October 2013

Capsule Communication Challenges

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 dateThousands 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

Demonstrated Revenue Growth and Profitability

3

2007 2008 2009 2010 2011 2012 2013

$113$125

$142

$158

$178 $181

1.1% 4.6%12.7% 12.0% 12.1% 12.8%

73.3% 73.6% 76.6% 77.4% 77.2% 77.2%

RevenueNon-GAAP Operating MarginGross Margin

($ in millions) $195-205*

*Guidance

Given Imaging’s Comprehensive GI Diagnostic and Monitoring Solutions

PillCam COLON 2 not cleared for use in U.S.

4

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 ESO 2 Capsule endoscopy procedure

for visualization of the esophagus

The only capsule-based pH test for GERD

Ambulatory pH testing gold standard

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

Complete reflux diagnostic solution for both capsule and catheter-based testing

Capsule implementation evolution

Optical head4 lenses

Optical HeadOne lens

LEDs

SB1[ 2003 ]

LEDs

C2[ 2009 ]

Batteries

Transmitter Chip Imager

The main technical challenges of Capsule Endoscopy

The Gold Standard in

Capsule Endoscopy

Fit within capsule form factor

A narrow ‘pipe’ to xfer the video

Two-way data transmission

Facilitation of effective detection of pathologies by physicians

Completion of medical procedure within allotted time

Battery operation & shelf life

Ensuring timely conclusions by the physician

Patient comfort before (prep), during and after procedure

Miniaturization

Data Transmission

Diagnostic Yield

Power Management

Reading Time

Patient-Friendly

2

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

7 04/10/2023

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 434MHz8 04/10/2023

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

9 04/10/2023

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 ]

10 04/10/2023

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!

11 04/10/2023

Thank You!