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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.

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CONTENTS
CHAPTER 1: INTRODUCTION
1
CHAPTER 2: HISTORY AND
DEVELOPMENT

CHAPTER 3: UNDERSTANDING
CAPSULE ENDOSCOPY

CHAPTER 4: ARCHITECTURAL
DESIGN

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

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LIST OF FIGURES
Fig. 2.1:EUS Endoscope
2
Fig. 3.1: A capsule in view
4
Fig. 4.1: Wireless Endoscope
6
Fig. 4.2: I internal view of a capsule
8
Fig..4.3: Sensor array belt
11
Fig. 4.4: Data recorder
Fig. 4.5: Real time viewer
13

12

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CHAPTE
R1
INTRODUC
TION
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 pr ocess
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 e 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 noninvasive 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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CHAPTE
R2
HISTORY
AND
DEVELOPMENT
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

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"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 tumours in

the
esophagus, stomach, pancreas, or rectum
have spread in a less invasive way. In
addition to using an

endoscope to stage

tumours, gastroenterologists can use the

instrument to take tissue samples with
fine needle aspiration(FNA). The
endoscope, specially equipped

with

biopsy needle, is guided to a specific site

and extracts a tissue sample.
One

technology

available

for

that

about

has
30

been
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, 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
certain medical centers, such as
University Hospital's Therapeutic Endoscopy

and GI Mobility Center, it is used to

place stents within bile ducts, remove
difficult bile duct stones, and obtain biopsy
samples.
Motility is the movement of food
from one place to another along
the
digestive

tract.

When

person

has

difficulty in swallow ing food or excreting

waste, there could be a motility problem.
"Manometry" is a specialised test that
gastroenterologists use to record muscle
pressure within the esophagus or
anorectal 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. I 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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CHAPTE

R3
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 sour
ce and take 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 send to recording device, which
has to wear on the body.

Fig.3.1:A
capsule in view

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Doctor will be able to view these pictures

at a later time and might be able to
provide useful information regarding a
humans 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 (Crohns disease) , ulcer s and
tumors of the small intestine

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9

CHAPTER 4
ARCHITECTURAL DESIGN

Measuring 1126 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
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
units
optimal
chargeare
dome
oxideshaped
magnetic
switch.
The
semiconductor
coupled
imaging
important.
that
devices.
toThere
cleans
its obtained.
are three

Fig.4.1: Wireless capsule endoscope

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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
cir cuits(ASI Cs).
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 hadliung 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 ASI C
transmitter minimizes the
power consumptions.
The systems 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.

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4.1 INTERNAL VIEW OF THE CAPSULE

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.

the light
It isreceiving
the front part
window
of the
of capsule
the capsule
and itand
is bullet
it is shaped.
a non- Optical
OPTICAL
conductor
prevent
dome
theDOME
material.
filtration
is
of
It digestive fluids inside the capsule.

Fig.4.2: Internal view of a capsule

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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 LEDs
Illuminating LEDs illuminate an object. Non reflection coating
id placed
on the light receiving window to pr event the reflection. Light
irradiated from the
LED 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. It
have high precise.
BATTERY
Battery used in the pill camera is bullet 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 received data from transmitter and then send to data
recorder.

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4.2 PILL CAMERA PLATFORM COMPONENTS

In or der 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 cam
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.

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Page

PILL CAMERA CAPSULE:-SB OR ESO

SB

ESO

Approved by Food and

Drug Administration.
For small bowel.

Approved b y Food and

Drug Administration.
For esophagus.

Standard lighting control.

One side imaging.

Automatic lighting control.

Two sided imaging.

Two images per second.

50,000 images in 8 hours.

14 images per second.

2,600 images in 20
minutes.

SENSOR ARRAY BELT

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Fig.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. 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 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 off
the Sensor Arr ay! 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 patients 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
takes several hours to
download through several connection.

Fig.4.4: Data recorder

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The Date Recorder stores the images of your examination.

Handle the Date
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
infor mation. Return all of the equipment as soon as possible.
REAL TIME VIEWER

Fig.4.5: Real time viewer

software
It
is a handheld
and colour
device
LCD
and
monitor.
it enables
It test
real-time
the proper
viewing.
functioning
It
contains
before
and
confirms
procedures
rapidlocation
reader of capsule.

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Page

WORKSTATION AND RAPID SOFTWARE

Rapid workstation per forms the function of reporting and
processing of
images and data. I mage data from the data recorder is
downloaded to a computer
equipped with software called rapid application software. 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,
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 wor kstation,
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
rever se directions, and to capture and label individual frames
as well as br ief
video clips. I mages 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 localisation of the capsule within the abdomen and
correlation to the
video images. Another new addition to the software package
automatically
highlights capsule images that correlates with the existence of
suspected blood or
red areas.

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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
free-floating
capsules
transit
through
study
normal
workstation
takes
the
or gut.
pathologic
approximately
takes
Download
approximately
findings
1the
of hour.
the
can
data
be
Invidual
2.5saved
into
the3frames
recording
and
hours.
exported
anddevice
video
as
rate
files
toclips
electronic
the
Interpretation
forofincorporation
of the
into procedure reports or patient records.

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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
Crones 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 Crohns
disease, r elated 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.
capsule
All
their
the
of
patients.
of
capsule
message
theendoscope
three
endoscope
Theresearch
and
researches
aim,
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

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21
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.
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,
side effects.
because
of the no
pain
stacking process.
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.

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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

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.

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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, barreffs esophagus.
Pill cam SB can detect Crohns disease, small bowel tumours,
small bowel
injury, celiac disease, ulcerative colitis etc.

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24
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chip technology.
Future diagnostic
The continued
developments
reduction
are
in likely
size, to
increases
include capsule
in
pixel numbers
gastroscopy,
and
improvements
attachment
to the
in imaging
gut wall, ultrasound
with the two
imaging,
rival technologiesbiopsy and
CCD andpropulsion
cytology,
CMOS is
likely to change
methods
and therapy
the nature
including
of endoscopy.
tissue coagulation.
The current
Narrow
differences
band
imaging
ar and
e becoming
blurred and hybrids
immunologically
or chemically
are emerging.The
targetedmain
optical
pr essure
recognition
is to
reduce
of
malignancy
the component
are
size, 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,
Union
as FP6
coagulation
projects:or
-the
therapy.
VECTOR
Newand
engineering
NEMO projects.
methods
for constructing
These
acronymstiny
stand
FUTURE SCOPE
moving
for:
VECTOR
parts, miniature
= Versatileactuators
Endoscopic
and Capsule
even motors
for into
capsule endoscopes
gastrointestinal
Tumour
are
being developed.
Recognition
and therapy and NEMO = Nano-based capsuleEndoscopy with
Molecular
It seems
Imaging
likely
andthat
Optical
capsule
biopsy.
endoscopy will become
Although semi- conductor lasers that are small enough to
swallowThe
arereason because
increasingly
effective
ofindoctors
diagnostic
rely typical
more
gastrointestinal
on
camera pill than
available,
the nature
of lasers
which
have
inefficiencies
endoscopy.
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.
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.
present,
because to
of power
requirements.
Double imager
capsules with increased frame rates have been used to
The construction of an electrosurgical generator small enough
image the
to
swallow for Barretts and esophageal varices. 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.
It may
be and lower gastrointestinal endoscopy. An
flexible
upper
possible to store power
in small capacitors for endosurgical
increase
in
the
use, and
the size to
framerate,
angle of view, depth of field, image numbers,
capacity ratio of some capacitor s has recently been reduced
duration of the
by the use
of
procedure
and improvements
illumination
seem likely.
tantalum.
Small motors
are currently in
available
to move
components
such
as
esophageal
andcontrolled
gastric capsules
will improve in
biopsy Colonic,
devices but
need radioactivators.

quality, eroding the supremacy of flexible endoscopy, and

One limitation to therapeutic capsule endoscopy is the low
become
mass of theinto screening programs. Therapeutic capsules will
embedded
capsule endoscope (3.7 g). A force exerted on tissue for
emerge with
example
by biopsy
cytology,
fluid aspiration,
biopsy
drug deliver y
forcepsbrushing,
may push
the capsule
away from
the and
tissue.
capabilities.
Opening
small biopsy may also become possible. 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,
conventional
biopsy is cancer recognition. Remote control
immunologic
typicallyand
about
100 g and the force to pull tissue free is about
movement
400 g.improve withwillthe use of magnets and/or electro stimulation
and perhaps
electromechanical methods. External wireless commands will
by
capsule
miniaturization
diagnosisofand
digital
therapy
chip camera
and will technology,
increasingly especially
entail the
influence
CMOS
use of real-

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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. 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 enetroscope) needs to be visualised. The ability of the
capsule to detect small
lesions that could cause recurrent bleeding(eg. 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 patients 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,
Gastrointestinal
et al. "
capsule endoscopy: from tertiary centres 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.