavity. The anoscope waveguide  143  may also be used as a general speculum. The anoscope waveguide is normally molded from a suitable optical material, such as polycarbonate or acrylic. It may also include an input connector  144  that serves to conduct light into the waveguide such that light is conducted around the entire circumference of the waveguide tube. Output optical structures  145  are typically placed near the distal end on the inside wall  146  along all or a portion of circumference  147 . Output optical structures placed on the end face  148  or outside wall  149  might cause irritation to the cavity walls during insertion. If output optical structures are required on end face  148  or outside wall  149 , any suitable coating or material may be used to lessen the irritation. The output optical structures provide even illumination of the entire cavity wall. The waveguide is designed to maximize light transmission efficiency. For example, a reflective or prismatic surface may be created on the proximal end face to send mis-reflected light rays back toward the distal output optical structures. 
         [0070]    Referring now to  FIG. 22  shows an example of a light directing structure that contributes to light distribution around circumference  147 . Light entering input connector  144  may be directed by a light control structure, such as structure  150 , which splits the incoming light and sends it down into the waveguide tube wall at an angle ensuring circumferential light distribution. 
         [0071]    Thus, while the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.