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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 diagnosethepatients,research shows that endoscopy
is apainstacking process not only for thepatients, butalsofor the doctors and nurses as well. From this, the
evolution ofthewirelesscapsule 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.

HISTORYAND DEVELOPMENT
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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 tostagetumors, 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,
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
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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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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

Doctorwill be able to view these pictures at alater time and might be ableto 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), ulcers and tumors of
the small intestine.
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ARCHITECTURAL DESIGN

Fig.4.1: Wireless Capsule Endoscope

Measuring 1126 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-metaloxide-semiconductortechnology to require significantly less
power than charge-coupled devices.

Other construction benefits include the units 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 threevital 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-specificintegratedcircuits(ASICs).
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The silver oxide batteries in the capsule power the CMOS detector, as well as theLEDs 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, andmanages to
integrate both the LEDs and imager under one domewhile handling 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 ASIC transmitter minimizes thepower consumptions.

The systems 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.

4.1 INTERNAL VIEW OF THE CAPSULE

Fig.4.2: Internal view of a capsule

The figure shows the internal view of the pill camera. It has 8 parts:
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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. Itprevents the filtration of digestive fluids inside the capsule.

LENS 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 is placedon the light receiving window to
prevent the reflection. Light irradiated from theLEDs pass through the light receiving window.

CMOS IMAGE SENSOR:

It has 140 degree field of view and detect object as small as 0.1mm. Ithave high precise.

BATTERY:
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Battery used in the pill camera is button 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 theseelectrodes 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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Fig.4.4: Receiver circuit inside capsule

In the first block diagram, one SMD type transistor amplifies the video signalfor 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 LEDs 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.

4.3 PILL CAMERA PLATFORM COMPONENTS

In order for the images obtained and transmitted by the capsule endoscopeto be useful, they must be
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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
can 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 CAPSULE: -SB OR ESO

SB ESO
Approved by Food and Approved by 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

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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 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 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 offthe Sensor Array! 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
camerato an array of sensorsplaced on the patients body. It is of the size of Walkman and it receives and
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stores5000 to 6000 JPEG images on a 9 GB hard drive. Images take several hours todownload through
severalconnections.

Fig.4.6: Data recorder

The Data Recorder stores the images of your examination. Handle the DataRecorder, Recorder Belt,
Sensor Array and Battery Pack carefully. Do not exposethem to shock, vibration or direct sunlight, which
may result in loss ofinformation. Return all of the equipment as soon as possible.
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REAL TIME VIEWER

Fig.4.7: Real time viewer

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 proceduresand confirms location of capsule.

WORKSTATION AND RAPID SOFTWARE

Rapid workstationperforms the function of reporting and processing ofimages and data. Image data
fromthe data recorder is downloaded to a computerequipped with software called rapid application software.
Ithelps 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 work station, 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 andreverse directions, and to capture and label
individual frames as well as briefvideo clips. Images showing normal anatomy of pathologic findings can
beclosely examined in full colour.
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A recent addition to the software package is a feature that allows somedegree of localization of the
capsule within the abdomen and correlation to thevideo images. Another new addition to the software
package automaticallyhighlights capsule images that correlate with the existence of suspected blood orred
areas.

THE CAPSULE ENDOSCOPY PROCEDURES

A typical capsule endoscopic procedures begins with the patientfasting after midnight on the day
before the examination. No formalbowel preparation is required; however, surfactant (e.g.:
simethicone)may be administered prior to the examination to enhance viewing.After acareful medical
examinationthe patient is fitted with theantenna array and image recorder. The recording device and its
batterypack are worn on a special belt that allows the patient to move freely. A fully charged capsule is
removed from itsholder; once the indicatorlights on the capsule and recorder show that data is being
transmittedand received,the capsule is swallowed with a small amount of water.At this point, the patient is
free to move about.Patients should avoidingesting anything other than clear liquids for approximately two
hoursafter capsuleingestion (although medications can be taken with water).Patients can eat food
approximately 4 hours after they swallow thecapsule without interfering with the examination.

Seven to eight hours after ingestion. The examination can beconsidered complete, and the patient can
returnthe antenna array andrecording device to the physician. It should be noted thatgastrointestinal motility
isvariable among individuals, and hyper andhypo motility states affect the free-floating capsules
transitratethrough the gut. Download of the data in the recording device to theworkstation takes
approximately 2.5 to 3 hours. Interpretation of thestudy takes approximately 1 hour. Individual frames and
video clips ofnormalor pathologic findings can be saved and exported as electronicfiles for incorporation into
procedure reports or patient records.

RESEARCHES
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One research suggests that , with the use of capsule endoscopy, certain gastrointestinal diseases
werediagnosed from a number of patients in ahospital, such as obscure gastrointestinal bleeding(OGB)
andCrones 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
capsuleendoscopy is useful for evaluation of suspected Crohnsdisease, related 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 cardiacdevices, 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 capsuleendoscopy was notassociated with any adverse cardiac events, and
implanted cardiac devices do notappear tointerfere with video capsule imaging. To put it simply, the
threeresearches conducted, emphasize that theuse of capsule endoscopy is safe, has noside effects, effective,
and is efficient in the careful diagnosis andtreatment of thepatients.

All of the three research studies were able to effectively conveytheir message andaim, and give
importance to the value and efficiency of usingthe capsule endoscope as a way of evaluating the existing
gastrointestinal diseasesof patients. The researchers were done by letting the participants swallow theCapsule
Endoscope for the physicians to examine and assess the conditions of theirgastrointestinal tract by the image
captured by the capsule endoscope. Thisprocess does not only help to detect the severity ofthe existing
gastrointestinaldisease but also determine its effective to the presence of implanted cardiacdevices.

The researchers 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.

ADVANTAGES
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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.

DISADVANTAGES

Gastrointestinal obstructions prevent the free flow of capsule.

Patients with pacemakers, pregnant women facedifficulties.
It is very expensive and not reusable.
Capsule endoscopy does not replace standard diagnosticendoscopy.
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.

APPLICATIONS
Biggest impact in the medical industry.
Nano robots perform delicate surgeries.
Pill cam ESO can detect esophageal diseases, gastrointestinal reflex diseases, and barreffs esophagus.
Pill cam SB can detect Crohns disease, small bowel tumours, small bowel injury, celiac disease, ulcerative
colitis etc.

FUTURE SCOPE

It seems likely that capsule endoscopy will becomeincreasingly effective in diagnostic

gastrointestinalendoscopy. This willbe attractive to patients especially for cancer or varices detection
becausecapsule endoscopy is painless and is likely to have a higher take up rate compared to conventional
colonoscopy and gastroscopy. Double imagercapsules with increased frame rates have been used to
image theesophagus for Barretts 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.
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An increase in theframe 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 inquality, eroding the supremacy of flexible
endoscopy, and becomeembedded into screening programs. Therapeutic capsules will emerge withbrushing,
cytology, and fluidaspiration; biopsy and drug delivery capabilities.Electro cautery 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
electrostimulation 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 CMOSchip 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 are becomingblurred and hybrids are emerging. The main
pressure 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 capsuleendoscopes arebeing developed.

Although semi-conductor lasers that are small enough to swallow areavailable, the nature of lasers which
have typical inefficiencies of 100-1000percent makes the idea of a remote laser in a capsule capable of
stoppingbleeding or cutting out tumours 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 capacitors 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 itfree 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.
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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 TumoursRecognition 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.

CONCLUSION

Wireless capsule endoscopy represents a significant technical breakthroughfor the investigation of the
smallbowel, especially in light of the shortcomings of otheravailable techniques to image this region.
Capsuleendoscopy 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
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hadnon-diagnostic traditional testing and whom the distal small bowel (beyond reach of apush electroscope)
needs to be visualized.

The ability of the capsule to detect smalllesions that could cause recurrent bleeding (e.g.tumours, ulcers)
seems ideally suited forthis particular role. Although a wide variety of indications for capsuleendoscopy
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 findingsencounteredare the source of patients problem. Still, in the
proper context, capsuleendoscopy can provide valuableinformation and assist in the management of
patientswith difficult-to-diagnose small bowel disease.

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