Pill Camera Page 1 ABSTRACT Scientific advances in areas such as nanotechnology and gene therapyPromise to revolutionize the way we discover and develop drugs, as well as howwe diagnose and treat disease. The ‘camera in a pill’ is one recent developmentthat is generating considerable interest. Until recently, only the proximal(esophagus, stomach and duodenum) and the distal (colon) portions of theGastrointestinal tract were easily visible using available technology. The twentyfeet or so of small intestine in between these two portions was essentiallyUnreachable. This hurdle might soon be overcome.
Pill Camera Page 2 CONTENTSCHAPTER 1: INTRODUCTION 1CHAPTER 2: HISTORY AND DEVELOPMENT 2CHAPTER 3: UNDERSTANDING CAPSULE ENDOSCOPY 4CHAPTER 4: ARCHITECTURAL DESIGN 6 4.1: Internal View of the Capsule 4.2: Pill Camera Platform ComponentsCHAPTER 5: THE CAPSULE ENDOSCOPY PROCEDURES 15CHAPTER 6: RESEARCHES 16CHAPTER 7: ADVANTAGES 18CHAPTER 8: DISADVANTAGES 19CHAPTER 9: APPLICATIONS 20CHAPTER 10: FUTURE SCOPE 21CHAPTER 11: CONCLUSION 24REFERENCES
Pill Camera Page 3 LIST OF FIGURESFig. 2.1:EUS Endoscope 2Fig. 3.1: A capsule in view 4Fig. 4.1: Wireless Endoscope 6Fig. 4.2: I internal view of a capsule 8Fig..4.3: Sensor array belt 11Fig. 4.4: Data recorder 12Fig. 4.5: Real time viewer 13
Pill Camera Page 4 CHAPTER 1 INTRODUCTION The advancement of our technology today has lead to its effective use andApplication to the medical field. One effective and purposeful application of theAdvancement of technology is the pr ocess of endoscopy, which is used to diagnoseand examine the conditions of the gastrointestinal tract of the patents. It has beenreported that this process is done by inserting an 8mm tube through the mouth, with a camera at one end, and images are shown on nearbymonitor, allowing the medics to carefully guide it down to the gullet or stomach. However, despite the effectiveness of this process to diagnose the patients,research shows that endoscopy is a pain stacking process not only for thepatients, but also for the doctors and nurses as well. From this, the evolution of thewireless capsule endoscope has emerged. Reports, that through the marvels ofminiaturization, people with symptoms that indicate a possible in thegastrointestinal tract can now swallow a tiny camera that takes snapshots insidethe body for a physician to evaluate. The miniature e camera, along with a light, transmitter ,and batteries, calledCapsule Cam, is housed in a capsule, the size of a large vitamin pill, and is used in aprocedure known as capsule endoscopy, which is a noninvasive and painless wayof looking into the esophagus and small intestine. Once swallowed, the capsule ispropelled through the small intestine by peristalsis, and acquires and transmitsdigital images at the rate of two per second to a sensor array attached to thepatients abdomen, through a recording device worn on a belt stores the images, tobe examined and reviewed.
Pill Camera Page 5 CHAPTER 2 HISTORY AND DEVELOPMENT EUS endoscopes are unique because they offer ultrasound guided needlebiopsy, colour Doppler and advanced image. The technology available to doctorshas evolved dramatically over the past 40 years, enabling specially trainedgastroenterologists to perform tests and procedures that traditionally requiredsurgery or were difficult on the patient. Fig .2.1: EUS endoscope
Pill Camera Page 6 "Basic endoscopy was introduced in the late 1960s”, and about 20 yearslater, ultrasound was added, enabling us to look at internal GI structures as neverbefore. Now, with EUS ,we can determine the extent to which tumours in theesophagus, stomach, pancreas, or rectum have spread in a less invasive way. Inaddition to using an endoscope to stage tumours, gastroenterologists can use theinstrument to take tissue samples with fine needle aspiration(FNA). Theendoscope, specially equipped with a biopsy needle, is guided to a specific siteand extracts a tissue sample. One technology that has been available for about 30 years, EndoscopicRetrograde Cholangio- pancreatography (ERCP),combines X-rays and endoscopyto diagnose conditions affecting the liver, pancreas, gallbladder, and theassociated ducts. An endoscope is guided down the patients esophagus, stomach,and small intestine, and dye is injected to tiny ducts to enhance their visibility onX-ray. ERCPs role has expanded, and in certain medical centers, such asUniversity Hospitals Therapeutic Endoscopy and GI Mobility Center, it is used toplace stents within bile ducts, remove difficult bile duct stones, and obtain biopsysamples. Motility is the movement of food from one place to another along thedigestive tract. When a person has difficulty in swallow ing food or excretingwaste, there could be a motility problem. "Manometry" is a specialised test thatgastroenterologists use to record muscle pressure within the esophagus oranorectal area, essential information for the diagnosis of esophageal disorder suchas achalasia, the failure of the lower esophageal sphincter muscle to relax, andproblem such as fecal incontinence or constipation-related rectal outletobstruction. The traditional pH test involves threading a catheter into the patients noseand down the throat; the catheter is attached to a special monitor, which is wornby the patient for 24 hours. A newer alternative eliminates the cathetercompletely. I instead, the gastroenterologist, using an endoscope, attaches a smallcapsule to the wall of the esophagus. The capsule transmits signals to a specialreceiver ; afterward, the data is downloaded to a computer at the doctors office.
Pill Camera Page 7 CHAPTER 3 UNDERSTANDING CAPSULE ENDOSCOPY Capsule Endoscopy lets the doctor to examine the lining of thegastrointestinal tract, which includes the three portion of the smallintestine(duodenum, jejunum, and ileum). A pill sized video camera is given toswallow. This camera has its own light sour ce and take picture of small intestineas it passes through. It produces two frames per second with an approximate of56,000 high quality images. These pictures are send to recording device, whichhas to wear on the body. Fig.3.1:A capsule in view
Pill Camera Page 8Doctor will be able to view these pictures at a later time and might be able toprovide useful information regarding a human’s small intestine. Capsuleendoscopy helps the doctor to evaluate the small intestine. This part of the bowelcannot be reached by traditional upper endoscopy or by colonoscopy. The mostcommon reason for doing capsule endoscopy is to search for a cause of bleedingfrom the small intestine. It may also be useful for detecting polyps, inflammatorybowel disease (Crohn’s disease) , ulcer s and tumors of the small intestine
Pill Camera Page 9 CHAPTER 4 ARCHITECTURAL DESIGN Fig.4.1: Wireless capsule endoscope Measuring 11×26 mm, the capsule is constructed with an isoplast outerenvelope that is biocompatible and impervious to gastric fluids. Despite itsdiminutive profile, the envelope contains LEDs, a lens, a colour camera chip, twosilver- oxide batteries, a transmitter, an antenna, and a magnetic switch. Thecamera chip is constructed in complementary-metal –oxide-semiconductortechnology to require significantly less power than charge-coupled devices. Other construction benefits includes the unit’s dome shaped that cleansitself of body fluids and moves along to ensure optimal imaging to its obtained.For this application, small size and power efficiency are important. There are three
Pill Camera Page 10 vital technologies that made the tiny imaging system possible:improvement of the signal-to-noise ratio (SNR) in CMOS detectors, developmentof white LEDs and development of application- specific integratedcir cuits(ASI Cs). The silver oxide batteries in the capsule power the CMOS detector, as wellas the LEDs and transmitter. The white- light LEDs are important becausepathologists distinguish diseased tissue by colour The developers provided a novel optical design that uses a wide-angle overthe imager ,and manages to integrate both the LEDs and imager under one domewhile hadliung stray light and reflections. Recent advances in ASIC designallowed the integration of a video transmitter of sufficient power output,efficiency, and band width of very small size into the capsule. Synchronousswitching of the LEDs, the CMOS sensor, and ASI C transmitter minimizes thepower consumptions. The system’s computer work station is equipped with software forreviewing the camera data using a variety of diagnostic tools. This allowsphysicians choice of viewing the information as either streaming or single videoimages.
Pill Camera Page 11 4.1 INTERNAL VIEW OF THE CAPSULE Fig.4.2: Internal view of a capsuleThe figure shows the internal view of the pill camera. It has 8 parts: 1. Optical Dome. 2. Lens Holder. 3. Lens. 4. Illuminating LEDs. 5. CMOS Image Sensor. 6. Battery. 7. ASIC Transmitter. 8. Antenna.OPTICAL DOME It is the front part of the capsule and it is bullet shaped. Optical dome isthe light receiving window of the capsule and it is a non- conductor material. Itprevent the filtration of digestive fluids inside the capsule.
Pill Camera Page 12LENS HOLDER This accommodates the lens. Lenses are tightly fixed in the capsule to avoiddislocation of lens.LENS It is the integral component of pill camera. This lens is placed behind theOptical Dome. The light through window falls on the lens.ILLUMINATING LEDs Illuminating LEDs illuminate an object. Non reflection coating id placedon the light receiving window to pr event the reflection. Light irradiated from theLED s pass through the light receiving window.CMOS IMAGE SENSOR It have 140 degree field of view and detect object as small as 0.1mm. Ithave high precise.BATTERY Battery used in the pill camera is bullet shaped and two in number andsilver oxide primary batteries are used. It is disposable and harmless material.ASIC TRANSMITTER It is application specific integrated circuit and is placed behind thebatteries. Two transmitting electrodes are connected to this transmitter and these .electrodes are electrically isolatedANTENNA Parylene coated on to polyethylene or polypropylene antennas are used.Antenna received data from transmitter and then send to data recorder.
Pill Camera Page 134.2 PILL CAMERA PLATFORM COMPONENTS In or der for the images obtained and transmitted by the capsule endoscopeto be useful, they must be received and recorded for study. Patients undergoingcapsule endoscopy bear an antenna array consisting of leads that are connected bywires to the recording unit, worn in standard locations over the abdomen, asdictated by a template for lead placement. The antenna array is very similar in concept and practice to the multipleleads that must be affixed to the chest of patients undergoing standard leadelectrocardiography. The antenna array and battery pack cam be worn underregular clothing. The recording device to which the leads are attached is capableof recording the thousands of images transmitted by the capsule and received bythe antenna array. Ambulary (non-vigorous) patient movement does not interferewith image acquisition and recording. A typical capsule endoscopy examinationtakes approximately 7 hours.Mainly there are 5 platform components: 1. Pill cam Capsule -SB or ESO. 2. Sensor Array Belt. 3. Data Recorder. 4. Real Time Viewer. 5. Work Station and Rapid Software.
Pill Camera Page 14PILL CAMERA CAPSULE:-SB OR ESO SB ESO Approved by Food and Approved b y Food and Drug Administration. Drug Administration. For small bowel. For esophagus. Standard lighting control. Automatic lighting control. One side imaging. Two sided imaging. Two images per second. 14 images per second. 50,000 images in 8 hours. 2,600 images in 20 minutes. SENSOR ARRAY BELT
Pill Camera Page 15 Fig.4.3:Sensor array belt Several wires are attached to the abdomen like ECG leads to obtain imagesby radio frequency. These wires are connected to a light weight data recorderworn on a belt. Sensor arrays are used to calculate and indicate the position ofcapsule in the body. A patient receiver belt around his or her waist over clothing.A belt is applied around the waist and holds a recording device and a batter y pack.Sensors are incorporated within the belt. Parts of sensor array are sensor pads,data cable, battery charging, and receiver bag. To remove the Sensor Array from your abdomen, do not pull the leads offthe Sensor Arr ay! Peel off each adhesive sleeve starting with the non adhesive tabwithout removing the sensor from the adhesive sleeve. Place the Sensor Arraywith the rest of the equipment.DATA RECORDER Data recorder is a small portable recording device placed in the recorderpouch, attached to the sensor belt. It has light weight (470 gm). Data recorderreceives and records signals transmitted by the camera to an array of sensorsplaced on the patients body. It is of the size of walkman and it receives and stores5000 to 6000 JPEG images on a 9 GB hard drive. Images takes several hours todownload through several connection. Fig.4.4: Data recorder
Pill Camera Page 16 The Date Recorder stores the images of your examination. Handle the DateRecorder, Recorder Belt, Sensor Array and Battery Pack carefully. Do not exposethem to shock, vibration or direct sunlight, which may result in loss ofinfor mation. Return all of the equipment as soon as possible.REAL TIME VIEWER Fig.4.5: Real time viewerIt is a handheld device and it enables real-time viewing. It contains rapid readersoftware and colour LCD monitor. It test the proper functioning before proceduresand confirms location of capsule.
Pill Camera Page 17 WORKSTATION AND RAPID SOFTWARE Rapid workstation per forms the function of reporting and processing ofimages and data. I mage data from the data recorder is downloaded to a computerequipped with software called rapid application software. I t helps to convertimages in to a movie and allows the doctor to view the colour 3D images. Once the patient has completed the endoscopy examination, the antennaarray and image recording device are returned to the health care provider. Therecording device is then attached to a specially modified computer wor kstation,and the entire examination is downloaded in to the computer, where it becomesavailable to the physician as a digital video. The workstation software allows theviewer to watch the video at varying rates of speed, to view it in both forward andrever se directions, and to capture and label individual frames as well as br iefvideo clips. I mages showing normal anatomy of pathologic findings can beclosely examined in full colour. A recent addition to the software package is a feature that allows somedegree of localisation of the capsule within the abdomen and correlation to thevideo images. Another new addition to the software package automaticallyhighlights capsule images that correlates with the existence of suspected blood orred areas.
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; however, surfactant (eg: simethicone) may be administered prior to the examination to enhance viewing. After a careful medical examination the patient is fitted with the antenna array and image recorder. The recording device and its battery pack ar e worn on a special belt that allows the patient to move freely. A fully charged capsule is removed from its holder; once the indicator lights on the capsule and recorder show that data is being transmitted and received, the capsule is swallowed with a small amount of water. At this point, the patient is free to move about. Patients should avoid ingesting anything other than clear liquids for approximately two hours after capsule ingestion( although medications can be taken with water). Patients can eat food approximately 4 hours after they swallow the capsule without inter fering with the examination. Seven to 8 hours after ingestion. The examination can be considered complete, and the patient can return the antenna array and recording device to the physician. It should be noted that gastrointestinal motility is variable among individuals, and hyper and hypo motility states affect the free-floating capsule’s transit rate through the gut. Download of the data in the recording device to the workstation takes approximately 2.5 to 3 hours. Interpretation of the study takes approximately 1 hour. Invidual frames and video clips of normal or pathologic findings can be saved and exported as electronic files for incorporation into procedure reports or patient records.
. Pill Camera Page 19 CHAPTER 6 RESEARCHESOne research suggests that , with the use of capsule endoscopy,certain gastrointestinal diseases were diagnosed from a number of patients in ahospital, such as obscure gastrointestinal bleeding(OGB) and Crone’s disease, andis believed useful in investigating and guiding further management of patientssuspected with the identified diseases. Another research by supports this claim,and reported that capsule endoscopy is useful for evaluation of suspected Crohn’sdisease, r elated enteropathy and celiac disease, and is helpful in assessment ofsmall bowel disease of children.The third study also evaluates the potential of capsuleendoscopy, and conducts a research to evaluate its safety in patients withimplanted cardiac devices, who were being assessed for obscure gastrointestinalbleeding, and determine whether implanted cardiac devices had any effect on theimage capture by capsule endoscopy.Thus, study concludes that capsule endoscopy was notassociated with any adverse cardiac events, and implanted cardiac devices do notappear to interfere with video capsule imaging. To put it simply, the threeresearches conducted, emphasize that the use of capsule endoscopy is safe, has noside effects, effective, and is efficient in the careful diagnosis and treatment of thepatients.All of the three research studies were able to effectively conveytheir message and aim, and give importance to the value and efficiency of usingthe capsule endoscope as a way of evaluating the existing gastrointestinal diseasesof patients. The researches were done by letting the participants swallow thecapsule endoscope for the physicians to examine and assess the conditions of their
Pill Camera Page 20gastrointestinal tract by the image captured by the capsule endoscope. Thisprocess does not only help to detect the severity of the existing gastrointestinaldisease but also determine its effective to the presence of implanted cardiacdevices.The researches also emphasized that the use of the capsuleendoscope is better than using the traditional endoscope, for the use of thetraditional endoscope does not only damage the gastrointestinal tract of thepatients but affects also the patients and the hospital staffs because of the painstacking process.
Pill Camera Page 21 CHAPTER 7 ADVANTAGESPainless, no side effects.Minature size.Accurate, precise (view of 150 degree) .High quality images.Harmless material.Simple procedure.High sensitivity and specificity .Avoids risk in sedation.Efficient than X-ray CT-scan, normal endoscopy.
Pill Camera Page 22 CHAPTER 8 DISADVANTAGES Gastrointestinal obstructions prevent the free flow of capsule. Patients with pacemakers, pregnant women face difficulties. It is very expensive and not reusable. Capsule endoscopy does not replace standard diagnostic endoscopy. It is not a replacement for any existing GI imaging technique, generally performed after a standard endoscopy and colocoscopy. It cannot be controlled once it has been ingested, cannot be stopped or steered to collect close-up details. It cannot be used to take biopsies, apply therapy or mark abnormalities for surgery.
Pill Camera Page 23 CHAPTER 9 APPLICATIONSBiggest impact in the medical industry.Nano robots perform delicate surgeries.Pill cam ESO can detect esophageal diseases, gastrointestinal reflexdiseases, barreff’s esophagus.Pill cam SB can detect Crohn’s disease, small bowel tumours, small bowelinjury, celiac disease, ulcerative colitis etc.
Pill Camera Page 24 CHAPTER 9 FUTURE SCOPEIt seems likely that capsule endoscopy will becomeincreasingly effective in diagnostic gastrointestinal endoscopy. This willbe attractive to patients especially for cancer or varices detection becausecapsule endoscopy is painless and is likely to have a higher take up ratecompared to conventional colonoscopy and gastroscopy. Double imagercapsules with increased frame rates have been used to image theesophagus for Barrett’s and esophageal varices. The image quality is notbad but needs to be improved if it is to become a realistic substitute forflexible upper and lower gastrointestinal endoscopy. An increase in theframerate, angle of view, depth of field, image numbers, duration of theprocedure and improvements in illumination seem likely.Colonic, esophageal and gastric capsules will improve inquality, eroding the supremacy of flexible endoscopy, and becomeembedded into screening programs. Therapeutic capsules will emerge withbrushing, cytology, fluid aspiration, biopsy and drug deliver y capabilities.Electrocautery may also become possible. Diagnostic capsules willintegrate physiological measurements with imaging and optical biopsy,and immunologic cancer recognition. Remote control movement willimprove with the use of magnets and/or electro stimulation and perhapselectromechanical methods. External wireless commands will influencecapsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about thefuture of technology in any detail are almost always wrong.The development of the capsule endoscopy was made possibleby miniaturization of digital chip camera technology, especially CMOS
Pill Camera Page 25chip technology. The continued reduction in size, increases in pixel numbers andimprovements in imaging with the two rival technologies-CCD and CMOS islikely to change the nature of endoscopy. The current differences ar e becomingblurred and hybrids are emerging.The main pr essure is to reduce the componentsize, which will release space that could be used for other capsule functions suchas biopsy, coagulation or therapy. New engineering methods for constructing tinymoving parts, miniature actuators and even motors into capsule endoscopes arebeing developed.Although semi- conductor lasers that are small enough to swallow areavailable, the nature of lasers which have typical inefficiencies of 100-1000per cent makes the idea of a remote laser in a capsule capable of stoppingbleeding or cutting out a tumour seems to be something of a pipe dream atpresent, because of power requirements. The construction of an electrosurgical generator small enough to swallowand powered by small batteries is conceivable but currently difficult because ofthe limitations imposed by the internal resistance of the batteries. It may bepossible to store power in small capacitors for endosurgical use, and the size tocapacity ratio of some capacitor s has recently been reduced by the use oftantalum. Small motors are currently available to move components such asbiopsy devices but need radio- controlled activators. One limitation to therapeutic capsule endoscopy is the low mass of thecapsule endoscope (3.7 g). A force exerted on tissue for example by biopsyforceps may push the capsule away from the tissue. Opening small biopsyforceps to grasp tissue and pull it free will require different solutions to thoseused at flexible endoscopy-the push force exerted during conventional biopsy istypically about 100 g and the force to pull tissue free is about 400 g.
Pill Camera Page 26 Future diagnostic developments are likely to include capsule gastroscopy,attachment to the gut wall, ultrasound imaging, biopsy and cytology, propulsionmethods and therapy including tissue coagulation. Narrow band imaging andimmunologically or chemically targeted optical recognition of malignancy arecurrently being explored by two different groups supported by the EuropeanUnion as FP6 projects: -the VECTOR and NEMO projects. These acronyms standfor: VECTOR = Versatile Endoscopic Capsule for gastrointestinal TumourRecognition and therapy and NEMO = Nano-based capsule-Endoscopy withMolecular Imaging and Optical biopsy. The reason because of doctors rely more on camera pill than other types ofendoscope is because the former has the ability of taking pictures of smallintestine which is not possible from the other types of tests.
Pill Camera Page 27 CHAPTER 10CONCLUSIONWireless capsule endoscopy represents a significant technical breakthroughfor the investigation of the small bowel, especially in light of the shortcomings of otheravailable techniques to image this region. Capsule endoscopy has the potential for use ina wide range of patients with a variety of illnesses. At present, capsule endoscopy seemsbest suited to patients with gastrointestinal bleeding of unclear etiology who have hadnon-diagnostic traditional testing and whom the distal small bowel(beyond reach of apush enetroscope) needs to be visualised. The ability of the capsule to detect smalllesions that could cause recurrent bleeding(eg. tumours, ulcers) seems ideally suited forthis particular role. Although a wide variety of indications for capsule endoscopy arebeing investigated, other uses for the device should be considered experimental at thistime and should be performed in the context of clinical trials.Care must be taken in patient selection, and the images obtained must beinterpreted approximately and not over read that is, not all abnormal findingsencountered are the source of patient’s problem. Still, in the proper context, capsuleendoscopy can provide valuable information and assist in the management of patientswith difficult –to- diagnose small bowel disease.
Pill Camera Page 28 REFERENCES Biomedical Circuits and Systems Conference, 2009. BioCAS 2009. IEEE Intelligent Systems2006 3rd International IEEE Conference on capsule endoscopy , Medical Imaging, IEEE Transactions on Dec. 2008 Sidhu, Reena, et al.Gastrointestinal capsule endoscopy: from tertiary centres to primary "care". BMJ, March 4 2006. 332:528-531. doi:10.1136/bmj.332.7540.528. "Capsule Endoscopy in Gastroenterology". Mayo Clinic. Accessed October 5 2007.