PillCamera Page 1 ABSTRACT Scientific advances in areas such as nanotechnology and gene therapy Promise to revolutionize the way we discover and develop drugs, as well as how we diagnose and treat disease. The ‘camera in a pill’ is one recent development that is generating considerable interest. Until recently, only the proximal (esophagus, stomach and duodenum) and the distal (colon) portions of the Gastrointestinal tract were easily visible using available technology. The twenty feet or so of small intestine in between these two portions was essentially Unreachable. This hurdle might soon be overcome. Pill Camera Page 2 CONTENTS CHAPTER 1: INTRODUCTION 1 CHAPTER 2: HISTORY AND DEVELOPMENT 2 CHAPTER 3: UNDERSTANDING CAPSULE ENDOSCOPY 4 CHAPTER 4: ARCHITECTURAL DESIGN 6 4.1: Internal View of the Capsule 4.2: Pill Camera Platform Components CHAPTER 5: THE CAPSULE ENDOSCOPY PROCEDURES CHAPTER 6: RESEARCHES 16 CHAPTER 7: ADVANTAGES 18 CHAPTER 8: DISADVANTAGES 19 15 CHAPTER 9: APPLICATIONS 20 CHAPTER 10: FUTURE SCOPE 21 CHAPTER 11: CONCLUSION 24 REFERENCES .2: I internal view of a capsule 8 Fig. 4.1:EUS Endoscope 2 Fig.4: Data recorder Fig.3: Sensor array belt 11 Fig.1: A capsule in view 4 Fig. 4. 3.1: Wireless Endoscope 6 Fig.5: Real time viewer 13 12 . 4.4. 4. 2.Pill Camera Page 3 LIST OF FIGURES Fig. . and images are shown on nearby monitor. One effective and purposeful application of the Advancement of technology is the pr ocess of endoscopy. with a camera at one end. which is used to diagnose and examine the conditions of the gastrointestinal tract of the patents. It has been reported that this process is done by inserting an 8mm tube through the mouth.Pill Camera Page 4 CHAPTE R1 INTRODUC TION The advancement of our technology today has lead to its effective use and Application to the medical field. allowing the medics to carefully guide it down to the gullet or stomach. . the evolution of the wireless capsule endoscope has emerged. people with symptoms that indicate a possible in the gastrointestinal tract can now swallow a tiny camera that takes snapshots inside the body for a physician to evaluate. Reports. is housed in a capsule. along with a light. called Capsule Cam. and is used in a procedure known as capsule endoscopy.However. but also for the doctors and nurses as well. research shows that endoscopy is a pain stacking process not only for the patients. which is a noninvasive and painless way of looking into the esophagus and small intestine. Once swallowed. despite the effectiveness of this process to diagnose the patients. transmitter . The miniature e camera. the capsule is propelled through the small intestine by peristalsis. that through the marvels of miniaturization. the size of a large vitamin pill. and acquires and transmits digital images at the rate of two per second to a sensor array attached to the . From this.and batteries. through a recording device worn on a belt stores the images. .patients abdomen. to be examined and reviewed. enabling specially trained gastroenterologists to perform tests and procedures that traditionally required surgery or were difficult on the patient. The technology available to doctors has evolved dramatically over the past 40 years. colour Doppler and advanced image.Pill Camera Page 5 CHAPTE R2 HISTORY AND DEVELOPMENT EUS endoscopes are unique because they offer ultrasound guided needle biopsy. . 2.1: EUS endoscope .Fig . Pill Camera Page 6 "Basic endoscopy was introduced in the late 1960s”. enabling us to . and about 20 years later. ultrasound was added. One technology available for that about has 30 been years. In addition to using an endoscope to stage tumours.combines X-rays and endoscopy to diagnose conditions affecting the liver. pancreas. stomach. pancreas. and dye is injected to tiny ducts to enhance their visibility on X-ray. and small intestine. is guided to a specific site and extracts a tissue sample. and the associated ducts. such as University Hospital's Therapeutic Endoscopy .we can determine the extent to which tumours in the esophagus. and in certain medical centers. Endoscopic Retrograde Cholangio- pancreatography (ERCP). Now. The endoscope. stomach. specially equipped with a biopsy needle. with EUS . or rectum have spread in a less invasive way. gastroenterologists can use the instrument to take tissue samples with fine needle aspiration(FNA). ERCP's role has expanded. An endoscope is guided down the patient's esophagus.look at internal GI structures as never before. gallbladder. Motility is the movement of food from one place to another along the digestive tract. and problem such as fecal incontinence or constipation-related rectal outlet obstruction. the failure of the lower esophageal sphincter muscle to relax. essential information for the diagnosis of esophageal disorder such as achalasia. remove difficult bile duct stones. there could be a motility problem. "Manometry" is a specialised test that gastroenterologists use to record muscle pressure within the esophagus or anorectal area. and obtain biopsy samples. A newer alternative eliminates the catheter . When a person has difficulty in swallow ing food or excreting waste. the catheter is attached to a special monitor.and GI Mobility Center. it is used to place stents within bile ducts. which is worn by the patient for 24 hours. The traditional pH test involves threading a catheter into the patient's nose and down the throat. the gastroenterologist. The capsule transmits signals to a special receiver . using an endoscope. attaches a small capsule to the wall of the esophagus. the data is downloaded to a computer at the doctor's office. afterward. I instead.completely. Pill Camera Page 7 CHAPTE . R3 UNDERSTANDING CAPSULE ENDOSCOPY Capsule Endoscopy lets the doctor to examine the lining of the gastrointestinal tract. and ileum). A pill sized video camera is given to swallow. which includes the three portion of the small intestine(duodenum. jejunum. These pictures are send to recording device. which has to wear on the body. It produces two frames per second with an approximate of 56. This camera has its own light sour ce and take picture of small intestine as it passes through. .000 high quality images. 1:A capsule in view .Fig.3. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. Capsule endoscopy helps the doctor to evaluate the small intestine. ulcer s and tumors of the small intestine . It may also be useful for detecting polyps.Pill Camera Page 8 Doctor will be able to view these pictures at a later time and might be able to provide useful information regarding a human’s small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. inflammatory bowel disease (Crohn’s disease) . . and a camera technology itself For this ofOther body application. chipto construction is fluids require constructed and small significantly moves benefits sizeinand along complementary-metal less includes power to power ensure efficiency the than unit’s optimal chargeare dome –oxideshaped magnetic switch. a lens. the envelope contains LEDs. The semiconductor coupled imaging important. are three . a colour camera chip. Despite its diminutive profile. a transmitter. two silver. an antenna. that devices. toThere cleans its obtained. the capsule is constructed with an isoplast outer envelope that is biocompatible and impervious to gastric fluids.Pill Camera Page 9 CHAPTER 4 ARCHITECTURAL DESIGN Measuring 11×26 mm.oxide batteries. 4.Fig.1: Wireless capsule endoscope . . This allows physicians choice of viewing the information as either streaming or single video images. Recent advances in ASIC design allowed the integration of a video transmitter of sufficient power output . the CMOS sensor. as well as the LEDs and transmitter. The white. The silver oxide batteries in the capsule power the CMOS detector. development of white LEDs and development of application. and band width of very small size into the capsule.Pill Camera Page 10 vital technologies that made the tiny imaging system possible: improvement of the signal-to-noise ratio (SNR) in CMOS detectors.efficiency. The system’s computer work station is equipped with software for reviewing the camera data using a variety of diagnostic tools.light LEDs are important because pathologists distinguish diseased tissue by colour The developers provided a novel optical design that uses a wide-angle over the imager .and manages to integrate both the LEDs and imager under one dome while hadliung stray light and reflections. and ASI C transmitter minimizes the power consumptions.specific integrated cir cuits(ASI Cs). Synchronous switching of the LEDs. . 6. 7. 5.1 INTERNAL VIEW OF THE CAPSULE The figure shows the internal view of the pill camera. the light It isreceiving the front part window of the of capsule the capsule and itand is bullet it is shaped. . Battery. a non.Pill Camera Page 11 4. Lens. It has 8 parts: 1. 3. ASIC Transmitter. 4.Optical OPTICAL conductor prevent dome theDOME material. filtration is of It digestive fluids inside the capsule. 2. Lens Holder. 8. Optical Dome. Illuminating LEDs. Antenna. CMOS Image Sensor. 2: Internal view of a capsule .Fig.4. ASIC TRANSMITTER It is application specific integrated circuit and is placed behind the batteries. ILLUMINATING LEDs Illuminating LEDs illuminate an object. Two transmitting electrodes are connected to this transmitter and these .Pill Camera Page 12 LENS HOLDER This accommodates the lens. Antenna received data from transmitter and then send to data recorder. Non reflection coating id placed on the light receiving window to pr event the reflection. CMOS IMAGE SENSOR It have 140 degree field of view and detect object as small as 0. It is disposable and harmless material. BATTERY Battery used in the pill camera is bullet shaped and two in number and silver oxide primary batteries are used. This lens is placed behind the Optical Dome. It have high precise. . electrodes are electrically isolated ANTENNA Parylene coated on to polyethylene or polypropylene antennas are used. Light irradiated from the LED s pass through the light receiving window. LENS It is the integral component of pill camera. Lenses are tightly fixed in the capsule to avoid dislocation of lens.1mm. The light through window falls on the lens. The antenna array and battery pack cam be worn under regular clothing. Ambulary (non-vigorous) patient movement does not interfere with image acquisition and recording. 2. Real Time Viewer. Patients undergoing capsule endoscopy bear an antenna array consisting of leads that are connected by wires to the recording unit. Data Recorder. 3. . worn in standard locations over the abdomen.Pill Camera Page 13 4. Mainly there are 5 platform components: 1. The antenna array is very similar in concept and practice to the multiple leads that must be affixed to the chest of patients undergoing standard lead electrocardiography. A typical capsule endoscopy examination takes approximately 7 hours. Work Station and Rapid Software. 4. The recording device to which the leads are attached is capable of recording the thousands of images transmitted by the capsule and received by the antenna array. Pill cam Capsule -SB or ESO.2 PILL CAMERA PLATFORM COMPONENTS In or der for the images obtained and transmitted by the capsule endoscope to be useful. as dictated by a template for lead placement. 5. they must be received and recorded for study. Sensor Array Belt. Standard lighting control. For small bowel. SENSOR ARRAY BELT . One side imaging. 14 images per second. Two sided imaging. 2. Two images per second.Pill Camera 14 Page PILL CAMERA CAPSULE:-SB OR ESO SB ESO Approved by Food and Drug Administration.000 images in 8 hours. Automatic lighting control.600 images in 20 minutes. For esophagus. 50. Approved b y Food and Drug Administration. . Place the Sensor Array with the rest of the equipment.4. Images takes several hours to download through several connection. Sensor arrays are used to calculate and indicate the position of capsule in the body.4: Data recorder .4.3:Sensor array belt Several wires are attached to the abdomen like ECG leads to obtain images by radio frequency. These wires are connected to a light weight data recorder worn on a belt. Data recorder receives and records signals transmitted by the camera to an array of sensors placed on the patients body. DATA RECORDER Data recorder is a small portable recording device placed in the recorder pouch. To remove the Sensor Array from your abdomen. attached to the sensor belt. Parts of sensor array are sensor pads. Sensors are incorporated within the belt. and receiver bag. A patient receiver belt around his or her waist over clothing. data cable.Pill Camera Page 15 Fig. Fig. A belt is applied around the waist and holds a recording device and a batter y pack. It has light weight (470 gm). do not pull the leads off the Sensor Arr ay! Peel off each adhesive sleeve starting with the non adhesive tab without removing the sensor from the adhesive sleeve. It is of the size of walkman and it receives and stores 5000 to 6000 JPEG images on a 9 GB hard drive. battery charging. . it enables It test real-time the proper viewing. Return all of the equipment as soon as possible.Pill Camera Page 16 The Date Recorder stores the images of your examination. Recorder Belt.5: Real time viewer software It is a handheld and colour device LCD and monitor. which may result in loss of infor mation. Do not expose them to shock. functioning It contains before and confirms procedures rapidlocation reader of capsule. vibration or direct sunlight. Sensor Array and Battery Pack carefully. . REAL TIME VIEWER Fig.4. Handle the Date Recorder. . to view it in both forward and rever se directions.Pill Camera 17 Page WORKSTATION AND RAPID SOFTWARE Rapid workstation per forms the function of reporting and processing of images and data. I mages showing normal anatomy of pathologic findings can be closely examined in full colour. the antenna array and image recording device are returned to the health care provider. The workstation software allows the viewer to watch the video at varying rates of speed. The recording device is then attached to a specially modified computer wor kstation. and to capture and label individual frames as well as br ief video clips. where it becomes available to the physician as a digital video. and the entire examination is downloaded in to the computer. I mage data from the data recorder is downloaded to a computer equipped with software called rapid application software. . A recent addition to the software package is a feature that allows some degree of localisation of the capsule within the abdomen and correlation to the video images. I t helps to convert images in to a movie and allows the doctor to view the colour 3D images. Once the patient has completed the endoscopy examination. Another new addition to the software package automatically highlights capsule images that correlates with the existence of suspected blood or red areas. and the patient can return the antenna array and recording device to the physician. pathologic approximately takes Download approximately findings 1the of hour. Patients should avoid ingesting anything other than clear liquids for approximately two hours after capsule ingestion( although medications can be taken with water). the can data be Invidual 2. surfactant (eg: simethicone) may be administered prior to the examination to enhance viewing. The recording device and its battery pack ar e worn on a special belt that allows the patient to move freely. After a careful medical examination the patient is fitted with the antenna array and image recorder. once the indicator lights on the capsule and recorder show that data is being transmitted and received. Seven to 8 hours after ingestion. The examination can be considered complete. the capsule is swallowed with a small amount of water. Patients can eat food approximately 4 hours after they swallow the capsule without inter fering with the examination. however. and hyper and hypo motility states affect free-floating capsule’s transit through study normal workstation takes the or gut. exported anddevice video as rate files toclips electronic the Interpretation forofincorporation of the into procedure reports or patient records. It should be noted that gastrointestinal motility is variable among individuals. . the patient is free to move about. A fully charged capsule is removed from its holder. At this point.5saved into the3frames recording and hours.Pill Camera Page 18 CHAPTER 5 THE CAPSULE ENDOSCOPY PROCEDURES A typical capsule endoscopic procedures begins with the patient fasting after midnight on the day before the examination. No formal bowel preparation is required. r elated enteropathy and celiac disease. such as obscure gastrointestinal bleeding(OGB) and Crone’s disease. and is efficient in the careful diagnosis and treatment of the patients.Pill Camera 19 Page . who were being assessed for obscure gastrointestinal bleeding. CHAPTER 6 RESEARCHES One research suggests that . and reported that capsule endoscopy is useful for evaluation of suspected Crohn’s disease. capsule All their the of patients. Another research by supports this claim. The third study also evaluates the potential of capsule endoscopy. the three researches conducted. for the as studies and aphysicians were way givewere of importance done evaluating able toby examine letting to effectively tothe the the and existing value assess and convey efficiency gastrointestinal participants the conditions of swallow using ofdiseases theirthe . and is helpful in assessment of small bowel disease of children. emphasize that the use of capsule endoscopy is safe. of capsule message theendoscope three endoscope Theresearch and researches aim. effective. certain gastrointestinal diseases were diagnosed from a number of patients in a hospital. study concludes that capsule endoscopy was not associated with any adverse cardiac events. has no side effects. and implanted cardiac devices do not appear to interfere with video capsule imaging. and is believed useful in investigating and guiding further management of patients suspected with the identified diseases. with the use of capsule endoscopy. and determine whether implanted cardiac devices had any effect on the image capture by capsule endoscopy. Thus. To put it simply. and conducts a research to evaluate its safety in patients with implanted cardiac devices. . . normal endoscopy. High sensitivity and specificity . . CHAPTER 7 The researches also emphasized that the use of the capsule ADVANTAGES endoscope is better than using the traditional endoscope. for the use of the traditional endoscope does not only damage the gastrointestinal tract of the patients but affects also the patients and the hospital staffs Painless. Simple procedure. Avoids risk in sedation.Pill Camera Page 20 Pill Camera Page 21 gastrointestinal tract by the image captured by the capsule endoscope. High quality images. This process does not only help to detect the severity of the existing gastrointestinal disease but also determine its effective to the presence of implanted cardiac devices. Harmless material. Minature size. Accurate. precise (view of 150 degree) . side effects. Efficient than X-ray CT-scan. because of the no pain stacking process. cannot be stopped or steered to collect close-up details. It cannot be controlled once it has been ingested. . It is very expensive and not reusable. pregnant women face difficulties. apply therapy or mark abnormalities for surgery. Patients with pacemakers.Pill Camera Page 22 CHAPTER 8 DISADVANTAGES Gastrointestinal obstructions prevent the free flow of capsule. It cannot be used to take biopsies. Capsule endoscopy does not replace standard diagnostic endoscopy. generally performed after a standard endoscopy and colocoscopy. It is not a replacement for any existing GI imaging technique. gastrointestinal reflex diseases. small bowel injury.Pill Camera Page 23 CHAPTER 9 APPLICATIONS Biggest impact in the medical industry. celiac disease. barreff’s esophagus. small bowel tumours. . Nano robots perform delicate surgeries. ulcerative colitis etc. Pill cam SB can detect Crohn’s disease. Pill cam ESO can detect esophageal diseases. . devices but need radioactivators. A force exerted on tissue for emerge with example by biopsy cytology. methods for constructing These acronymstiny stand FUTURE SCOPE moving for: VECTOR parts. Double imager capsules with increased frame rates have been used to The construction of an electrosurgical generator small enough image the to swallow for Barrett’s and esophageal varices. Small motors are currently in available to move components such as esophageal andcontrolled gastric capsules will improve in biopsy Colonic. rival technologiesbiopsy and CCD andpropulsion cytology. present. because to of power requirements. depth of field.conductor lasers that are small enough to swallowThe arereason because increasingly effective ofindoctors diagnostic rely typical more gastrointestinal on camera pill than available. to increases include capsule in pixel numbers gastroscopy. and the size to framerate. increasingly especially entail the influence CMOS use of real- . and One limitation to therapeutic capsule endoscopy is the low become mass of theinto screening programs. eroding the supremacy of flexible endoscopy.improve withwillthe use of magnets and/or electro stimulation and perhaps electromechanical methods. the nature of lasers which have inefficiencies endoscopy. biopsy drug deliver y forcepsbrushing. fluid aspiration. CMOS is likely to change methods and therapy the nature including of endoscopy.The targetedmain optical pr essure recognition is to reduce of malignancy the component are size. An flexible upper possible to store power in small capacitors for endosurgical increase in the use. The image esophagus and powered by small batteries is conceivable but currently quality is not difficultbad because of but imposed needs to by be improved if itresistance is to become a realistic the limitations the internal of the substitute for batteries. Diagnostic forcepsElectrocautery to grasp tissue and pull it free will require different capsules will solutions to those integrate physiological measurements with imaging and used at flexible endoscopy-the push force exerted during optical biopsy.Pill PillCamera Camera 25 26 Page 24 Pill Camera Page chip technology. and improvements attachment to the in imaging gut wall. The current Narrow differences band imaging ar and e becoming blurred and hybrids immunologically or chemically are emerging. conventional biopsy is cancer recognition. capacity ratio of some capacitor s has recently been reduced duration of the by the use of procedure and improvements illumination seem likely. other types ofThis will of 100-1000 endoscope be attractive is because patients the former has the for ability cancer taking or varices per cent makes thetoidea of aespecially remote laser in aof capsule pictures detection of small because capable of stopping capsule endoscopy is painless is likely of totests. endoscopy will become Although semi. may push the capsule away from the and tissue. image numbers. Remote control immunologic typicallyand about 100 g and the force to pull tissue free is about movement 400 g. have a higher intestine which is from theand other bleeding or cuttingnot outpossible a tumour seems to be types something of a take up rate pipe dream at compared conventional colonoscopy and gastroscopy. Union as FP6 coagulation projects:or -the therapy. Therapeutic capsules will embedded capsule endoscope (3.7 g). VECTOR Newand engineering NEMO projects. Future diagnostic The continued developments reduction are in likely size. miniature = Versatileactuators Endoscopic and Capsule even motors for into capsule endoscopes gastrointestinal Tumour are being developed. It may be and lower gastrointestinal endoscopy. which currently being will release exploredspace by two that different could be groups usedsupported for other by CHAPTER 9 capsule the European functions such as biopsy. angle of view. Recognition and therapy and NEMO = Nano-based capsuleEndoscopy with Molecular It seems Imaging likely andthat Optical capsule biopsy. ultrasound with the two imaging. tissue coagulation. Opening small biopsy may also become possible. capabilities. External wireless commands will by capsule miniaturization diagnosisofand digital therapy chip camera and will technology. quality. tantalum. The ability of the capsule to detect small lesions that could cause recurrent bleeding(eg. other uses for the device should be considered experimental at this time and should be performed in the context of clinical trials.Pill Camera 27 Page CHAPTER 10 CONCLUSION Wireless capsule endoscopy represents a significant technical breakthrough for the investigation of the small bowel. especially in light of the shortcomings of other available techniques to image this region. ulcers) seems ideally suited for this particular role. At present. Capsule endoscopy has the potential for use in a wide range of patients with a variety of illnesses.diagnose small bowel disease. capsule endoscopy can provide valuable information and assist in the management of patients with difficult –to. in the proper context. Although a wide variety of indications for capsule endoscopy are being investigated. capsule endoscopy seems best suited to patients with gastrointestinal bleeding of unclear etiology who have had non-diagnostic traditional testing and whom the distal small bowel(beyond reach of a push enetroscope) needs to be visualised. Still. . tumours. and the images obtained must be interpreted approximately and not over read that is. Care must be taken in patient selection. not all abnormal findings encountered are the source of patient’s problem. Gastrointestinal et al. . doi:10. IEEE  Intelligent Systems . "Capsule Endoscopy in Gastroenterology". 2008  Sidhu.1136/bmj. Mayo Clinic. " capsule endoscopy: from tertiary centres to primary care". Reena. BMJ. 332:528-531. 2006 3rd International IEEE Conference on capsule endoscopy  Medical Imaging.7540. BioCAS 2009.332.Pill Camera Page 28 REFERENCES Biomedical Circuits and Systems Conference.528.2009. March 4 2006.IEEE Transactions on Dec. Accessed October 5 2007. Care must be taken in patient selection. capsule endoscopy can provide valuable information and assist in the management of patients with difficult –to.diagnose small bowel disease. Capsule endoscopy has the potential for use in a wide range of patients with a variety of illnesses. in the proper context. Although a wide variety of indications for capsule endoscopy are being investigated. other uses for the device should be considered experimental at this time and should be performed in the context of clinical trials. especially in light of the shortcomings of other available techniques to image this region. At present. and the images obtained must be interpreted approximately and not over read that is. not all abnormal findings encountered are the source of patient’s problem.Pill Camera 27 Page CHAPTER 10 CONCLUSION Wireless capsule endoscopy represents a significant technical breakthrough for the investigation of the small bowel. ulcers) seems ideally suited for this particular role. . Still. capsule endoscopy seems best suited to patients with gastrointestinal bleeding of unclear etiology who have had non-diagnostic traditional testing and whom the distal small bowel(beyond reach of a push enetroscope) needs to be visualised. tumours. The ability of the capsule to detect small lesions that could cause recurrent bleeding(eg.