Capsule Endoscopy

Andy DionRyan Tirtariyadi

Outline

Anatomy of the GI tract

Diseases

Conventional Endoscopy

Capsule Endoscopy

Current Technology

Future Concepts/Developements

The G.I. Tract7.5 meters long

Upper GI tract

Mouth -> esophagus

Lower GI Tract

Bowel (Intestine)

Small intestines

Large Intestines

Diseases of the GI Tract

Ulcers

Drug/food induced inflammations (NSAID)

Bleeding

Tumors

Cancers

Parasites

What is EndoscopyAll these diseases are very visible, but they’re on the inside of your body

Most GI diseases affect the Mucosa layer which comes in direct contact with the food (or bolus).

Easily diagnosed if doctors can See it.

Endoscopy allows doctors to visualize the GI tract

Two ways to look inside:

Exploratory Surgery

Endoscopy

Endoscope

Types of Endoscopy

Pros / Cons

Quick

Can fix things (cautery)

Can grab tissue samples (biopsy)

Manual control

Small Intestines

Duodenum (20cm)

Jejunum (100-210cm)

Illeum (150-160cm)

1/3 the diameter of the Large intestines

4-5x the length of the Large intestines

Small Intestine Disorders

Capsule Endoscopy

• Small intestine is • Too convoluted• Too long

• Capsule endoscopy is wireless• Can see the entire length of small

intestine

Brief History

• Started by Gavriel Iddan• Formerly an Israeli scientist working

on guided missile technology• Inspired by his friend who suffers

from chronic abdominal pain

Early Capsules

• Other capsules were developed• Measures pH, temperature, pressure

Current Technology

• PillCam SB/ESO• Norika3 and Sayaka• MiRO

PillCam (May 2001)

• Camera at the tip of the capsule• Strobe LEDs sync-ed with picture taking• 2 frames per second• CMOS sensor (190,000 - 210,000 pixels)• Battery powered• 26 x 11mm• US$450 each

Norika3 (December 2001)

• Camera at the tip of the capsule (slightly angled downwards for better exposure)

• Focus adjustment

• Wireless power transmission

• Posture control

• Simulated 3D images by LED manipulation

• 30 frames per second

• CCD Sensor (410,000 pixels)

• 23 x 9mm

• US$100

Sayaka (Dec 2005)

• Camera on the side of the capsule

• Twin layered capsule (camera rotation)

• ‘Stepping rotation’ using electromagnets

• Creates a flat map of the entire GI tract

• 30 frames per second (870,000 pictures over 8 hour)

• CCD Sensor (410,000 pixels)

• Focus adjustment

• 2MB/mm2

• 75x magnification on 17” display

• Wireless power transmission

MiRO

• In development• 320 x 320 pixel resolution• f/sec 1.4-2.8 (focusing capabilities)• Localization (Reverse Telemetry)• Real time image acquisition

• Displays to a PC/PDA• 11 x 24mm• Battery powered

Pros

• Non-invasive• Can access the entire small intestine• No need for exploratory surgery• Cheap• Time-efficient

Cons

• Lack of control• Pill can get stuck• Cannot further examine areas of

interest• Camera view might be obscured by

bowel contents

Development Challenges

• How to create a device small enough, and comfortable enough to swallow while packing sophisticated electronics.

• The microelectronics must be able to take high resolution pictures, transmit the data back, and operate for at least 6-8 hours.

• How to give user more control over the capsule’s movement and camera direction

Anatomy of the Pill

Size

• Size reduction means removing unnecessary components

• Batteries are typically large and carries limited amount of power

• Micro-devices:• Biopsy tools• Drug sprayers• Laser or Cautery devices (+power supply)

Section Drawings

Power

• Batteries typically do not carry enough power to last the desired amount of operation time.

• Batteries can be toxic if leaked into the digestive system

• Solution: Remove the battery• Wireless power transmission offers the possibility

of unlimited operation time, size reduction, and no risk of toxin contamination

Block DiagramWireless power transmission

Splitting the DSP from the imaging CCD circuit allows for 94% of the power consumption to be handled externally

Image Resolution

• Images taken must be clear, sharp, and have good colour definition

• CCD vs. CMOS• Focus adjustment• Simulated 3D (depth perception)

Movement Control

• Norika3 uses Electromagnet induced ‘Posture Control’

• Sayaka uses Electromagnets to produce ‘Stepping Rotations’

• MiRO sends telemetry back to inform user of current position

Posture adjustment

Pictures

Normal intestinal lining

Lymphoma Cystic erythema inflammation

Crohn’s

PillCam SB

Videos

PillCam SB

Norika3

Norika3

Future Developments

• Drug delivery• Micro-biopsy• Laser treatments• Additional sensors

• (pH, Temp, pressure sensors)• Cost reduction

Last CommentsCapsule endoscopy marks a leap in the quality of care for patients

Pills for Small intestine visualization are available today

Next step, the Sayaka capsule will allow for visualization of the entire Gi tract

Very painless, low-cost procedure with high degree of accuracy

Future pills can be controlled and will be involved in treatment process and more involved diagnosis techniques

Questions?

References

• A. Arshak, K.Arshak, D. Morris, E.Jafer, O. Korostynska, G.Lyons, & D. Waldron. A Review of Digestible Microsystems for Gastrointestinal Tract Diagnostic Applications In: Critical Reviews in Biomedical Engineering, 34(2): 163-186 (2006)

• IEEE Standard for Safety levels with Respect to Human Exposure to Radio Frequency, Electromagnetic Fields, 3kHz to 300GHz. In: IEEE Standard c95.1-1991. New York: IEEE; 1999.

• Glukhovsky A, Jacob H. The Development and application of wireless capsule endoscopy. Int J Med Robot Comput Assist Surg. 2004; 1(1):112-23.

• Iddan G, Meron G, Glukhovsky A, Swain P. Wireless Capsule Endoscopy. Nature. 2000; 405-417.

• Norika3. Data Sheet; 2003.

• RF System Adopts Silicon Laboratories’ Small Form Factor Microcontroller for Advanced Medical Application. In: Business Wire. Aug. 09, 2006

• Tortora G. J., Derrickson B. Principles of Anatomy and Physiology 11th Edition. John Wiley & Sons. 2006. U.S.

• http://microsystem.re.kr/main_eng/menu04/sub_menu01.asp

• http://www.rfnorika.com/eng/system/sys_001.html - sys_009.html

• http://www.rfamerica.com/sayaka/index.html

• http://www.givenimaging.com/Cultures/en-US/given/english

• http://www.dalsa.com/markets/ccd_vs_cmos.asp

• http://www.highbeam.com/doc/1G1-108722548.html

References (Cont’d)

• http://www.cbc.ca/health/story/2002/09/04/video_pill020904.html

• http://www.cbc.ca/news/story/2001/08/03/nano_camera010803.html

• http://www.findarticles.com/p/articles/mi_m0EIN/is_2005_August_9/ai_n14875232

• http://www.teachnet.ie/farmnet/images/Digest3.gif

• http://en.wikipedia.org/wiki/Electric_motor

• http://en.wikipedia.org/wiki/Electromagnetic_wave

• http://en.wikipedia.org/wiki/Magnets

• http://en.wikipedia.org/wiki/Small_intestine

• http://en.wikipedia.org/wiki/Large_Intestine

• http://en.wikipedia.org/wiki/Gavriel_Iddan

• http://en.wikipedia.org/wiki/Wireless_capsule_endoscopy

• http://en.wikipedia.org/wiki/Gastrointestinal_tract

Thank you