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The aim of technology is to make products in a large scale for cheaper prices andincreased quality. The current technologies have attained a part of it, but themanufacturing technology is at macro level. The future lies in manufacturing productright from the molecular level. Research in this direction started way back in eighties. At that time manufacturing at molecular and atomic level was laughed about.But due toadvent of nanotechnology we have realized it to a certain level. One such productmanufactured is PILL CAMERA, which is used for the treatment of cancer, ulcer andanemia. It has made revolution in the field of medicine. At that time manufacturing atmolecular and atomic level was laughed .But due to advent of nanotechnology wehave realized it to a certain level. One such product manufactured is PILL CAMERA,which is used for the treatment of cancer, ulcer and anemia. It has made revolution inthe field of medicine.This tiny capsule can pass through our body, without causing any harm.
It takes picturesof our intestine and transmits the same to the receiver of the Computer analysis of ourdigestive system. This process can help in tracking any kind of disease related todigestive system. Also we have discussed the drawbacks of PILL CAMERA and howthese drawbacks can be overcome using Grain sized motor and bi-directional wirelesstelemetry capsule .Besides this we have reviewed the process of manufacturing productsSome other important applications are also discussed along with their potential impactson various fields. We have made great progress in manufacturing products. Lookingback from where we stand now, we started from flint knives and stone tools andreached the stage where we make such tools with more precision than ever.If you have ever had to endure medical testing like a lower GI to give the doctor an ideaof what is going on in your intestines, you know that it is a truly terrible experience.Now, let’s all cheer as such uncomfortable testing may never be needed again.
We have made great progress in manufacturing products. Looking back from where westandnow, we started from flint knives and stone tools and reached the stage where wemake such tools with more precision than ever. The leap in technology is great but it isnotgoing to stop here. With our present technology we manufacture products by casting,milling, grinding, chipping and the likes. With these technologies we have made morethings at a lower cost and greater precision than ever before. In the manufacture of theseproducts we have been arranging atoms in great thundering statistical herds. All of usknow manufactured products are made from atoms. The properties of those productsdepend on how those atoms are arranged. If we rearrange atoms in dirt, water and air weget grass. The next step in manufacturing technology is to manufacture products atmolecular level. The technology used to achieve manufacturing at molecular level is“NANOTECHNOLOGY”. Nanotechnology is the creation of useful materials, devicesand system through manipulation of such miniscule matter (nanometer).Nanotechnologydeals with objects measured in nanometers.
Nanometer can be visualized as billionth ofa meter or millionth of a millimeter or it is 1/80000 width of human hair.Thesetechnologies we have made more things at a lower cost and greater precision thanbefore.Trillions of assemblers will be needed to develop products in a viable time frame.Inorder to create enough assemblers to build consumer goods, some machine’s calledexplicators will be developed using self-replication process, will be programmed to buildmore assemblers. Self-replication is a process in which devices whose diameters are ofatomic scales, on the order of nanometers, create copies of themselves. For of self-replication to take place in a constructive manner, three conditions must be met. Once swallowed, an electric current flowing through the UW endoscope causes the fiberto bounce back and forth so that its lone electronic eye sees the whole scene.
1.2 IMAGE PROCESSING:
The image processing then combines all this information to create a two-dimensionalcolorpicture. In the tested model the fiber swings 5,000 times per second, creating 15 color picture per second. “The procedure is so easy I could imagine it being done in a shopping mall,”Seibel said.A wireless scope manufactured by a different group, originally designed topass through thebody and detect intestinal cancer, is now being marketed for esophagealcancer screening. The competing technology comes in a pill about the width of an adultfingernail and twice as long. It consists of just a single optical fiber for illumination and six fibers for collecting light, all encased in a pill. Seibel acted as the human volunteer in the first test of the UWdevice. He reports that it felt like swallowing a regular pill, and the tether, which is 1.4mm wide, did not bother him. It is disposable and expelled normally and effortlesslywith the next bowel movement. The scanning endoscope developed at the UW isfundamentally different.
After the exam, the patient returns to the doctor’s office and the recording device isRemoved. The stored images are transferred to a computer PC workstation where theyare transformed into a digital movie which the doctor can later examine on the computermonitor. Patients are not required to retrieve and return the video capsule to thephysician. At the same time the fiber spins and its tip projects red, green and blue laserlight. The image processing then combines all this information to create a twodimensional color picture.In the tested model the fiber swings 5,000 times per second, creating 15 color picturesper second. “The procedure is so easy I could imagine it being done in a shopping mall,”Seibel said.A wireless scope manufactured by a different group, originally designed topass through the body and detect intestinal cancer, is now being marketed for esophagealcancer. It consists of just a single optical fiber for illumination and six fibers for collecting light,all encased in a pill. Seibel acted as the human volunteer in the first test of the UWdevice. He reports that it felt like swallowing a regular pill, and the tether, which is 1.4mm wide, did not bother him. It is disposable and expelled normally and effortlesslywith the next bowel movement.
2.1 NEED FORSTUDY:
In the manufacture of these products we have been arranging atoms in greatthundering statistical herds. All of us know manufactured products are made fromatoms. The properties of thoseproducts depend on how those atoms are arranged. If werearrange atoms in dirt, water and air we get grass. The next step in manufacturingtechnology is to manufacture products at molecular level.The technology used toachieve It takes pictures of our intestine and transmits the same to the receiver of theComputer analysis of our digestive system. This process can help in tracking any kind ofdisease related to digestive system. Also we have discussed the drawbacks of PILL CAMERA and how these drawbacks can be overcome using Grain sized motor and bi-directional wireless telemetry capsule.
2.2 HISTORICAL OVERVIEW:
Fig 2.2.1 view of capsule
Manipulation of atoms is first talked about by noble laureate Dr. RichardFeynman long ago in 1959 at the annual meeting of the American Physical Societyat the California institute oftechnology -Caltech and at that time it was laughed about.
2.2.1 ENGINES OF CREATION:
Drexel in the year 1981 through his article “The Engines of Creation”. In 1990, IBMresearchers showed that it is possible to manipulate single atoms. They positioned 35Xenon atoms on the surface of nickel crystal, using an atomic force microscopyinstrument.
Fig 2.2.1 view of capsuleFig 2.2.1 view of capsule
2.3 MANUFACTURING PRODUCTS USING NANOTECHNOLOGY:
There are three steps to achieving nanotechnology-produced goods: Atoms are hisbuilding blocks for all matter in our Universe. All the products that are manufactured are made from atoms.The properties of those products depend of how those atoms are arranged. for e.g. If werearrange the atoms in coal we get diamonds, if we rearrange the atoms in sand and pinch of impurities we get computer chips.Scientists must be able to manipulateindividual atoms. This means that they will have to develop a technique to grab singleatoms and movethem to desired positions. In 1990 ,IBM researchers showed this bypositioning 35 xenon atoms on the surface of a nickelcrystal, using an atomic force microscopy instrument. These positioned atoms spelledout the letters “IBM.”.
· The next step will be to develop nanoscopic machines, called assemblers. Beprogrammed to manipulate atoms and molecules at will. It would take thousands ofyears for a single assembler to produce any kind of material one atom at a time. Trillionsof assemblers will be needed to develop products in a viable time frame.In order tocreate enough assemblers to build consumer goods, some Nanomachines calledexplicators will be developed using self-replication process, will be programmed to buildmore assemblers. Self-replication is a process in which devices whose diameters are ofatomic scales, on the order of nanometers, create copies of themselves. For of self-replication to take place in a constructive manner, three conditions must be met .
The 1st requirement is that each unit be a specialized machine called Nanorobot,one of whose functions is to construct atleast one copy of itself during its operationallife apart from performing its intended task. An eg: of self-replicating Nano robot is artificial antibody. In addition to reproducing itself, it seeks and destroys disease causingorganism.
The 2nd requirement is existence of all energy and ingredients necessary to buildcomplete copies of Nano robot in question. Ideally the quantities of each ingredientshould be such that they are consumed in the correct proportion.if the process isintended to be finite , then when desired number of Nano robots has been constructed ,there should be no unused quantities of any ingredient remaining.
2.3.3 REPLICATION PROCESS:
The 3rd requirement is that the environment be controlled so that the Replicationprocess can proceed efficiently and without malfunctions. Excessive turbulence,temperature extremes, intense radiation, or other adverse circumstances might preventthe proper functioning of the Nano robot and cause the process to fail or falter. Once Nano robots are made in sufficient numbers, the process of most of the Nano robots ischanged from self-replication to mass manufacturing of products. The Nano robots areconnected and controlled by super computer which has the design details of the productto be manufactured. These Nano robots now work in tandem and start placing eachmolecules of product to be manufactured in the required position. Theprocess of most ofthe Nano robots is changed from self-replication to mass manufacturing of products.
2.4 POTENTIAL EFFECTS OF NANOTECHNOLOGY:
As televisions, airplanes, computers revolutionized the world in the last century. Scientists claim that nanotechnology will have an even more profound effect on the nextcentury. Nanotechnology is likely to change the way almost everything, includingmedicine, computers and cars, are designed and constructed. The resolution is betterthan 100 microns, or more than 500 lines per inch. Although conventional endoscopesproduce images at higher resolution, the tethered-capsule endoscope is designedspecifically for low-cost screening.Using the scanning device is cheap because it’s sosmall it doesn’t require anesthesia and sedation, which increase the cost of the traditionalprocedure. The capsule must be expelled before you can have an MRI (Magnetic ResonanceImaging) study. This can easily be checked by an x-ray if you’re not sure.In August, a year after Given Imaging received U.S. Food and Drug Administrationapproval to begin clinical trials in the United States, the FDA granted Given Imagingpermission to begin marketing the capsule. In FDA testing, the Given Imaging DiagnosticSystem detected physical abnormalities more successfully than push andsurgical techniques.
“In my study, the M2A capsule was able to identify pathologies in the small intestine thatwere not identified by standard methods,” said Blair S. Lewis, associate clinical professorof medicine at Mount Sinai School of Medicine in New York and a member of GivenImaging’s Medical Advisory Board, who headed the clinical tests..As a result of the FDA approval, the company, which has already released its product in ? Europe, Australia and Israel, now has access to the U.S. market. The swallow able pills,which will cost about $300 each, can be used for diagnostic tests and treatments forgastrointestinal diseases such as cancer, Cohn’s disease and irritable bowel syndrome..Given Imaging raised $60 million when it issued its initial public offering on theNASDAQ market at the beginning of October.
It floated 5,000,000 ordinary shares at anopening price of $12 in the exchange’s first public offering in seven weeks. LehmanBrothers served as global book-running manager for the offering and Credit Suisse FirstBoston was joint lead manager with Robertson Stephens acting as co-manager. The company so far has no revenue or profits, and as of June 30 had accumulated lossesof $19.5 million. When its innovative product started receiving recognition, peoplewonderedif, like so many hot technologies coming out of Israel, it would end up on theblock for some high-priced acquisition. The trend in Israel is to develop something and wait for someone to buy it,” said Arcady Glukhovsky, Given’s vice president of research and development. “Not in our case. Wewant to develop, manufacture and sell the M2A. We are not a one-shot company but amultiple shot.
2.4.1 Scope test:
In this situation, one of the first diagnostic studies ordered are special “scope” tests of thedigestive tract. Gastroscopyis used to check the first 4 feet of the upper digestive tract(colored pink above) and colonoscopyto evaluate the colon and rectum (colored brownabove). As you can see, most of the 20 feet of small intestine (colored green above) liesbeyond the reach of these two studies. Fortunately, most bleeding problems seem tooccur in the area than can be “scoped” and the source of bleeding is usually found andtreated. Common problems would include hiatal hernia, gastritis, ulcers, polyps, and,sometimes, stomach or colon cancer.A patient had severe iron deficiency anemia and scope tests of the stomach and colon arenormal? It is not uncommon for doctors to evaluate a patient with unexplained anemiaand neither gastroscopy nor colonoscopy scope examinations reveal the diagnosis.
By aprocess ofelimination, it then becomes likely that the source of bleeding lies somewhere in between below the reach of the gastroscopy and above the reach of the colonoscopyin the 20 feet of small intestine. How then is this area examined?Well, not very well. Gastroscopy and colonoscopy cannot reach this far. Contrary topopular belief, special imaging studies like CT scan or MRI are not useful in thiscircumstance. X-rays of the small intestine can be performed after drinking a chalkysolution of barium. Called a small bowel series, this test has been available for manyyears, but has a limited accuracy. X-rays are still only shadow pictures and does not viewthe object itself like a camera.
2.4.2 Why not use large endoscope?
Since scope tests were first invented, doctors have wanted to be able to visualize theentire gut – all 30 feet. But, a direct view of the small intestine has remained elusive.Attempts have been made to develop longer endoscopic instruments. This techniquecalled push enteroscopy has had only limited success. The longer instruments are difficultto control and manipulate and are hard to maintain. The accuracy of push enteroscopy isstill limited since even in the best of hands the entire small intestine is not visualized.In 1981, an Israeli physician, Dr. Gavriel Iddan, began development of a video camerathat would fit inside a pill. Technology was not ready and the idea was put on hold. Ittook 20 years for technology to catch up with Dr. Iddan. In 2001, the FDA approvedthe Given Diagnostic Imaging System. This may sound like science fiction, but this 11 x26 mm capsule weighs only 4 Gms (about 1/7th of an ounce) and contains a color video Camera and wireless radiofrequency transmitter, 4 LED lights, and enough battery powerto take 50,000 color images during an 8-hour journey through the digestive tract. Aboutthe size of a large vitamin, the capsule is made of specially sealed biocompatible materialthat is resistant to stomach acid and powerful digestive enzymes. Another name for thisnew technique is Wireless Capsule Endoscopy.
2.4.3 Peristaltic activity:
Patients report that the video capsule is easier to swallow than an aspirin. It seems thatthe most important factor in ease of swallowing is the lack of friction. The capsule is verysmooth, enabling it to slip down the throat with just a sip of water. After the Given M2Acapsule is swallowed, it moves through the digestive track naturally with the aid of theperistaltic activity of the intestinal muscles. The patient comfortably continues withregular activities throughout the examination without feeling sensations resulting fromthe capsule’s passage. During the 8 hour exam, the images are continuously transmitted tospecial antenna pads placed on the body and captured on a recording device about thesize of a portable Walkman which is worn about the patient’s waist. After the exam, thepatient returns to the doctor’s office and the recording device is removed. The storedimages are transferred to a computer PC workstation where they are transformed into adigital movie which the doctor can later examine on the computer monitor. Patients arenot required to retrieve and return the video capsule to the physician.
It is disposable andexpelled normally and effortlessly with the next bowel movement. If you’ve ever been plagued by temporary amnesia and forgotten whether or not you took your medication, take heart: U.S. researchers have engineered a pill that will jog your memory. The pill, designed by engineers at the University of Florida, is embedded with a tiny,non-toxic microchip and antenna that can be digested. When it’s ingested, it emits a signalthat is picked up by a small electronic device carried or worn by the patient. That device,in turn, signals a cell phone or laptop, letting a patient or medical professional know thepill has been taken.”It is a way to monitor whether your patient is taking their medication in a timelymanner,” said Rizwan Bashirullah, an assistant professor in electrical and computerengineering at the University of Florida.The pill is intended to improve patient compliance with prescriptions. Many peopleforget to take their medications regularly, which can exacerbate their medical problems,result in unexpected hospitalizations and undermine clinical trial results. The pill has yet to be tested on humans. To date, it has been tried out on cadavers and Models of humans. Scientists have also conducted experiments on the pill to see how Effectively it dissolves in stomach acid.
2.4.4 Gastrointestinal tract:
Research shows that the pill leaves behind a trace of silver when it passes through the body. Silver coats the pill and also makes up the antenna; however, the amount leftbehind in the body is less than is absorbed by the average person drinking tap water,according to researchers.Scientific advances in areas such as nanotechnology and genetherapy promise to revolutionize the way we discover and develop drugs, as well as howwe diagnose and treat disease. The ‘camera in a pill’ is one recent development that isgenerating considerable interest. Until recently, only the proximal (esophagus, stomachand duodenum) and the distal (colon) portions of the gastrointestinal tract were easilyvisible using available technology. The twenty feet or so of small intestine in betweenthese two portions was essentially unreachable. This hurdle might soon be overcome.
On the left hand side, there is a column for Antenna type. Results can vary, but from myexperience I was able to pull in stations coded in yellow and red with a veryinexpensive $16 antenna from Radio Shack. If you are more than 30 miles from moststations, you will probably want to get a larger grid type antenna and place it in your roofor attic. A computer workstation using given’simaging propriety software processes thedata and produces a video of the images together with additional relevant informationfrom the digestive tract. Doctors can then view, edit, and save both individual images andthe streaming video. The images produced are of an especially high quality. It looks likethe given ingestible video capsule is a win-win situation. With clinical trial resultsshowing the M2A capsule more effective than enteroscopy and this procedure being,understandably, more popular, patients with suspected small intestine disorders will bepopping the M2A pill with a smile.The patient comfortably continues with regular activities throughout the examination without feeling sensations resulting from thecapsule’s passage. During the 8 hour exam, the images are continuously transmitted tospecial antenna pads placed on the body and captured on a recording device about thesize of a portable Walkman which is worn about the patient’s waist.
Image sensorelements with in-pixel amplifiers were described by Noble in 1968, by Chamberlain in1969, and by Weimer . At a time when passive-pixel sensors – that is, pixel sensorswithout their own amplifiers – were beinginvestigated as a solid-state alternativeto vacuum-tube imaging devices. The MOS passive-pixel sensor used just a simpleswitch in the pixel to read out the photodiode integrated charge. Pixels were arrayed in atwo-dimensional structure, with access enable wire shared by pixels in the same row, andoutput wire shared by column. At the end of each column was an amplifier. Passive-pixelsensors suffered from many limitations, such as high noise, slow readout, and lack of scalability. The addition of an amplifier to each pixel addressed these problems, andresulted in the creation of the active-pixel sensor. Noble in 1968 and Chamberlain in1969 created sensor arrays with active MOS readout amplifiers per pixel, in essentiallythe modern three-transistor configuration. The CCD was invented in 1970 at Bell Labs. CHAPTER3: PILLCAMERAAPPLICATION
3.1 PILL –SIZED CAMERA:
Imagine a vitamin pill-sized camera that could travel through your body takingpictures, helping diagnose a problem which doctor previously would have found onlythrough surgery. No longer is such technology the stuff of science fiction films.
3.2 CONVENTIONAL METHOD:
Currently, standard method of detecting abnormalities in the intestines is throughendoscopic examination in which doctors advance a scope down into the small intestinevia the mouth. However, these scopes are unable to reach through all of the 20-foot-longsmall intestine, and thus provide only a partial view of that part of the bowel. With thehelp of pill camera not only can diagnoses be made for certain conditions routinelymissed by other tests, but disorders can be detected at an earlier stage, enablingtreatment before complications develop. however, the amount left behind in the body isless than is absorbed by the average person drinking tap water, according toresearchers.Scientific advances in areas such as nanotechnology and gene therapy promise to revolutionize the way we discover and develop drugs, as well as how wediagnose and treat disease. The ‘camera in a pill’ is one recent development that isgenerating considerable interest.
3.2.1 Diagnostic imaging system:
The device, called the given Diagnostic Imaging System, comes in capsule form andcontains a camera, lights, transmitter and batteries. The capsule has a clear end thatallows the camera to view the lining of the small intestine. Capsule endoscopy consistsof a disposable video camera encapsulated into a pill like form that is swallowed withwater. The wireless camera takes thousands of high-quality digital images within thebody as it passes through the entire length of the small intestine. The latest pill camera issized at 26*11 mm and is capable of transmitting 50,000 color images during itstraversal through the digestive system of patient.
Video chip consists of the IC CMOS image sensor which is used to take pictures ofintestine .The lamp is used for proper illumination in the intestine for taking photos. Micro actuator acts as memory to store the software code that is the pH, temp andpressure instructions. The antenna is used to transmit the images to the receiver. For the detection of reliable and correct. The tiny cameras are swallowed by patients who want less invasive examinations oftheir digestive track. Until now U.S. DRAM maker Micron Technology Inc. had beenthe biggest promoter of the camera-in-a-pill concept, with companies such as Israel’sGiven Imaging charging as much as $450 for its PillCam. MagnaChip is highlighting thelow-light sensitivity of the camera, but provided no specification detail. Usually, anLED flash is used to illuminate the area around the capsule.
3.2.2 Video chip:
Video chip consists of the IC CMOS image sensor which is used to take pictures ofintestine .The lamp is used for proper illumination in the intestine for taking photos.Micro actuator acts as memory to store the software code that is the instructions. Theantenna is used to transmit the images to the receiver. For the detection of reliable andcorrect information, capsule should be able to designed to transmit several biomedicalsignals, such as pH, temp and pressure.
3.3 COMPONENTS OF CAPSULE CAMERA
3.3.1. Optical Dome:
* This shape results in easy orientation of the capsule axis along the central axis ofsmall intestine and so helps propel the capsule forward easily. * The Optical Dome contains the Light Receiving Window.
3.3.2 Lens Holder:
* The Lens Holder is that part of the capsule which accommodates the lens. * The lens is tightly fixed to the holder so that it doesn’t get anytime
* The Lens is an integral component of the capsule.
* It is arranged behind the Light Receiving Window.
3.3.4 .Illuminating LED’s:
* Around the Lens & CMOS Image Sensor, four LED’s (Light Emitting Diodes)are present.These plural lighting devices are arranged in donut shape.
3.3.5.CMOS Image Sensor:
· CMOS (Complementary Metal Oxide Semiconductor) Image Sensor is the most important part of the capsule. It is highly sensitive and produces very high qualityimages. · It has 140º field of view and can detect objects as small as possible
Battery used in the capsule is button shaped and are two in number as shown. batteries are arranged together just behind the CMOS Image Sensor. Silver Oxide primary batteries are used (Zinc/Alkaline Electrolyte/Silver Oxide). Such a
battery has a even discharge voltage, disposable and doesn’t cause harm to the body.
3.3.7 ASIC Transmitter:
The ASIC (Application Specific Integrated Circuit) Transmitter is arranged behind the Batteries as shown. Two Transmitting Electrodes are connected to the outlines of the ASIC Transmitter. These electrodes are electrically isolated from each other.
As shown, the Antennae is arranged at the end of the capsule. It is enclosed in a dome shaped hamper. Once swallowed, the missile pill travels through the small intestine propelled by the contractions of the gastrointestinal tract. The squeezing motion acts as a squeegee, wiping the lens clean for clear pictures. Along the way it films digital images and transmits them to a receiver worn by the patient. The recorder also tracks the capsule’s location within the body. The capsule itself is larger than an aspirin, about 11 mm x 26 mm in size and about 4grams in weight. Called the M2A, it is not a medication, but rather a single-use videocolor-imaging capsule. Besides the miniature color video camera, the capsule contains alight source, batteries, a transmitter, and an antenna. Once swallowed this capsule/cameratravels easily through the digestive tract and is naturally excreted. It is never absorbed inthe body. The patient wears a wireless Given Data Recorder on a belt around his or her.Standard CMOS APS pixel today consists of a photodetector (a pinned photodiode), afloating diffusion, a transfer gate, reset gate,selection gate and source-follower readouttransistor the so-called 4T cell. The pinned photodiode was originally used in interline.
CHAPTER-4 ENDOSCOPY PROCEDURE
4.1 SWALLOWED CAPSULE:
Capsule is swallowed by the patient like a conventional pill.It takes images as it ispropelled forward by peristalsis.A wireless recorder, worn on a belt, receivesimage transmitted by the pill.A computer workstation processes the data and produces a continuous still images. Movement Of capsule Through The Digestive System Produces two images per second, approximately 2,600 high quality images.
Fig 4.1 movement of capsule
4.2 CIRCUIT BLOCK DIAGRAM OF TRANSMITTER AND RECEIVER:
In the first block diagram, one SMD type transistor amplifies the video signal.
Fig4.2 : Received circuit inside capsule
For efficient modulation using a 3 biasing resistor and1 inductor.In the bottomBlock,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. ForReceiver block diagram a commercialized ASK/OOK (ON/OFF Keyed) superheterodyne 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 singlefrequency, is based on an external reference crystal or clock. The decoder IC receiver 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 imagesensor is very important.
4.3 EXTERNAL CONTROL UNIT:
A schematic of the external control circuit unit is illustrated below, where theON/OFF operation of the switch in the front of the unit is encoded into 4 channelsControl signals. These digital signals are then transferred to a synthesizer andmodulated into an RF signal using OOK transmitter with a carrier frequency of 433MHz. To verify the operation of the external control unit and telemetry capsule, CH1 was used to control ON/OFF of CMOS image sensor and CHs 2-4 to control led lighting. The foursignals in front of the control panel were able to make 16different control signals(4 bit, 2^4 = 16).The bi-directional operation of telemetry module is verified bytransmitting video signal from CMOS image sensor image data was then displayed .
Fig 4.3 external control unit The proposed telemetry capsule can simultaneously transmit a video signal and receive acontrol determining the behavior ofthe capsule. As a result, the total power consumption of the telemetry capsule can be reduced by turning off the camera powerduring dead time and separately controlling the LEDs for proper illumination in theintestine. Accordingly, proposed telemetry module for bidirectional and multi-channelcommunication has the potential applications.
This miniature motor, when attached to the pill camera gives it a propelling action insidethe body, which makes it easy for the pill to find its way through the digestive system.Also the grain-sized motor has an application of its own too. It can be employed torupture and break painful kidney stones inside the body. The other two drawbacks canbe overcome using a bidirectional wireless telemetry camera. The current paper presents the design of a bidirectional wireless telemetry camera, 11mm in diameter, which can transmit video imagesfrom inside thehuman body andreceive the control signals from an external control unit. It includes transmitting antennaand receiving antenna, a demodulator, a decoder, four LED’s, a CMOS image sensor,along with their driving circuits. The receiver demodulates the received signal that isradiated from the external control unit. Next, the decoder receives this serial stream andinterprets the five of the binary digits as address code. The remaining signal isinterpreted as binary data.
As a result proposed telemetry model can demodulate theexternal signals to control the behavior of the camera and 4 LED’s during thetransmission of video image. The CMOS image sensor is a single chip 1/3 inch formatvideo camera, OV7910, this can provide high level functionality with in small print Footage. The image sensor supports an NTSC-type analog color video and can directlyinterface with VCR TV monitor. Also image sensor has very low power consumption asit requires only 5 volt dc supply. The capsule is capable of transmitting up to eight hours of video before being naturally expelled. No hospitalization is required.
The film is downloaded to a computerworkstation and processed using a software program called RAPID (reporting and processing of images and data), also developed by Given Imaging. It condenses the filminto a 30-minute video. The software also provides an image of the pill as it passesthrough the small intestine so the physician can match the image to the location of thecapsule. Future capsules to be developed using its basic platform. It is not inconceivablethat this same technology can be used to pump medication locally and directly. The power system need only make up for losses caused by inefficiencies in this Process. These losses could presumably be made small, thus allowing our artificial red blood cells to operate with little energy consumption conditions of temperatureandpressure.
RESOLUTION OF LENS
Starting at the top level that closest to the transparent portion of the capsule?is the lens/illumination layer. An annular PCB surrounds the single plastic molded lens,supporting the LEDs and their associated current-limit resistors. Below this lens level isthe imager layer, home to a 256-by-256pixel CMOS color image sensor. Marking on thechip indicates it is a custom device from Photo bit, a company acquired by MicronImaging in 2001. Combined with the plastic lens, the camera offers a claimed 140?viewing angle and 0.1mm feature resolution within the GI tract being imaged.Behind the imager layer is a pair of Eveready No. 399 silver oxide watch batteries,wired in series to create the sole 3V supply for the PillCam. The two button cellsprovide 3V at 55mA-hr, or 165mW-hr of total available energy. Since the device runsfor up to eight hours, a time-averaged power draw of approximately 20mW is implied.
5.1.1 Switch layer:
The switch layer located behind the batteries provides the means to preserve precious battery energy before the PillCam is ingested by the patient. A reedswitchmounted on the switch layer circuit board is held open by a magnet in the PillCam’s shipping holster,interrupting the battery connection. When the package is opened and the capsule isremoved from its holster for swallowing, the reed switch closes and power to thePillCam begins to flow.
5.1.2 Transmitter layer:
The final strata of the PillCam is the transmitter layer is home to the only other IC, a custom ASIC developed by Given and of unmarked foundry origin. The chip mustprovide system control along with radio transmission. A 27MHz crystal located on thereverse side of the transmitter layer is consistent with both functions. The 3.2-by-3.5mmflip-chip ASIC contains a small block of logic, a very small memory array and a varietyof mixed-signal circuits. Since the output from the image sensor is presumed to bepreconverted to digital form, the radio and LED drive circuits are the likely functionsincluded in the analog portion of the ASIC. The switch layer located behind the batteries provides the means to preserve preciousbattery energy before the PillCam is ingested by the patient. A red switchmounted onthe switch layer circuit board is held open by a magnet in the PillCam’s shipping holster,interrupting the battery connection. When the package is opened and the capsule isremoved from its holster for swallowing, the reed switch closes and power to the Pill Cam begins to flow.
5.2 RFEMISSION GUIDELINES:
Per FCC filings, the transmitter operates at either 432.13MHz or 433.94MHz, with minimum-shift-keying modulation. MSK has the general benefits of providing constantenvelopemodulation, transmitter simplicity and good spectral efficiency. A simple aircoil is the radiating antenna element, tucked into the rounded capsule end opposite thecamera. Transmit power is held low to manage power consumption, as the receiverantennas are in close proximity with the waist-worn monitor.Nevertheless, FCC filings indicate the PillCam stays within emitted RF guidelinesonly when the pill is inside the body. The minute or so that it takes the pill to go fromactivated/depackaged form to ingestion is apparently given a waiver as part of thePillCam’s regulatory approval.Image capture, switch and transmitter layers are all fabricated on a single rigid-flexPCB. Delayering theboard among the three islands of functionality creates flex circuitsto interconnect those regions. The assembly is folded up around the batteries, and a pairof gold-plated coil springs distributes power from the imager layer to thelens/illumination layer through holes in the lens barrel.The 8hr PillCam lifetime provides up to 57,000 images at a 2fps rate, with the LEDsflashing only during image capture. The combination of lowpower CMOS imagers.
5.2.1 Pill camera not so hard for patient to swallow:
As the miniaturization of cameras continues apace, more and more innovative products are thrown up, such as this pill camera. Basically a lens on a piece of string (isn’t thatsomething that Hell’s Angelslike to do involving string, bacon and laden, and goes bythe name of Wolf bagging , the technology costs just $300—far less than a $5,000 endoscope. Developed at the University of Washington, the only person who has tried itout so far is research associate professor Eric Siebel. “Never in your life have you ever swallowed anything and it’s still sticking out of yourmouth, but once you do it, it’s easy,” he said of the device. It consists of seven fiber optic cables in a capsule about the size of a painkiller, with a 1.4-mm tether that allows thedoctor to move the camera around and pull it back up once the exploration is finished.Testing starts at theSeattle Veterans’ Administration hospital next year. Once given thethumbs-up, the reusable gadget (disinfect, rinse, repeat, I guess) is expected to be used inthe fight against esophagealcancer. Normal endoscopes are considerably bigger and canonly be swallowed after the patient has been sedated (and liberally greased up,probably).
5.2.2 Gastro esophageal reflux disease:
(GERD), is a backflow of acid-containing fluid from the stomach into the esophagus.If it persists, it can develop into a more serious condition known as Barrett’s esophagus.Barrett’s esophagus is a condition in which cells of the lining of the esophagus becomepre-malignant and can lead to a potentially fatal form of cancer known as esophageal.
5.2.3 Pico Endo:
Pico Endo is about to produce a functional prototype. An even smaller camera sensorthan the current 2.55 mm is under development. The processing software exists. Thedevelopers believe that by using a combination of white, UV, and NIR LEDs in the lensholder, that it may be possible to conduct an optical biopsy in situ instead of (or inaddition to) a physical biopsy. A search for suitably sized UV and NIR LEDs is underway. Besides the miniature color video camera, the capsule contains a light source, batteries ,a transmitter, and an antenna. Once swallowed this capsule/camera travels easilythrough the digestive tract and is naturally excreted. It is never absorbed in the body.The patient wears a wireless Given Data Recorder on a belt around his or her waist,much like a portable “Walkman. These signals can also track the physical course of thecapsule’s progress. During this procedure, users feel no pain or discomfort and are ableto continue their regular activities as the camera works inside the body and the sensors belt work outside. The entire process takes about eight hours. CHAPTER-6
6.1 ENDOSCOPY PROCEDURE:
Pill endoscopy is a new spin off of regular endoscopy, where and endoscope it insertedinto the body to observe the walls of various organs andracts. Now there are pill cameras you can swallow that will take pictures of your organs and tracts,without thediscomfort of having a tube inserted intoyour body.A major issue with currentendoscopies is there is about 20 feet of the digestivetrackthatis out reach of currentmethods. In order to overcome this an Israeli physician, Dr. Divan, in 1981 began thedevelopment of a camera that wouldfitinto a pill. Unfortunately, technology wasn’tready for this. It took until 2001 for it to be possible. In 2001 the FDA approved theGiven Diagnostic Imaging System. The system was an 11x26mm 4 gram capsule, whichcontained a color video camera, a radio transmitter, 4 LEDs and a battery. The camera could take up to 50,000 pictures in the 8-hour trip through the digestive track. The pill is moved around the body with peristaltic contractions. Throughout the procedure thepatient can perform daily tasks without discomfort.Throughout the 8-hours, the imagesare transmitted to a device about the size of a Walkman.
The images are received throughspecial antenna pads placed on the body. From this the images can be downloaded to thecomputer for examination. One company has put a new twist on the pill camera. Otherpill cameras have their lenses and sensor in the moving direction, requiring a wide anglelens. The problem with this is the peripheral regions of the picture become distorted. SoRF Systems developedSajama. It is designed to take picture of the whole surface of thedigestive tract.This is possible by its spinning camera, which takes pictures in a full 360degrees. Another advancement withSajama is it is not battery powered. Instead itgets its power through induction charging. A vest worn by the patient transmits power,due to a coil in the vest. Once the pill reaches the intestines it begins to take 30 picturesper second. The walls of the intestine are lit by florescent and white LEDs. In order tospin the camera 360 degrees, an electromagnet reverses its polarity causing a permanentmagnet to rotate the inner capsule and the mage sensor 60 degrees every two seconds. Afull rotation takes 12 seconds, which it perfect to get a continuous picture of the internalwall of the intestine.
For it takes the capsule about 2 minutes to travel an inch within theintestine.A German company is developing a pill that can be moved up and down the esophagus using an external magnet. This would allow doctors to view a specific spotinthe esophagus. Overall pill endoscopy is becoming an efficient low cost way to view the internal walls of Organs and the digestive tract. Preparation for a pill camera studyrequires fasting for 10-12 hours beforehand to ensure an empty stomach. Followingcapsule ingestion, after a brief period of observation, patients are permitted to leave theendoscopy center, with instructions to return within seven hours, at which time the datarecorder will be removed. During the study, normal activity may be resumed. Light foodis generally permitted beginning four hours after the capsule is ingested. The capsule isdisposable and will usually pass naturally during a bowel movement within 8-24 hours.Patients with a history of abdominal surgery, cardiac pacemaker or difficulty inswallowing should notify the doctor in advance.
Complications are rare with pill camera studies,and generally occur when there is an obstruction in the intestinal tract. Notify thedoctorif inthe event of abdominal pain, chest pain, fever or vomiting. Do not undergoan MRI study until the capsule has passed. Results of the examination will be availableafter the captured images have been transferred to a computer and studied by yourdoctor.We have a solid track record and a strong reputation in precision molded parts, plasticaspheric lenses and high-precision opto-mechanical assemblies. In series ranging from10.000 per year to 20 million per year. Today, we are active in miniature camera-lensesfor mobile and automotive applications, printer sensor optics, optical storage and highpower LED lens solutions.We are developing our business growth through the creationand mass manufacturing of low cost, high volume optical solutions. The Key strategy isto make the most of our optics skill set, by combining it with world class toolbuildingand our over 75 years experience in plastics processing. All of these skills are applied ina one multi company team approach to ensure higher assembly performance and,consequently, improved customer system performance.
6.1.1 Collimating lenses:
Among the products manufactured in Triumph HT Optics are miniature cameralenses for CIF, VGA and several Megapixel formats. The international SMIA standard issupported with several designs, including the EMC shielding of the lens amount. The lenses are characterized by an optimal design for manufacturing, resulting in high yieldprocesses and therefore a reliable delivery to our customers. A 100% MTF test on stateof the art test equipment is part of our outgoing inspection.Other product lines are collimating lenses for laser applications and Fresnel lenses forsolar concentrators and illumination, mouse optics and rearview cameralenses for theautomotive industry. A true specialty is the objective lenses which are manufactured for pill cameras.
6.1.2 Smallest tethered endoscope:
The Pico Endo endoscope is the smallest tethered endoscope in the world (4.5mm x12.0mm). It is also inexpensive enough to use and discard. It provides a dramatic costreduction in equipment requirements from conventional endoscope or pill camerasystems, which can cost upwards of $30,000 USD. PicoEndo delivers more images at animproved quality, including images processed into 3D. The PicoEndo system isapplicable to medical tasks such as photographing the surface of the esophagus and toapplications in any other industry that needs to place a tiny electronic camera eye in alocation that is difficult to view, such as inspecting the interiors of assembled engines.
6.1.3 Treeing cable:
Because of its string (or tether), which also acts as an electronic connection and teeringcable, the body of the endoscope does not have to contain batteries, memory, orprocessing electronics as do the much larger camera pills. The size of the camera andlens system determines the size of the unit. PicoEndo currently uses a camera and lenssystem 2.55mm across, but a system about half that size is under development. The unitis small enough for even children to swallow easily without sedation. The attachedelectronic tether string allows the camera capsule to be withdrawn or steered after it hasentered as far as the operator needs. The tether connects Pico Endo to a special signal processing unit that in turn connects to a standard office PC. The disposable endoscopyhead, image processing unit, and software are estimated to cost $1,000 USD, asubstantial cost reduction from the less capable larger systems.
The system offers160,000 pixel resolution at 30 fps (about that of a conventional endoscope) in a camerahead that is far smaller and that requires no sedation; it offers a 140-degree field of viewthat allows it to “see around corners,’ which a conventional endoscope cannot do.In collaboration with engineers from Given Imaging, the Israelite Hospital in Hamburgand the Royal Imperial College in London, researchers from the Fraunhofer Institute forBiomedical Engineering have developed the first-ever control system for the camera pill.The camera pill can be swallowed by a patient. A doctor can move the camera pill by amagnetic remote control. The steerable camera pill consists of a camera, a transmitterthat sends the images to the receiver, a battery and several cold-light diodes whichbriefly flare up like a flashlight every time a picture is taken.
6.2 FROM ENTRANCE TO EXIT:
The camera-in-a-pill capsule, or pill-cam, measures 2.5cm by 1.1cm and contains aminuscule digital camera, a light source, and of course a battery to power it up.However, the real genius of the pill-cam lies in its tiny radio transmitter and antenna (also contained in the capsule!) which enables it to transmit data (pictures!) to a datarecorder that the patient wears strapped around the waist. From the moment it isswallowed it takes pictures at a rate of two shots every second, right up until the momentit is excreted. 6.2.1 Solving a mystery illness:
Tony Hula (name changed to respect privacy), a 19-year-old university student wasone of the first people in Australia to benefit from using pill-cam technology. Tony hadbeen suffering abdominal pain, anemia, and bleeding from the bowel for over eighteenmonths, and had undergone numerous intrusive tests in hospital. Yet none of these testshad been able to identify his mystery illness. 6.2.2 Intrusive tests:
Like other patients with these symptoms, Tony had undergone an endoscopy – anintrusive procedure in which doctors pass a tube down the throat and into the gut to try and see what might be wrong. Tony was also subjected to a colonoscopy, which does thesame thing but tries to take a look from the other direction! Neither of these tests couldidentify his problem.
6.3 SWALLOWING A PILL – LESS PAINFUL THAN SURGERY:
In the past, doctors have been diagnosing problems associated with the small intestine –such as cancer, ulcers and polyps – by using X-rays or exploratory surgery. Thesetechniques are both unpleasant and painful, as is surgery. The beauty of pill-camtechnology is that patients don’t need to go through any special bowel preparation or gounder anaesthetic. Patients can simply swallow the pill-cam in the morning and then goabout their normal daily life (even go shopping!) and then return the data recorder to thedoctor at the end of the day.
6.4. SOME AMAZING FACTS ABOUT THE CAM PILL:
The pill-cam ‘capsule’ is about the same size as a large multi-vitamin tablet, i.e.2.5cm x 1cm.Two digital images of the intestine lining are taken every secondtime taken for the pill cam’s entire journey through the body is approximately 7hours.Hospitals make use of a computer software programme to speed up viewing thevideo .Half of the pill-cam ‘capsule’ consists of batteries .The miniature lens takespictures from 2-3cm away.The tiny Perspex dome over the lens ensures that all imagestaken are in focus – even when it is touching the wall of the intestine.The procedurecosts about £1000, with the pill-cam itself costing about half that amount.The officialname of the so-called ‘pill-cam’ is the M2A™ Capsule Endoscopy, and it wasdeveloped by the Israeli company given Imaging Ltd.The tiniest endoscope yet takes 30 two-megapixel images per second and offloads them wirelessly. See how it works insidethe body in an animation Pop this pill, and eight hours later, doctors can examine a high resolution Video of your intestines for tumors and other problems, thanks to a newspinning camera that captures images in 360 degrees.
Developed by the Japanese RFSystem Lab, the Sayaka endoscope capsule enters clinical trials in the U.S. this month.A fundamentally new design has created a smaller endoscope that is more comfortablefor the patient and cheaper to use than current technology. Its first use on a human,scanning for early signs of esophageal cancer, will be reported in IEEE Transactions onBiomedical Engineering.”Our technology is completely different from what’s availablenow. This could be the foundation for the future of endoscopy,” said lead author EricSeibel, a University on research associate professor of mechanical engineering.In the past 30 years diagnoses of esophageal cancer have more than tripled. The esophagus is the section of digestive tract that moves food from the throat down to thestomach. Esophageal cancer often follows a condition called Barrett’s esophagus, anoticeable change in the esophageal lining.
Patients with Barrett’s esophagus can behealed, avoiding the deadly esophageal cancer. But because internal scans are expensivemost people don’t find out they have the condition until it’s progressed to cancer, and bythat stage the survival rate is less than 15 percent.”These are needless deaths,” Seibel said. “Any screen that detected whether you had a treatable condition before it had turned into cancer would save lives.”An endoscope is a flexible camera that travels into the body’s cavities to directlyinvestigate the digestive tract, colon or throat. Most of today’s endoscopes capture theimage using a traditional approach where each part of the camera captures a differentsection of the image. These tools are long, flexible cords about 9 mm wide, about thewidth of a human fingernail. Because the cord is so wide patients must be sedated duringthe scan.
6.4.1 Scanning endoscope:
The scanning endoscope developed at the UW is fundamentally different. It consists ofjust a single optical fiber for illumination and six fibers for collecting light, all encasedin a pill. Seibel acted as the human volunteer in the first test of the UW device. Hereports that it felt likeswallowing a regular pill, and the tether, which is 1.4 mm wide,did not bother him.Once swallowed, an electric current flowing through the UW endoscope causes the fiberto bounce back and forth so that its lone electronic eye sees the whole scene, one pixel ata time. At the same time the fiber spins and its tip projects red, green and blue laserlight. The image processing then combines all this information to create a two dimensional color picture. In the tested model the fiber swings 5,000 times per second, creating 15 color pictures per second.”The procedure is so easy I could imagine it being done in a shopping mall,” Seibel said.
A wireless scope manufactured by a different group, originally designed to pass throughthe body and detect intestinal cancer, is now being marketed for esophageal cancerscreening. The competing technology comes in a pill about the width of an adultfingernail and twice as long. By contrast, the UW’s scanning fiber endoscope’sdimensions are about half as big and the device fits inside a standard pill capsule. Thepill could be even smaller, Seibel said, but the researchers chose a size that would beeasy to handle and swallow. Another disadvantage of wireless capsules is they only allow a single fly-by view. “we have no control over the other pill once it’s swallowed. It just flutters down,” Seibel said. But since the UW scope is tethered, the doctor can move it up and down along the region of interest.
6.4.2 Missile optical camera:
Only a small percentage of people who get Barrett’s esophagus, about 5 percent to 10percent,develop Israeli military scientist Gabriel Iddan spent years working on missile technologyas the head of the electro-optical design section of the Rafael Armament DevelopmentAuthority at the Ministry of Defense. Iddan had worked on the seeker, or the “eye” of themissile, which captures the targets and guides it, and believed the same technology. While on sabbatical eight years ago in Boston, Iddan decided to design a tiny capsulecontaining a guided missile optical camera that could be swallowed, and would sendimages in real time as it traversed a patient’s intestines. But money for the project wasscarce. “I tried in vain to raise money,” he said. “People thought theidea was farfetched.They thought it was good for a movie but not for a business. Rafael told me to raisemoney by myself. Iddan pressed on, creating the M2A Swallow able Imaging Capsule, orthe missile pill.
6.4.3 Three-dimensional camera:
During the next four years, Iddan developed a three-dimensional camera capable ofa Iddan and his team worked on the capsule, numerous technological breakthroughsoccurred that made his concept more realistic. First, a new silicon, called CMOS, madeit possible for all of the components of the camera to be placed on a single chip -reducing both its size and powerconsumption. Advances in ASIC design allowed
theintegration of a tiny video transmitter with sufficient output, efficiency and bandwidth tofit inside the capsule. White light emitting diode illumination made it possible for the reflections. They went to work. Dov Avni, whom Iddan calls “the guru of video cameras” at Rafael,invented a camera the third of the size of a dime. The color video camera sits on a chipthat is 4 mmsquare and 1 mm wide. On another 3 mm chip sits a transmitter and anoptical sensor.
Altogether, the camera, transmitter, battery, a tiny floodlight and anantenna fit into a disposable pill that is 2.5 cm long and 1.5 cm wide. “It’s like swallowing a missile that doesn’t explode,” says Gavriel Meron, chief executiveofficer of Given Imaging, the company established three years ago to produce the pill.Meron, who volunteered to swallow the pill, said: “It was easier than swallowing anaspirincancer. So any screening method must have a low price to be cost-effective.”The next big challenge is to make this cheaply,” Seibel said. The researchers are Negotiating a contract to commercialize the technology. In the future they hope to not only take pictures, but also deliver treatments through the device, and to apply it to other Diseases.The research was funded by the National Cancer Institute and Pentax Corp. Earlyfunding was provided by the Whitaker Foundation and the Washington TechnologyCenter. Co-authors at the UW are Drs. Michael Kimmey and Jason Dominitz ingastroenterology at the UW Medical Center; Richard Johnston, C. David Melville andCameron Lee in mechanical engineering; Steve Seitz in computer science andengineering; and Robert Carroll, now in electrical engineering and computer science atthe University of California, Berkeley. 6.4.4 Smooth plastic capsule:
The smooth plastic capsule contains a miniature video camera and is equipped with alight source on one end, batteries, a radio transmitter and antenna. After it is swallowed,the PillCam SB capsule transmits approximately 50,000 images over the course of an 8-hour period (about 2 images per second) to a data recording device attached to a beltworn around the patient’s waist. The small bowel images are then downloaded into a Given Workstation computerwhere a physician can review the images in order to make a diagnosis. The patient gulpsdown the capsule, and the digestive process begins.
6.5 ESO CAPSULE ENDOSCOPY WORK:
During the 20-minutes procedure, the PillCam ESO video capsule transmits about 2,600 color images (14 images per second) to a data recording device attached to a beltworn around the patient’s waist. The images are then downloaded into a Given®Workstation computer where a physician can review the images in order to make adiagnosis.A patient fasts for 10 hours prior to the procedure, then swallows the PillCam SBvideo capsule with a glass of water. Images and data are acquired as the PillCam SBcapsule passes through the digestive system over an 8-hour period. This information istransmitted via a Sensor Array to the portable Data Recorder attached to a belt wornaround the patient’s waist.
6.5.1 Data recorder:
Once the patient swallows the capsule they can continue with their daily activities.After eight hours they return to the physician’s office with the Data Recorder so theimages can be downloaded, and a diagnosis can be made.A patient will fast for at least two hours before swallowing the PillCam ESO videocapsule. The capsule is easily swallowed with water while the patient lies on his or her back. The patient is then raised by 30 degree angles every two minutes until the patientis sitting upright. Similar to the PillCam SB procedure, the patient is wearing theData Recorder on a belt around the waist. A PillCam capsule endoscopy requires no preparation or sedation, and recovery is immediate. Both the Pill Cam SB and Pill Cam ESO disposable capsules make their way through the rest of the gastrointestinal tract and then are passed naturally and painlessly from the body, usually within 24 hours.Both PillCam SB and ESO video capsules are 11 mm x 26 mm and weigh less than 4grams. Capsule endoscopy with PillCam SB video capsule is widely covered in the U.S.
A list of payers can be obtained from our Reimbursement Center. A permanent CPTCode for capsule endoscopy with PillCam ESO was assigned by the American MedicalAssociation and the Center for Medicare and Medicaid Services effective January 1,2007.Endoscopy and radiological imaging are the traditional methods for small boweldiagnostics. In endoscopy, the physician inserts an endoscope, a flexible tube and opticalsystem approximately 3.5 feet long, through the patient’s mouth or anus. Typically, thisprocedure will include sedation and recovery time. During a radiological imagingexamination, the patient swallows a contrast medium (such as barium) or a dense liquidthat coats the internal organs to make them appear on x-ray film. The procedure produces a series of black and white x-ray images of the lumen, or cavity, of the smallintestine. 6.5.2 Lighted flexible tube:
A doctor uses an endoscope, a long, thin, lighted flexible tube with a small cameraon the end. The endoscope is inserted through the patient’s mouth and into theesophagus. Although the patient is awake during the procedure, doctors administersedatives intravenously, and spray numbing agents into the patient’s throat to prevent gagging. Recovery time is one to two hours until the effects of the sedatives wear offand the patient’s throat may be sore for up to two days. Both the PillCam SB and ESO procedures do not require sedation and can beadministered in a doctor’s office. Studies have shown patients undergoing eitherPillCam procedure have a much higher level of satisfaction due to proceduralconvenience and comfort and immediate recovery. The PillCam SB is considered thegold standard for detecting diseases of the small bowel such as Crohn’s disease and obscure bleeding. In a study of 106 patients, the sensitivity level of the PillCam ESO was rated similarto the sensitivity level of a traditional endoscopy in detecting abnormalities in a patient’sesophagus.
PillCam ESO accuracy is comparable to traditional endoscopy.Inflammatory Bowel Disease (IBD) is a family of chronic diseases affecting theintestines. Crohn’s disease and ulcerativecolitis both fall under the same umbrella andwere once believed to be the same disease. Patients with IBD experience such symptomsas persistent diarrhea, abdominal pain or cramps, fever and weight loss, and joint, skin,or eye irritations in varying degrees. Some may not experience all of these symptoms.Patients may also experience cycles of remission and relapse as the disease progresses.While Crohn’s disease is rarely fatal, there is no cure. Instead, doctors focus on treatingthe symptoms. If left untreated, symptoms may worsen, and health problems such as Abscesses, obstruction, malnutrition and anemia may occur. 6.5.3 Gastrointestinal association data:
According to American Gastrointestinal Association data, approximately 19 million ofAmericans suffer from various disorders of the small intestine including bleeding,Crohn’s disease, celiac disease, irritable bowel syndrome and small bowel cancers. Ofthese 19 million people, approximately 500,000 people suffer from Crohn’s disease.
6.6 ESOPHAGEAL VARICES:
Gastro esophageal varies are present in 40-60% of patients with cirrhosisHemorrhage from esophageal varices is a leading cause of death in cirrhotic patients,with mortality rates as high as 50% .Varices are veins that have become enlarged due toincreased pressure. The increased blood flow causes these fragile blood vessels tobecome so stretched that they are susceptible to breaking and bleeding.
CHAPTER-7 ENDOSCOPIC EXAMINATION
Additionally, Nano robots could change your physical appearance. They could beprogrammed to perform cosmetic surgery, rearranging your atoms to change your ears,nose, eye color or any other physical feature you wish to alter.There’s even speculationthat Nano robots could slow or reverse the aging process, and life expectancy couldincrease significantly. In the computer industry, the ability to shrink the size oftransistors on silicon microprocessors will soon reach its limits. Nanotechnology will beneeded to create a new generation of computer components. Molecular computers couldcontain storage devices capable of storing trillions of bytes of information in a structurethe size of a sugar cube. Nanotechnology has the potential to have a positive effect on the environment. Forinstance, airborne Nanorobots could be programmed to rebuild the thinning ozone layer.Contaminants could be automatically removed from water sources, and oil spills couldbe cleaned up instantly. And if nanotechnology is, in fact, realized, it might be thehuman race’s greatest scientific achievement yet, completely changing every aspect ofthe way we live.
7.2 EXISTING SYSTEM:
Currently, standard method of detecting abnormalities in the intestines is throughendoscopic examination in which doctors advance a scope down into the smallintestine via the mouth. However,these scopes are unable to reach through all of the 20-foot-long small intestine, and thus provide only a partial view of that part of the bowel.With the help of pill camera not only can diagnoses be made for certain conditionsroutinely missed by other tests, but disorders can be detected at an earlier stage,enabling treatment before complications develop.
7.3 PROPOSED SYSTEM:
The capsule is the size and shape of a pill and contains a tiny camera. After a patientswallowsthe capsule, it takes pictures of the inside of the gastrointestinal tract. Theprimary use of capsule endoscopy is to examine areas of the small intestine that cannotbe seen by other types of endoscopy such as colonoscopy oresophagogastroduodenoscopy (EGD).This type of examination is often done to findsources of bleeding or abdominal pain .
7.4 CAPSULE WORKING:
It is slightly larger than normal capsule. The patient swallows the capsule and the naturalmuscular waves of the digestive tract propel it forward through stomach, into smallintestine, through the large intestine, and then out in the stool. It takes snaps as it glidesthrough digestive tract twice a second. The capsule transmits the images to a datarecorder, which is worn on a belt around the patient’s waist while going about his or herday as usual.The physician then transfers the stored data to a computer for processingand analysis. The complete traversal takes around eight hours and after it has completedtaking pictures it comes out of body as excreta. Study results showed that the camera pillwas safe, without any side effects, and was able to detect abnormalities in the smallintestine, including parts that cannot be reached by the endoscope.
The tiniest endoscopeyet takes 30 two-megapixel images per second and offloads them wirelessly. See how itworks inside the body in animation.Pop this pill, and eight hours later,doctors can examine a high-resolution video of yourintestines for tumors and other problems, thanks to a new spinning camera that capturesimages in 360 degrees. Developed by the Japanese RF System Lab, the Sayakaendoscope capsule enters clinical trials in the U.S. this month.The patient gulps down the capsule, and the digestive process begins.Over the nexteight hours, the pill travels passively down the esophagus and through roughly 20 to 25feet of intestines, where it will capture up to 870,000 images. The patient feels nothing. 7.4.1 Power up:
The Sayaka doesn’t need a motor to move through your gut, but it does require 50 mill watts to run its camera, lights and computer. Batteries would be too bulky, so the cam draws its power through induction charging. A vest worn by the patient contains a coil that continuously transmits power. 7.4.2 Start snapping:
When it reaches the intestines, the Sayaka cam begins capturing 30 two-megapixelby mounting the camera facing the side and spinning 360 degrees so that it shootsdirectly at the tissue walls. As the outer capsule travels through the gut, an electromagnetinside the pill reverses its polarity. This causes a permanent magnet to turn the innercapsule and the image sensor 60 degrees every two seconds. It completes a full swingevery 12 seconds plenty of time for repeated close-ups, since the capsule takes about twominutes to travel one inch. 7.4.4 Offload data:
Instead of storing each two-megapixel image internally, Sayaka continually transmitsshots wirelessly to an antenna in the vest, where they are saved to a standard SDmemory card. 7.4.5 Deliver video:
Doctors pop the SD card into a PC, and software compiles thousands of overlappingimages into a flat map of the intestines that can be as large as 1,175 megapixels. Doctorscan replay the ride as video and magnify a problem area up to 75-fold to study details. 7.4.6 Leave
At around $100, the cam is disposable, so patients can simply flush it away. The belowis the block diagram of receiver that receives the pictures snapped by the camera inside the stomach. Nanotechnology which is the rice- grain sized motor. This miniature motor, whenattached to the pill camera gives it a propelling action inside the body, which makes iteasy for the pill to find its way through the digestive system. Also the grain-sized motorhas an application of its own too. It can be employed to rupture and break painful kidneystones inside the body. The other two drawbacks can be overcome using a bidirectionalwireless telemetry camera.Patients report that the video capsule is easier to swallow thanan aspirin. It seems that the most important factor in ease of swallowing is the lack offriction. The capsule is very smooth, enabling it to slip down the throat with just a sip ofwater. After the Given M2A capsule is swallowed, it moves through the digestive tracknaturally with the aid of the peristaltic activity of the intestinal muscles. The patientcomfortably continues with regular activities throughout the examination without feeling Sensations resulting from the capsule’s passage.
During the 8 hour exam, the images arecontinuously transmitted to special antenna pads placed on the body and captured on arecording device about the size of a portable Walkman which is worn about the patient’swaist. After the exam, the patient returns to the doctor’s office and the recording deviceis removed. The stored images are transferred to a computer PC workstation where theyare transformed into a digital movie which the doctor can later examine on the computermonitor. Patients are not required to retrieve and return the video capsule to thephysician. It is disposable and expelled normally and effortlessly with the next bowelmovement.It passively down the esophagus and through roughly 20 to 25 feet of intestines, whereit will capture up to 870,000 images.This is an exam of the small intestine of your digestive system. You will need toswallow a small capsule that contains a camera with flash.
The capsule is about the sizeof a multivitamin pill. This capsule takes 75,000 to 80,000 pictures as it passes throughthe digestive tract. These pictures will transmit to sensor pads that are placed belly. Theimages are stored in a small device that is held on a belt you will wear around the waist.Research shows that the pill leaves behind a trace of silver when it passes through thebody. Silver coats the pill and also makes up the antenna; however, the amount left behind in the body is less than is absorbed by the average person drinking tap water,according to researchers. The capsule transmits the images to a data recorder, which isworn on a belt around the patient’s waist while going about his or her day as usual. Thestored images are transferred to a computer PC workstation where they are transformedinto a digital movie which the doctor can later examine on the computer monitor. Patientsare not required to retrieve and return the video capsule to the physician. It is disposableand expelled normally and effortlessly with the next bowel movement.
8.1 SMALL INTESTINE:
The best of hands the entire small intestine is not visualized. The visit to attach the sensor pads and swallow the capsule will take 30 minutes to an hour. You are able to leave thehospital at this time. the digestive track naturally with the aid of the peristaltic activity ofthe intestinal muscles. The patient comfortably continues with regular activitiesthroughout the examination without feeling sensations resulting from the capsule’spassage.
* Crohn’s Disease.
* Malabsorption Disorders.
* Tumors of the small intestine & Vascular Disorders.
* Ulcerative Colitis
* Medication Related To Small Bowel Injury
* Biggest impact on the medical industry
* Nanorobots can perform delicate surgeries.
* They can also change the physical appearance.
* They can slow or reverse the aging process.
* Used to shrink the size of components.
* Nano technology has the potential to have a positive effect on the Environment.
It is a revolution, no question about it but the capsule poses medical risks 1.”Unfortunately, patients with gastrointestinal structures or narrowing are not goodcandidates for this procedure due to the risk of obstruction”. It might also happen thatthe pill camera might not be able to traverse freely inside digestive system, which maycause the tests to be inconclusive. 2. If there is a partial obstruction in the small intestine, there is a risk that the pill will get stuck there and a patient who might have come in for diagnostically reasons mayend up in the emergency room for intestinal obstruction. 3. The pill camera can transmit image from inside to outside the body. Consequently itbecomes impossible to control the camera behavior, including the on/off powerfunctions and effective illuminations inside the intestine.
The first drawback is overcome using another product manufactured with the help of nanotechnology whichis the rice- grain sized motor. The bidirectional wireless telemetry camera, 11mm in diameter, can transmit videoimages from inside the human body and receive the control signals from an externalcontrol unit. It include stream transmitting antenna and receiving antenna, ademodulator, a decoder, four LED’s, a CMOS image sensor, along with their drivingcircuits.The receiver demodulates the received signal that is radiated from the externalcontrol unit. Next, the decoder receives this serial stream and interprets the five of thebinary digits as address code. The remaining signal is interpreted as binary data. As aresult proposed telemetry model can demodulate the external signals to control thebehavior of the camera and 4 LEDs during the transmission of video image.
The CMOSimage sensor is a single chip 1/3 inch format video camera, OV7910; this can providehigh level functionality with in small print footage. The image sensor supports an NTSCtypeanalog color video and can directly interface with VCR TV monitor. Also imagesensor has very low power consumption as it requires only 5 volt dc supply. Since scopetests were first invented, doctors have wanted to be able to visualize the entire gut – all feet. But, a direct view of the small intestine has remained elusive. Attempts have been made to develop longer endoscopic instruments. This techniquecalled push enteroscopy has had only limited success. The longer instruments are difficultto control and manipulate and are hard to maintain. The accuracy of push enteroscopy is still limited since even in the best of hands the entiresmall intestine is not visualized. The visit to attach the sensor pads and swallow thecapsule will take 30 minutes to an hour. You are able to leave the hospital at this time.
The given endoscopy capsule is a pioneering concept for medical technology of the21stcentury.The endoscopy system is the first of its kind to be able to provide noninvasiveimaging of theentire small intestine.It has revolutionized the field of diagnosticimaging to a great extent and has proved to be of great help to physicians all over the world. Though nanotechnology has not evolved to its full capacity yet the first rung ofproducts have already made an impact on the market. In the near future most of theconventional manufacturing processes will be replaced with a cheaper and bettermanufacturing process “nanotechnology”. Scientists predict that this is not allnanotechnology is capable of. They even foresee that in the decades to come, with thehelp of nanotechnology one can make hearts, lungs, livers and kidneys, just by providingcoal, water and some impurities and even prevent the aging effect.
Nanotechnology hasthe power to revolutionize the world of production, but it is sure to increase Unemployment. Nanotechnology can be used to make miniature explosives, which would create havoc inhuman lives. Every new technology that comes opens new doors and horizons but closessome. The same is true with nanotechnology too. You will need to return at the time your nurse gives you. The study takes 8 hours. The capsule most often will pass in your bowel movement. You will not need to retrieve the capsule. In the rare case that the capsule does not pass it may need to be removedendoscopically or surgically. The remaining signal is interpreted as binary data. As aresult proposed telemetry model can demodulate the external signals to control thebehavior of the camera and 4 LEDs during the transmission of video image.
1. Rondo natti E et al. “Video capsule endoscopy in the diagnosis of celiac disease: A multicenter study. Am J Gastroenterology 2007;102:1624-1631 2. Pink tentacle. Sayaka: Next-generation Capsule endoscopy”. January 1 2008 3. “Capsule Endoscopy in Gastroenterology’’. Mayo Clinic. Accessed October 5 2007 4. Herrerias, J.M., et al.”Capsule Endoscopy in patients with Suspected Crohn’s Disease and Negative Endoscopy”.Endoscopy.European society of Gastrointestinal Endoscopy.2003;35:564-568 DOI: 10.1055/s-2007-40241