Answered Essay: Getting an Inside Look: Given Imaging’s Camera Pill Gavriel Iddan was an electro

Getting an Inside Look: Given Imaging’s Camera Pill

Gavriel Iddan was an electro-optical engineer at Israel’s Rafael Armament
Development Authority, the Israeli authority for development of weapons and
military technology. One of Iddan’s projects was to develop the “eye” of a guided
missile, which leads the missile to its target. In 1981, Iddan traveled to Boston
on sabbatical to work for a company that produced X-ray tubes and ultrasonic
probes. While there, he befriended a gastroenterologist (a physician who focuses
on digestive diseases) named Eitan Scapa. During long conversations in which each
would discuss his respective field, Scapa taught Iddan about the technologies used
to view the interior lining of the digestive system. Scapa pointed out that the existing
technologies had a number of significant limitations, particularly with respect
to viewing the small intestine.b The small intestine is the locale of a number of
serious disorders. In the United States alone, approximately 19 million people suffer
from disorders in the small intestine (including bleeding, Crohn’s disease, celiac
disease, chronic diarrhea, irritable bowel syndrome, and small bowel cancer).c
Furthermore, the nature of the small intestine makes it a difficult place to diagnose
and treat such disorders. The small intestine (or “small bowel”) is about 5 to 6
meters long in a typical person and is full of twists and turns. X-rays do not enable
the physician to view the lining of the intestine, and endoscopes (small cameras
attached to long, thin, flexible poles) can reach only the first third of the small intestine
and can be quite uncomfortable for the patient. The remaining option, surgery,
is very invasive and can be impractical if the physician does not know which part of
the small intestine is affected. Scapa thus urged Iddan to try to come up with a better
way to view the small intestine, but at that time Iddan had no idea how to do it.
Ten years later, Iddan visited the United States again, and his old friend Scapa
again inquired whether there was a technological solution that would provide a better
solution for viewing the small intestine. By this time, very small image sensors—
charge-coupled devices (CCDs)—had been developed in the quest to build small
video cameras. Iddan wondered if perhaps it would be possible to create a very small
missile-like device that could travel through the intestine without a lifeline leading
to the outside of the body. Like the missiles Iddan developed at Rafael, this device
would have a camera “eye.” If the device were designed well, the body’s natural
peristaltic action would propel the camera through the length of the intestine

When Iddan returned to Israel he began working on a way to have a very
small CCD camera introduced into the digestive system and transmit images
wirelessly to a receiver outside of the body. Initially unsure whether images
could be transmitted through the body wall, he conducted a very rudimentary
experiment with a store-bought chicken: he placed a transmitting antenna
inside the chicken and a receiving antenna outside the chicken. The results
indicated that it was possible to transmit a clear video image. Encouraged by
this, he set about overcoming the battery life problem: the small CCD sensors
consumed so much energy that their batteries were often depleted within 10
minutes. Fortunately, advances in semiconductors promised to replace CCD
imagers with a new generation of complementary metal oxide semiconductors
(CMOS) that would consume a fraction of the power of CCD imagers. Iddan
began developing a prototype based on CMOS technology and applied for an
initial patent on the device in 1994. In 1995, he presented his product idea to
Gavriel Meron, the CEO of Applitec Ltd., a company that made small endoscopic
cameras. Meron thought the project was a fascinating idea, and founded Given
Imaging (GI for gastrointestinal, V for video, and EN for endoscopy) to develop
and market the technology.d
Unbeknownst to Iddan or Meron, another team of scientists in the United
Kingdom was also working on a method for wireless endoscopy. This team
included a physician named C. Paul Swain, a bioengineer named Tim Mills, and
a doctoral student named Feng Gong. Swain, Mills, and Gong were exploring
applications of commercially available miniature video cameras and processors.
They scouted out miniature camera technology at “spy shops” in London that
supplied small video cameras and transmitters to private detectives and other
users.e By 1994 they were developing crude devices to see if they could transmit
moving images from within the gut using microwave frequencies. By 1996
they had succeeded in their first live animal trial. They surgically inserted their
prototype device into a pig’s stomach, and demonstrated that they could see the
pylorus valve of the stomach open and close. Their next hurdle was to develop a
device that could be swallowed instead of surgically inserted.
In the fall of 1997, Gavriel Meron met Dr. Swain at a conference in Birmingham,
England, and they concluded that their progress would be much faster if they
joined forces. Swain’s team had superior expertise in anatomy and the imaging
needs of diagnosing small intestine disorders, while Iddan’s CMOS-based sensors
enabled the production of a smaller device with lower power requirements. The
teams thus had complementary knowledge that each knew would be crucial to
producing a successful capsule endoscope.
In 1999, the team got permission from the ethics committee at the Royal
London Hospital to conduct their first human trial. Dr. Swain would be the patient,
and Dr. Scapa (whose initial urgings had motivated Iddan to develop the wireless
endoscope) would be the surgeon who would oversee the procedure. In October
of 1999, in Scapa’s clinic near Tel Aviv, Israel, Dr. Swain swallowed the prototype
capsule. The first images were of poor quality because of the team’s inexperience at
holding the receiving antenna in an optimal position. The team was not sure how
far the capsule had traveled, so they used a radiograph to find the position of the
capsule. The radiograph revealed that the device had reached Swain’s colon, and

thus had successfully traversed the entire length of the small intestine. The team
was thrilled at this victory, and urged Swain to swallow another capsule, which he
did the next morning. Now that the team was more practiced at optimizing the
receiving antennas, they achieved much better quality images. Swain remarked
that he “enjoyed watching the lovely sea view” of his lower intestine. Though
the first capsule had transmitted for only about 2 hours before its battery life was
depleted, the second capsule transmitted for more than 6 hours, and the team
knew they had obtained quality images of a substantial length of small intestine.f
Over the next few months the team conducted several animal and human trials,
and by April of 2000 they had used the device to find a small intestinal bleeding
source in three patients with “obscure recurrent gastrointestinal bleeding”
(a difficult problem to diagnose and treat). An article on the device was published
that year in Nature (a prestigious scientific journal), with a header reading “The
discomfort of internal endoscopy may soon be a thing of the past.”g By August
of 2001 the device had received FDA clearance, and by October of 2001 Given
Imaging had gone public, raising $60 million in its initial public offering.
Given Imaging marketed its device as a system that included a workstation,
proprietary software, wearable video recording packs, and the swallowable capsules
(called “PillCams”). After swallowing the $450 PillCam, the patient goes
about the day while the PillCam broadcasts images to a video recording pack the
patient wears around the waist. When the patient returns the pack to the physician,
the physician uploads the images and can both view them directly and utilize
Given’s computer software, which employs algorithms that examine the pixels in
the images to identify possible locations of bleeding. The PillCam exits the patient
naturally. By February of 2006, more than 300,000 patients had utilized the system
worldwide, and many insurers provided coverage for the treatment.h
Until 2005, Given enjoyed the benefits of offering a medical technology with
tremendous advantages over existing alternatives, and having no competitors.
However, in 2005, Japanese optics giant Olympus introduced its own camera
pill—the “Endocapsule”—into the European market, and received FDA approval to
market the drug in the United States in 2007. In 2008, Philips Research announced
that it too had developed a camera pill called the iPill that incorporated a drug
delivery system, permitting the pill to release medicine directly to multiple locations
within the intestine. Additionally, several teams of scientists around the world were
working on developing capsule endoscopes that would incorporate robotic functions
such as small legs and clamps that would enable the capsule to move, attach
to the wall of the intestine, or remove a small amount of tissue for a biopsy.i Given
defended its position in the U.S. market by filing for a thicket of patents on the
technology, and by trying to rapidly build its installed base of Given workstations
in hospitals and clinics. The more Given workstations that were in use, and the
more physicians trained in their use, the greater the switching costs would be for a
hospital or clinic to adopt a competing technology. It also began work on versions
of the camera pill that would target the esophagus and the colon, respectively.
By 2011, Given had introduced several generations of PillCam technology, and
had grown to $178 million in annual sales. Its products were marketed and sold
in over 60 countries, and though it still faced formidable competitors such as
Olympus, Given Imaging remained the world leader in capsule endoscopy devices.

Please answer the following questions:

1. What are the advantages and disadvantages that owned by Medtronic?

2. What were the advantages and disadvantages of Iddan and Meron collaborating with Dr. Swain’s team?

Expert Answer


1) Medtronic is a medical company which develop different type of medical technologies . Different advantages of medtronic is that they develop cutting edge technology most appropiate time , ahead of others . They have good experiecne staff but since there are many other companies which work on same around the world so market share get divided and profit reduce

2) Advantages of Iddan and Meron collaborating with Dr Swain is

  • ​Iddan is expert is small camera and battery and Swain is expert is biology and human body . So when they come , they were able to combine there expert knowledge and get the best product in all respect
  • Also they are able to do live experiments also on human being and animals which helped them in finalizing the design
  • They were also able to understand its limitation and remove same in future products
  • They were able to create optimium solution of that age

Disadvantages are

  • ​When large teams combine then decision making is tough as some point
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