CAPSULE CAPSULE CAMERACAMERA

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VIEVIEWW

What is capsule endoscopy?

Capsule endoscopy is a novel noninvasive technology designed primarily to provide diagnostic imaging .

This Miniature Ingestible Camera was conceived by Tarun Mullick developed in late 1980's with the help of gastroenterologist, Dr. Sudhir Dutta.

HISTORY

The Camera Pill The Camera Pill

Swallowable Camera Capsule, Swallowable Camera Capsule, from Given Imaging, including from Given Imaging, including Zarlinks ULP RF TransmitterZarlinks ULP RF Transmitter

Specifications Diameter of 10 mm and a Length of 20 mm.

Bullet shape - This shape and its diameter are critical for mapping the small intestine.

Uses Silver oxide button batteries - high energy density & disposable.

Made up of biocompatible material.

Features of the Capsule

Capsule takes two images per secondOn average, 50,000 images are obtained during an

8 hour examMagnification: 8xCapsule coating: non-adherantDisposable

CONSTRUCTION OF CAPSULE CONSTRUCTION OF CAPSULECAMERACAMERA

- HAS 8 PARTS- HAS 8 PARTS

Capsule Capsule Electronics Electronics 1.Optical dome2. Lens holder 3. Lens 4.Illuminating LEDs5. CMOS imager6 .Battery7. ASIC transmitter8. Antenna

CAPSULE CAMERA(Internal view)

1.Optical Dome

Front part of capsule Bullet shapedEasy orientation Easy propelling

2.Lens Holder

Lens Holder holds lens tightly & avoids its dislocation.

3.Lens

Arranged behind Light Receiving Window

Focuses light on the CMOS Image Sensor behind it.

4.CMOS Image Sensor

PIXELARRAY

OSCILLATING

CIRCUIT

CURRENTLIMITINGCIRCUIT

CONTROL CIRCUIT

CODINGCIRCUIT

SWITCHINGCIRCUIT

READCIRCUIT

5.Battery

Made of Zinc/Alkaline Electrolyte/Silver Oxide Has discharge voltage, disposable and doesnt cause harm to the body.

Button shaped & two in number

6.ASIC Transmitter

The ASIC (Application Specific Integrated Circuit) Transmitter Two Transmitting Electrodes are connected to the outlines of the ASIC Transmitter.These electrodes are electrically isolated from each other.

7.Antennae

As shown, the Antennae is arranged at the end of the capsule. Itis enclosed in a dome shaped chamber.

The Antennae receives the data from the ASIC Transmitter and sends it to the Data Recorder tied to the patients waist.

The dome containing the Antennae is made of non conducting material which is harmless to the human body.

Parylene coated onto polyethylene or polypropylene is used.

PillCam Platform Components PillCam ESO or SB Data Recorder Given Workstation RAPID Software

Data Recorder with pick up antennae & a Computer.

A view of Data Recorder being mounted on a belt pack tied to the patients waist.

SB 2 with RAPID 4 SB 2 with RAPID 5

Improved Diagnostic Confidence:RAPID Atlas

All images reviewedand labeled byphysician advisorypanel. Enables side-by-sidecomparison of caseimage to knownpathology. Searchable by CapsuleEndoscopy StructuredTerminology (CEST),findings, and diseases.

TYPES AND TYPES AND APPLICATIONAPPLICATION

-4 TYPES

PillcamSB

Approved by FDA in 2001Size-11mm x 26 mmWeight-3.7 gramsOne-sided imagingTwo pictures per second1:8 magnification140 degree field of viewOver 50,000 images in 8 hoursPillcamSB 2-cleared by FDA May 2007-offers wider field of view and improved optics

PillcamESO

Approved by the FDA in 2004Size 11mm x 26mmWeight-3.7 gramsTwo sided photography14 images per second2,600 pictures in 20 minutesPillcamESO 2-cleared by FDA May 2007-offers wider field of view and 18 images per second

Agile Patency CapsuleSame size as actual video capsuleComposed of lactoseContains a timer, radiofrequency identification tag, and radio-opaque materialCan be seen by plain abdominal film or by special handheld radiofrequency detectorDesigned to progressively dissolve after 40 hours of contact with digestive secretionsDisintegrates completely between 80 and 100 hoursAllows localization of site of stenosis before video capsuleNot considered standard of practice

PillCam SB- Crohn's Disease, Small bowel tumors, Small bowel injury, Celiac Disease, Mal-Absorption Disorders, Vascular Disorders, Ulcerative Colitis

PillCam ESO -esophageal diseases, gastro esophageal reflux disease, Barrett's esophagus PillCam COLON- colon

Agile patency capsule- intestinal patency

UsesUses

EXISTING PRODUCTSEXISTING PRODUCTS1.OMOM 2.M2A

3.PILLCAM 4.NORIKA35.MTSI

PreparationPatient fasts overnight or for at least 12 hoursNo iron pills for 5 days or olestraColyte prep: clear liquid diet at noon, 2/3 gallon colyteat 6 PM, 4 hours prior to capsule take 1/3 gallon colyteand 2 simethicone tabletsMagnesium Citrate prep: clear liquid diet at noon, 1 bottle of magnesium citrate followed by 1 bottle of gatoradeat 6 PM, 8 PM and 4 hours prior to capsule with 2 simethicone tablets 4 hours prior

Procedure for PillcamSB

Patient comes to endoscopy center8-lead antenna placed on patient and battery pack placed on patientPatient swallows pill and leaves unitCan ingest liquids 2 hours after capsule takenCan eat food 4 hours after capsule takenPatient brings back recorder approximately 8 hours after ingestionPatient does NOT recover capsuleRecorder then downloaded onto computer which can take 2.5 to 3 hoursCapsule then read on computer

Procedure for PillcamESO

Patient swallows the pill while lying down with little or no waterThe patient is then slowly elevatedThis allows for the capsule to spend a longer time in the esophagus and therefore allow for better visualization of the esophagus

Endoscopy Procedure

Capsule is swallowed by the patient like a conventional pill.

It takes images as it is propelled forward by peristalsis.

A wireless recorder, worn on a belt, receives the images transmitted by the pill.

A computer workstation processes the data and produces a short video clip or still images.

The Diagnostic Procedure The Diagnostic Procedure

Capsule Imaging Moved by peristalsis 2Hz, 576 X576 color image Typical studies are around 6-8hours. 10,000s of images from eachstudy Somewhat cumbersome to

In approximately eight hours, thepatient will return to the clinic forremoval of equipment.

9:00 am 5:00 pm

Advantages Painless, no side affects or complications.

Miniature size, so can move easily through the digestive system.

Accurate, precise & low power consumption.

Images taken are of very high quality which are sent almost instantaneously to the data recorder for storage. Made of bio compatible material, doesnt cause any harm to the body. The procedure is simple.

Use of Suspected Blood Indicator (SBI)which add no cost. AdvanCE (Advance CE) for patients unable to swallow High sensitivity and specificity for detecting lesions.CE avoids the risks associated with sedation and radiation. It is noninvasive and may not require the patient to miss work.

Reducing physician reading times and improving cost-effectiveness. More efficient than normal endoscopy,the X ray or the CT scan.

Remote interpretation for rural settings

Image Spectrum: PillCam Capsule Endoscopy

BleedingSuspected Crohns

Tumors

Celiac Disease

Capsule Endoscopy Versus Other Imaging Modalities

Study Yield

Capsule vs Ileoscopy 61% vs 46%Capsule vsPush enterosc 51% vs 7%Capsule vs CT enterography 75% vs 37%Capsule vs Small bowel MRI 60% vs 40%

Disadvantages

Gastrointestinal obstructions and swallowing disorders prevent free flow of capsule through the digestive system.

Patients with pacemakers, pregnant women and all pediatrics have to be monitored continuously while taking the capsule.

The M2A procedure is not a replacement for Colonoscopy.

It is not reusable.

Capsule obstruction which necessitate surgical removal More expensive than the other procedures

Batteries may not last long

Presence of cardiac pacemakers and cardiac defibrillators could lead to corruption and loss of the transmitted data.

MRI not possible while the capsule inside the patient's body

v

CAPSULE ENDOSCOPY RETENTION

Capsule retained proximal to an intestinal narrowing for at least TWO WEEKS.

Untreated, may be permanent.

Capsule removal requires medical endoscopic or surgical intervention

Future Improvements

Equipping the capsule with a LASER.

Adding additional features like Zooming & Auto Focus.

Can be used in Restorative Surgery & Pharmacological Intervention.

Further reduction in size using Nano Technology.Making it cost effective.

SB2 with new features mmRAPID REAL TIME VIEWERLabeling the bowel wall, sample luminal contents, biopsy the mucosa, provide therapeutic ablation of lesions, or control the movement of the device. Evaluation of celiac sprue and chronic abdominal pain. Longer battery half-life Humanoid robot Capsule camera with telemetric capacities Making it cost effective.

RAPID REAL TIMEVIEWER

Remote Patient Check-in

Real-time viewing Data Transfer to GDS PillCam ESO Viewing

Conclusion

The Endoscopy capsule is a pioneering concept for Medical Technology of the 21st century.

The endoscopy system is the first of its kind to be able to provide non-invasive imaging of the entire small intestine.

It has revolutionized the field of diagnostic imaging to a great extent and has proved to be of great help to physicians all over the world.

THANK YOUTHANK YOU

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