Pill camera documentation

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CVSE 1 2010-2014
CHAPTER 1
INTRODUCTION
The advancement of our technology today has lead to its effective use and application to the medical
field. One effective and purposeful application of the advancement of technology is the process of
Endoscopy, 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, with a camera at
one end, and images are shown on nearby monitor, 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 the patients, but also for the doctors and nurses as well.
From this, the evolution of the wireless capsule endoscope has emerged. Reports, that through the marvels
of miniaturization, 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.
The miniature camera, along with a light, transmitter, and batteries, called capsule cam, is housed in a
capsule, the size of a large vitamin pill, and is used in a procedure known as capsule endoscopy, which is a
non-invasive and painless way of looking into the esophagus and small intestine. Once swallowed, the
capsule is propelled through the small intestine by peristalsis, and acquires and transmits digital
images at the rate of two per second to a sensor array attached to the patients abdomen, through a
recording device worn on a belt stores the images, to be examined and reviewed.

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CHAPTER 2
HISTORY AND DEVELOPMENT
Endoscopic Ultrasound (EUS) endoscopes are unique because they offer ultrasound guided needle
biopsy, colour Doppler and advanced image. The technology available to doctors has evolved dramatically
over the past 40 years, enabling specially trained gastroenterologists to perform tests and procedures
that traditionally required surgery or were difficult on the patient.
Fig.2.1: EUS endoscope
"Basic endoscopy was introduced in the late 1960s”, and about 20 years later, ultrasound was added,
enabling us to look at internal GI structures as never before. Now, with EUS ,we can determine the
extent to which tumors in the esophagus, stomach, pancreas, or rectum have spread in a less invasive
way. In addition to using endoscope to stage tumors, gastroenterologists can use the instrument to take
tissue samples with fine needle aspiration (FNA). The endoscope, specially equipped with a biopsy needle,
is guided to a specific site and extracts a tissue sample.
One technology that has been available for about 30 years, Endoscopic Retrograde Cholangio-
pancreatography(ERCP),combines X-rays and endoscopy to diagnose conditions affecting the liver,
pancreas, gallbladder, and the associated ducts. An endoscope is guided down the patient's esophagus,

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CVSE 3 2010-2014
stomach, and small intestine, and dye is injected to tiny ducts to enhance their visibility on X-ray. ERCP's
role has expanded, and in retain medical centers, such as University Hospital's Therapeutic Endoscopy
and GI ability center, it is used to place stents within bile ducts, remove difficult bile duct tones, and obtain
biopsy samples.
Motility is the movement of food from one place to another along the digestive tract. When a
person has difficulty in swallow in food or excreting waste, there could be a motility problem.
"Manometer" is a specialized test that gastroenterologists use to record muscle pressure within the
esophagus or anorectic area, essential information for the diagnosis of esophageal disorder such as
achalasia, the failure of the lower esophageal sphincter muscle to relax, and problem such as fecal
incontinence or constipation-related rectal outlet obstruction.
The traditional pH test involves threading a catheter into the patient's nose and down the throat; the
catheter is attached to a special monitor, which is worn by the patient for 24 hours. A newer alternative
eliminates the catheter completely. Instead, the gastroenterologist, using an endoscope, attaches a small
capsule to the wall of the esophagus. The capsule transmits signals to a special receiver; afterward, the data
is downloaded to a computer at the doctor's office.

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CHAPTER 3
UNDERSTANDING CAPSULE ENDOSCOPY
Capsule Endoscopy lets the doctor to examine the lining of the gastrointestinal tract, which
includes the three portion of the small intestine(duodenum, jejunum, and ileum). A pill sized video
camera is given to swallow. This camera has its own light source and takes picture of small intestine as it
passes through. It produces two frames per second with an approximate of 56,000 high quality images.
These pictures are sending to recording device, which has to wear on the body.
Fig.3.1: A capsule in view
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. Capsule Endoscopy helps the doctor to evaluate the small intestine.
This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most
common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It
may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers and tumors of
the small intestine.

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CHAPTER 4
ARCHITECTURAL DESIGN
Fig.4.1: Wireless Capsule Endoscope
Measuring 11×26 mm, the capsule is constructed with an isoplast outer envelope that is biocompatible
and impervious to gastric fluids. Despite its diminutive profile, the envelope contains LEDs, a lens, a colour
camera chip, two silver- oxide batteries, a transmitter, an antenna, and a magnetic switch. The camera
chip is constructed in complementary-metal–oxide-semiconductor technology to require significantly less
power than charge-coupled devices.
Other construction benefits include the unit’s dome shaped that cleans itself 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 vital technologies that made the tiny imaging system possible: improvement
of the signal-to-noise ratio (SNR) in CMOS detectors, development of white LEDs and development of
application-specific integrated circuits (ASICs).

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The silver oxide batteries in the capsule power the CMOS detector, as well as the LEDs and transmitter.
The white- 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 handling stray light and reflections. Recent
advances in ASIC design allowed the integration of a video transmitter of sufficient power output,
efficiency, and band width of very small size into the capsule. Synchronous switching of the LEDs,
the CMOS sensor, and ASIC transmitter minimizes the power consumptions.
The system’s computer work station is equipped with software for reviewing the camera data
using a variety of diagnostic tools. This allows physicians choice of viewing the information as either
streaming or single video images.
4.1 INTERNALVIEW OF THE CAPSULE
Fig.4.2: Internal view of a capsule

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The 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 is the light receiving window of the
capsule and it is a non- conductor material. It prevents the filtration of digestive fluids inside the capsule.
LENS HOLDER:
This accommodates the lens. Lenses are tightly fixed in the capsule to avoid dislocation of lens.
LENS:
It is the integral component of pill camera. This lens is placed behind the Optical Dome. The light
through window falls on the lens.
ILLUMINATING LED’S:
Illuminating LEDs illuminate an object. Non reflection coating is placed on the light receiving window
to prevent the reflection. Light irradiated from the LED’s pass through the light receiving window.
CMOS IMAGE SENSOR:
It has 140 degree field of view and detect object as small as 0.1mm. It have high precise.

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BATTERY:
Battery used in the pill camera is button shaped and two in number and silver oxide primary batteries are
used. It is disposable and harmless material.
ASIC TRANSMITTER:
It is application specific integrated circuit and is placed behind the batteries. Two transmitting
electrodes are connected to this transmitter and these electrodes are electrically isolated
ANTENNA:
Parylene coated on to polyethylene or polypropylene antennas are used. Antenna receives data from
transmitter and then sends to data recorder.
4.2 BLOCK DIAGRAM OF TRANSMITTER AND RECEIVER
Fig.4.3: Video signal transmitter of capsule.

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CVSE 9 2010-2014
Fig.4.4: Receiver circuit inside capsule
In the first block diagram, one SMD type transistor amplifies the video signal for efficient modulation
using a 3 biasing resistor and 1 inductor. In the bottom block, a tiny SAW resonator oscillates at 315 MHZ
for modulation of the video signal. This modulated signal is then radiated from inside the body to outside the
body. For Receiver block diagram a commercialized ASK/OOK (ON/OFF Keyed) super heterodyne receiver
with an 8-pin SMD was used. This single chip receiver for remote wireless communications, which includes
an internal local oscillator fixed at a single frequency, is based on an external reference crystal or clock. The
decoder IC receives the serial stream and interprets the serial information as 4 bits of binary data. Each bit is
used for channel recognition of the control signal from outside the body. Since the CMOS image sensor
module consumes most of the power compared to the other components in the telemetry module, controlling
the ON/OFF of the CMOS image sensor is very important.
Moreover, since lightning LED’s also use significant amount of power, the individual ON/OFF control of
each LED is equally necessary. As such the control system is divided into 4 channels in the current study. A
high output current amplifier with a single supply is utilized to drive loads in capsule.

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CVSE 10 2010-2014
4.3 PILL CAMERA PLATFORM COMPONENTS
In order for the images obtained and transmitted by the capsule endoscope to be useful, they must be
received and recorded for study. Patients undergoing capsule endoscopy bear an antenna array consisting of
leads that are connected by wires to the recording unit, worn in standard locations over the abdomen,
as dictated by a template for lead placement.
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. The antenna array and battery pack
can be worn under regular clothing. 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. Ambulary
(non-vigorous) patient movement does not interfere with image acquisition and recording. A typical capsule
endoscopy examination takes 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 CAPSULE: - SB OR ESO
SB ESO
Approved by Food and
Drug Administration.
Approved by Food and
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.

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CVSE 11 2010-2014
SENSOR ARRAY BELT
Fig.4.5: 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. Sensor arrays are used to calculate
and indicate the position of capsule 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 battery 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 off the Sensor Array! Peel off
each adhesive sleeve starting with the non-adhesive tab without removing the sensor from the adhesive
sleeve. Place the Sensor Array with the rest of the equipment.
DATA RECORDER
Data recorder is a small portable recording device placed in the recorder pouch, attached to the sensor
belt. It has light weight (470 gm.). Data recorder receives and records signals transmitted by the camera
to an array of sensors placed on the patient’s body. It is of the size of Walkman and it receives and stores
5000 to 6000 JPEG images on a 9 GB hard drive. Images take several hours to download through several
connections.

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Fig.4.6: Data recorder
The Data Recorder stores the images of your examination. Handle the Data Recorder, Recorder Belt,
Sensor Array and Battery Pack carefully. Do not expose them to shock, vibration or direct sunlight,
which may result in loss of information. Return all of the equipment as soon as possible.
REAL TIME VIEWER
Fig.4.7: Real time viewer

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It is a handheld device and it enables real-time viewing. It contains rapid reader software and colour LCD
monitors. It tests the proper functioning before procedures and confirms location of capsule.
WORKSTATION AND RAPID SOFTWARE
Rapid workstation performs the function of reporting and processing of images and data. Image data from
the data recorder is downloaded to a computer equipped with software called rapid application software. It
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, the antenna array and image recording
device are returned to the health care provider. The recording device is then attached to a specially modified
computer work station, and the entire examination is downloaded in to the computer, where it becomes
available to the physician as a digital video. The workstation software allows the viewer to watch the video at
varying rates of speed, to view it in both forward and reverse directions, and to capture and label individual
frames as well as brief video clips. Images showing normal anatomy of pathologic findings can be closely
examined in full colour.
A recent addition to the software package is a feature that allows some degree of localization of the
capsule within the abdomen and correlation to the video images. Another new addition to the software
package automatically highlights capsule images that correlate with the existence of suspected blood or red
areas.

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CVSE 14 2010-2014
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 (e.g.: 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 are
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 interfering with the examination.
Seven to eight 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. Individual 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.

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CVSE 15 2010-2014
CHAPTER 6
RESEARCHES
One research suggests that , with the use of capsule endoscopy, certain gastrointestinal diseases were
diagnosed from a number of patients in a hospital, such as obscure gastrointestinal bleeding(OGB) and
Crone’s disease, and is believed useful in investigating and guiding further management of patients
suspected with the identified diseases. Another research by supports this claim, and reported that capsule
endoscopy is useful for evaluation of suspected Crohn’s disease, related enteropathy and celiac disease,
and is helpful in assessment of small bowel disease of children.
The third study also evaluates the potential of capsule endoscopy, and conducts a research to evaluate
its safety in patients with implanted cardiac devices, who were being assessed for obscure
gastrointestinal bleeding, and determine whether implanted cardiac devices had any effect on the image
capture by capsule endoscopy.
Thus, study concludes that capsule endoscopy was not associated with any adverse cardiac events, and
implanted cardiac devices do not appear to interfere with video capsule imaging. To put it simply, the three
researches conducted, emphasize that the use of capsule endoscopy is safe, has no side effects, effective, and
is efficient in the careful diagnosis and treatment of the patients.
All of the three research studies were able to effectively convey their message and aim, and give
importance to the value and efficiency of using the capsule endoscope as a way of evaluating the existing
gastrointestinal diseases of patients. The researchers were done by letting the participants swallow the
Capsule Endoscope for the physicians to examine and assess the conditions of their gastrointestinal tract by
the image captured by the capsule endoscope. 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.
The researchers also emphasized that the use of the capsule 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 because of the
pain stacking process.

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CHAPTER 7
ADVANTAGES
 Painless, no side effects.
 Miniature 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.

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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 colonoscopy.
 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.

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CHAPTER 9
APPLICATIONS
 Biggest impact in the medical industry.
 Nano robots perform delicate surgeries.
 Pill cam ESO can detect esophageal diseases, gastrointestinal reflex diseases, and barreff’s
esophagus.
 Pill cam SB can detect Crohn’s disease, small bowel tumours, small bowel injury, celiac disease,
ulcerative colitis etc.

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CHAPTER 10
FUTURE SCOPE
It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal
endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule
endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy
and gastroscopy. Double imager capsules with increased frame rates have been used to image the
esophagus for Barrett’s and esophageal varices. The image quality is not bad but needs to be improved if
it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase
in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements
in illumination seem likely.
Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible
endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing,
cytology, and fluid aspiration; biopsy and drug delivery capabilities. Electro cautery may also become
possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy,
and immunologic cancer recognition. Remote control movement will improve with the use of magnets
and/or electro stimulation and perhaps electromechanical methods. External wireless commands will
influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However,
it should be noted that speculations about the future of technology in any detail are almost always wrong.
The development of the capsule endoscopy was made possible by miniaturization of digital chip camera
technology, especially CMOS chip technology. The continued reduction in size, increases in pixel numbers
and improvements in imaging with the two rival technologies-CCD and CMOS is likely to change the
nature of endoscopy. The current differences are becoming blurred and hybrids are emerging. The main
pressure is to reduce the component size, which will release space that could be used for other capsule
functions such as biopsy, coagulation or therapy. New engineering methods for constructing tiny moving
parts, miniature actuators and even motors into capsule endoscopes are being developed.
Although semi-conductor lasers that are small enough to swallow are available, the nature of lasers which
have typical inefficiencies of 100-1000 percent makes the idea of a remote laser in a capsule capable of
stopping bleeding or cutting out tumours seems to be something of a pipe dream at present, because of power
requirements.

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The construction of an electrosurgical generator small enough to swallow and powered by small batteries
is conceivable but currently difficult because of the limitations imposed by the internal resistance of the
batteries. It may be possible to store power in small capacitors for endosurgical use, and the size to capacity
ratio of some capacitors has recently been reduced by the use of tantalum. Small motors are currently
available to move components such as biopsy devices but need radio- controlled activators.
One limitation to therapeutic capsule endoscopy is the low mass of the capsule endoscope (3.7 g). A force
exerted on tissue for example by biopsy forceps may push the capsule away from the tissue. Opening small
biopsy forceps to grasp tissue and pull it free will require different solutions to those used at flexible
endoscopy-the push force exerted during conventional biopsy is typically about 100 g and the force to pull
tissue free is about 400 g.
Future diagnostic developments are likely to include capsule gastroscopy, attachment to the gut wall,
ultrasound imaging, biopsy and cytology, propulsion methods and therapy including tissue coagulation.
Narrow band imaging and immunologically or chemically targeted optical recognition of malignancy are
currently being explored by two different groups supported by the European Union as FP6 projects: -the
VECTOR and NEMO projects. These acronyms stand for: VECTOR = Versatile Endoscopic Capsule for
gastrointestinal Tumours Recognition and therapy and NEMO = Nano-based capsule-Endoscopy with
Molecular Imaging and Optical biopsy.
The reason because of doctors rely more on camera pill than other types of endoscope is because the
former has the ability of taking pictures of small intestine which is not possible from the other types of tests.

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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.
Capsule endoscopy has the potential for use in a wide range of patients with a variety of illnesses. At present,
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 electroscope)
needs to be visualized.
The ability of the capsule to detect small lesions that could cause recurrent bleeding (e.g. tumours, ulcers)
seems ideally suited for this particular role. 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.
Care must be taken in patient selection, 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. Still, in the
proper context, capsule endoscopy can provide valuable information and assist in the management of patients
with difficult-to-diagnose small bowel disease.

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REFERENCES
[1] Biomedical Circuits and Systems Conference, 2009. BioCAS 2009. IEEE.
[2] Intelligent Systems, 2006 3rd International IEEE Conference on capsule endoscopy.
[3] Medical Imaging, IEEE Transactions on Dec. 2008.
[4] Sidhu, Reena, etal. " Gastrointestinal capsule endoscopy: from tertiary centers to primary care". BMJ,
March 4 2006. 332:528-531. doi:10.1136/bmj.332.7540.528.
[5] "Capsule Endoscopy in Gastroenterology". Mayo Clinic. Accessed October 5 2007.

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