Rafi Nave, VP R&D, Given Imaging, presents at mHealth Israel Conference & Business Contest, October 7, 2013. Title is Given Imaging- Capsule Communication Challenges

1. Capsule Communication
Challenges
October 2013

2. Given Imaging - Recognized Industry Leader
World Leader in Minimally-Invasive GI Diagnostics
>85% Market share globally [ >95% share in the U.S. ]
One of the largest GI sales and marketing organizations in
North America (nearly 100 sales and marketing professionals
in the US alone)
~5,500 active PillCam customers:
2,750 Americas, 1,000 APJ, 1750 EMEA
Over 2 Million capsules ingested to date
Thousands of lives saved due to the CE [ Capsule Endoscope ]
More than 2,000 PillCam peer-reviewed publications
Strong IP: ~350 registered patents, ~230 pending patents
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3. Demonstrated Revenue Growth and Profitability
Revenue
($ in millions)
$178
Non-GAAP Operating Margin
Gross Margin
$181
$195-205*
$158
$142
$125
$113
73.3%
1.1%
2007
73.6%
4.6%
2008
76.6%
77.4%
77.2%
77.2%
12.7%
12.0%
12.1%
12.8%
2009
2010
2011
2012
2013
*Guidance
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4. Given Imaging’s Comprehensive GI
Diagnostic and Monitoring Solutions
 The only capsule-based pH test for GERD
 PillCam ESO 2
 Capsule endoscopy procedure for
 Ambulatory pH testing gold standard
visualization of the esophagus
Complete reflux
diagnostic solution for
both capsule and
catheter-based testing
 PillCam SB 2
 Most widely used capsule
endoscope for visualization of
the entire small bowel
 The standard of care in
numerous countries
 PillCam COLON 2
 Safe, minimally invasive, sedation-
free, patient-friendly modality to
visualize the colon and rectum
PillCam COLON 2 not cleared for use in U.S.
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High-Resolution Manometry
with physiology
visualization and data
analysis software for
identification of motility
disorders
Ingestible, wireless motility capsule
using sensor technology to measure
pH, pressure and temperature from
within the entire GI tract

5. Capsule implementation evolution
SB1
[ 2003 ]
Optical Head
One lens
LEDs
Optical head
4 lenses
C2
[ 2009 ]
LEDs
Transmitter
Chip
Batteries
Imager

6. The main technical challenges of Capsule Endoscopy
Power Management
Miniaturization

Fit within capsule form factor

Completion of medical
procedure within allotted time

Battery operation & shelf life
Reading Time
Diagnostic Yield


Facilitation of effective
detection of pathologies by
physicians
Patient-Friendly
Data Transmission


A narrow ‘pipe’ to xfer the video

Ensuring timely
conclusions by the
physician
Two-way data transmission
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Patient comfort before
(prep), during and after
procedure
The Gold
Standard in
Capsule
Endoscopy

7. The Capsule Communication Challenges
 High volume data:
 up to 35 Frames/sec
 Frame/image size: now at ~100K pixels. Next generation may need much more!
 Confined carrier Frequency choice
 Very high attenuation in the human body above 1GHz
 But… our high bandwidth necessitates high frequency
 The lower the frequency the worse is a given size antenna’s effectiveness
 We should use ISM [ Industrial, Scientific, Medical ] frequency bands
 Attempt to fit within narrow bandwidth
 Regulatory constraints
 Noise immunity
 Consume very low power
 Battery operated. Needs to last a 10-12 hours procedure
 Need cost-effective, medium volume, reliable solution
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10/14/2013

8. The frequency range
 There are several sub-1GHz ISM bands.
 Since we need to support high-bandwidth – the higher the
frequency – the better
 The capsule size implies antenna that is smaller than 1 cm.
It is apparent that we lose most of the transmission power due
to antenna frequency mismatch.
Still, the higher the frequency – the better the transmission
 In the 750 – 900MHz domain there are ISM bands.
However, they vary from region to region [ US, EMEA, Japan,
China… ]. It will complicate substantially the implementation if
we need to devise a dedicated transmitter/frequency per
region!
 The most suitable ISM band that we found, under the above
constraints, is around 434MHz
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10/14/2013

9. Coping with the bandwidth challenge
 The consumer world migrates to ever-increasing image
quality:
 HD TV and PC/Internet quality
 Digital Cameras growing M-Pixels count
 The GI Physicians migrate to HD Endoscopes and start
expecting HD image quality from Capsule Endoscopy
 But… the ‘pipe’ of our communication is narrow [ circa
13MHz ] due to both Regulation and Noise constraints
 So… we must employ every trick in the book to squeeze
the utmost of the given ‘pipe’: Modern modulation
and, especially, compression solutions
 The capsule is limited in its power budget. Hence, we
seek for asymmetrical compression solutions that do not
exhaust extensive power on the transmitting side
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10/14/2013

10. Coping with the low power constraint
 As mentioned – wherever possible, the solution is tuned so
that the burden is on the Receiver side and the transmitting
capsule has less power-exhausting tasks to perform.
 Since capsule movement in the bowels is intermittent
[ it parks for a while and then speeds up ] – we do not want
to take photos at high rate all the time, but, on the other
hand, do not want to miss pathologies while traveling fast.
 Hence: We developed AFR [ Adaptive Frame Rate ] that
detects fast movement and temporarily switches to a Very
High Rate [ 10X ]
 All common tricks of power-saving [ turning off modules
while not being used, using low-power manufacturing
process & circuit solutions ]
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11. In summary
 The Video Capsule attains effective clinical performance by
making the best out of a highly constrained environment:
 Correct selection of the carrier frequency/band
 Careful selection of the working-point
 Application of asymmetrical compression
 Adaptive Frame Rate
 Careful low-power design
All the above lead to a Market Leading highly popular product!
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10/14/2013

12. Thank You!