Received 14 January 2022; revised 1 March 2022; accepted 2 March 2022.

Date of publication 24 March 2022; date of current version 4 April 2022.

Digital Object Identifier 10.1109/OJAP.2022.3162110

Next-Generation Healthcare: Enabling Technologies

for Emerging Bioelectromagnetics Applications
ASIMINA KIOURTI 1 (Senior Member, IEEE), AMIN M. ABBOSH 2 (Fellow, IEEE),
MARIA ATHANASIOU 3 (Student Member, IEEE), TONI BJÖRNINEN 4 (Senior Member, IEEE),
ALINE EID 5 (Graduate Student Member, IEEE), CYNTHIA FURSE 6 (Fellow, IEEE),
KOICHI ITO 7 (Life Fellow, IEEE), GIANLUCA LAZZI 8 (Fellow, IEEE),
MOHAMED MANOUFALI 2 (Member, IEEE), MATTEO PASTORINO 9 (Fellow, IEEE),
MANOS M. TENTZERIS 5 (Fellow, IEEE), KATRINA TISDALE 1 (Graduate Student Member, IEEE),
ERDEM TOPSAKAL 10 (Senior Member, IEEE), LEENA UKKONEN11 (Member, IEEE),
WILLIAM G. WHITTOW 12 (Senior Member, IEEE), HUANAN ZHANG13 ,
AND KONSTANTINA S. NIKITA 3 (Fellow, IEEE)
1 Department of Electrical and Computer Engineering, Ohio State University, Columbus, OH 43212, USA

2 School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD 4072, Australia

3 School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece

4 Faculty of Information Technology and Communication Sciences, Tampere University, 33014 Tampere, Finland

5 School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA

6 Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, USA

7 Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan

8 Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA

9 Department of Electrical, Electronic, Telecommunications Engineering and Naval Architecture, University of Genoa, 16145 Genoa, Italy

10 Department of Electrical and Computer Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA

11 Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland

12 School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, U.K.

13 Department of Chemical Engineering, University of Utah, Salt Lake City, UT 84112, USA

CORRESPONDING AUTHOR: K. S. NIKITA (e-mail: [email protected])

ABSTRACT Rapid advances in antennas, propagation, electromagnetics, and materials are opening new
and unexplored opportunities in body area sensing and stimulation. Next-generation wearables and implants
are seamlessly providing round-the-clock monitoring. In turn, numerous applications are brought forward
with the potential to ultimately transform healthcare, sports, consumer electronics, and beyond. This review
paper provides a comprehensive overview, discusses challenges and opportunities, and indicates future
directions for: (a) enabling technologies needed to make body area sensing and stimulation a reality,
and (b) emerging bioelectromagnetics applications that may readily benefit from such technologies.

INDEX TERMS Implants, wearables, wireless power transfer, wireless telemetry, neurosensing, neurostim-
ulation, materials, microwave imaging, electromagnetic imaging, bioelectromagnetics, dosimetry.

I. INTRODUCTION realm of applications in healthcare, sports, gaming, con-

R APID advances in mobile, wireless, and sensing tech-

nologies are opening up new opportunities in body
area sensing and stimulation, promising an entirely new
sumer electronics, and beyond [1]. Remote diagnosis, patient
and elderly monitoring, sensing of vital parameters of peo-
ple suffering from chronic diseases such as asthma, diabetes,

This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

VOLUME 3, 2022 363

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

neurodegenerative and cardiovascular diseases, are just a few Biocompatible, biostable, and soft materials that do not
examples. compromise conductivity are also emerging, promising safe
The development of such transformative applications chronic in vivo performance of wireless implants [12].
entails critical requirements and challenges, including timely Once the prototype is assembled, evaluation of in tissue-
and reliable access to diagnostic information, energy-efficient emulating phantoms circumvents numerous limitations asso-
biosensor design, biocompatibility, system integration, sen- ciated with conventional in vivo testing. A multitude of
sor miniaturization, patient safety, emergency response, and recipes has been reported in this regard, including phan-
detection. Groundbreaking technological developments in toms of diverse consistencies, emulating diverse types of
antennas, electromagnetics, and materials can address these tissues across diverse frequencies and bandwidths [13], [14].
challenges and revolutionize healthcare delivery and wellness Dosimetry studies are of paramount importance at this eval-
management. This can be enabled through next-generation uation stage as well, helping to ensure patient safety via
implants and wearables that, in turn, enable emerging conformance with national and/or international standards for
bioelectromagnetics applications such as neurosensing, neu- the specific absorption rate (SAR) [15].
rostimulation, and innovative imaging modalities [2]. Indeed, Overall, wireless medical devices used to sense phys-
disease detection and diagnosis using wireless medical iological parameters (sensors) and stimulate the nervous
devices is seen as a transformative approach to health- system (stimulators) are becoming increasingly vital and
care, addressing the unsustainability of current healthcare can facilitate medical prevention, diagnosis, and treatment
provision models. of a multitude of conditions including cancer, chronic
Wireless implants are integrated with efficient implantable pain, and neurological disorders. Image-guided Microwave
antennas, which, depending on the application, may oper- Ablation (MWA) has emerged as a minimally invasive ther-
ate in subcutaneous and/ or deep-tissue environments [3]–[5]. apeutic modality for the treatment of unresectable tumors
Wireless capabilities permit unobtrusive and ubiquitous com- and cardiac arrhythmias, neuromodulation, and other appli-
munication with exterior monitoring/control equipment, such cations [16]. Antennas used in MWA systems should ensure
as a smart phone, smart watch, or other type of smart wear- efficient power transfer to tissue, through a heating pattern
able garment. Accordingly, the design of wearable antennas well matched to the size and shape of the targeted tissue.
has attracted significant scientific interest for reducing Furthermore, microwave techniques have gained increased
absorption by the lossy biological tissues, optimizing radia- research interest towards the development of Microwave
tion efficiency, miniaturizing their footprint, and so on [6]. In Imaging (MWI) systems, due to reduced complexity and
other cases, particularly when the distance between the trans- miniaturization advantages compared to other techniques.
mitter and receiver is short, wireless telemetry may be per- Clinical applications of MWI include breast cancer screen-
formed via inductive links [7]. Optimized single- and multi- ing, monitoring of fluid accumulation in the lungs, triaging
coil configurations have long been reported in this regard. of stroke patients, and more. The advent of wearable elec-
Additionally, the science of wirelessly powering medical tromagnetic systems has further pushed research towards
devices becomes increasingly relevant and significant. For this direction, sparking the intensive study of flexible and
wearables, wireless powering may be a matter of convenience, bio-matched radiating devices to be employed in portable
but, for implants, wireless powering further enhances patient systems [17]. Deep brain neurosensors and neurostimulators
safety and minimizes healthcare costs. That is, Wireless Power have recently attracted significant interest for several appli-
Transfer (WPT) makes biomedical implants more practical cations, including epilepsy, Parkinson’s disease, Alzheimer’s
thanks to the appeal of charging wirelessly and conveniently [8]. disease, addictions, etc. Wireless and batteryless brain
Electromagnetic-based wireless powering solutions range from implants are envisioned to enable continuous monitoring of
inductive to Radio-Frequency (RF) links, both of which are neural activity with minimum impact on the individual’s
viewed as critical enabling components. Assuming a wireless activity [18]. Furthermore, implantable neurostimulators [19]
implant, inductive powering entails implanted and on-body constitute a promising solution and are used to stimulate
coils that transfer energy by means of magnetic flux and the nervous system in order to treat and relieve symp-
Faraday’s law. In the case of wireless RF powering (namely, toms of visual impairment, Parkinson’s, dystonia, depression,
RF power harvesting), antennas are used to capture the abun- Alzheimer’s, sleep apnea, chronic pain, and many more.
dant electromagnetic energy radiated by random or dedicated Within this framework, several research efforts are pursued
sources in the surrounding environment. in order to address challenges related to electrode shape and
Advances in materials and related fabrication techniques size, miniaturization and biocompatibility issues, microan-
are also critical towards the development of seamless tenna design enabling high-data rate transmission, etc.
implants and wearables. Flexible materials along with addi-
tive manufacturing technologies like inkjet printing have II. ENABLING TECHNOLOGIES
brought forward the development of conformal, flexible A. WIRELESS TELEMETRY
and robust antennas and electronics for use with everyday 1) RF TELEMETRY
clothing, wearable sensors, biomedical wireless sensors 1) Wearable Antennas: Wearable antennas have gained pop-
and radio frequency identification (RFID) systems [9]–[11]. ularity in recent years due to increased number of Internet of

364 VOLUME 3, 2022

TABLE 1. Some of the most highly cited journal papers about wearable antennas.

Things (IoT) and medical implantable devices and our need

to communicate with them [20], [21]. They can be fabri-
cated from textiles, be inkjet printed, be etched on small
rigid substrates or thin flexible laminates. If conventional
etching techniques are used, the behavior is well known
in terms of the detuning and reduced efficiency due to
the proximity of the body. This section focuses on tex-
tile wearable antennas, which present additional challenges
due to the fabrication resolution, the shape changing as the
textile bends, and the reduced conductivity and thickness
of the conducting part. Table 1 summarizes some of the
most cited designs [22]–[28]. There are various techniques to
design and fabricate textile antennas [29]. The most common
ones are embroidery [30]–[32] and screen printing [20] (see
Fig. 1). Different fabrication approaches to wearable anten-
nas are shown in Fig. 2. These wearable antennas are usually
planar microstrip type with or without a ground plane. The FIGURE 1. Specialist digital embroidery machine at Loughborough University for
embroidering conductive threads. The designs can be converted into a picture and
presence of the body has minor impact on antennas that then fabricated automatically. It is important to be able to control the machine
include a ground plane. However, the performance of anten- tensions as the threads are designed for their conductivities not their physical
properties. The machine can also control the stitch spacing and direction.
nas without ground planes is strongly affected by the distance
from the body. In addition, the antenna can move or crum-
ple, thereby shifting the resonant frequency. If there is no
ground plane or just a small ground plane, the efficiency As an example case, we refer to a wideband monopole
increases as the antenna is moved away from the body. The antenna that was previously designed to work well on the
radiation efficiency is much higher when placed on the low- body and at several distances from the body. The monopole
conductivity fat tissue compared to the higher conductivity consisted of a circle with a partial ground plane only under-
of the muscle. neath the feedline. The monopole antenna was wideband but

VOLUME 3, 2022 365

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

2) Implantable Antennas: Implantable antennas enable wire-

less medical devices to operate within the body for long
periods and are central to wireless technology advance-
ments that bring healthcare home and make it personalized
and continuously available [36]–[38]. However, the human
body as an operating environment entails key challenges
to antenna design. First, all medical implants must be mini-
mally intrusive. This requirement restricts the viable size and
structure of the implantable antennas, making their design
and fabrication challenging [39]. Second, the biological mat-
ter exhibits high permittivity and appreciable conductivity
adding to the formidable challenge of achieving acceptable
radiation efficiency. Third, the human body presents signif-
icant variability between individuals, and it is a complex
structure for numerical electromagnetic (EM) simulations.
FIGURE 2. Different fabrication approaches to wearable antennas. (a) Nora The biological matter features decreasing and increasing
Dell [125] conductive sheet that can be cut to size, (b) embroidered meshed wideband
monopole (note this creates challenges to maintain a 50  transmission line and to trends in the relative permittivity and conductivity versus
ensure a good electrical connection where the embroidered threads cross), frequency, respectively [40]. As a result, due to high path
(c) combination of Nora Dell, conventional embroidery and embroidered conductive
threads, (d) and (e) copper tape on felt, (f) screen printing and inkjet printing on loss, the communication link between an implantable antenna
textiles, (g) a zoomed in version of (f); the darker line is the conductive inkjet printed and an external receiver becomes unfeasible beyond the low-
line and either side of that is a screen printed interface line to ensure a flat surface for
the thin inkjet layer. GHz frequencies [41], [42]. The main reason is the rapidly
increasing propagation loss versus the frequency experi-
enced by the EM wave traveling inside the body [41], [43].
Specifically, this means that although the electrical size
was affected by the body due to the partial ground plane. If of an implantable antenna can be increased by increasing
the circle of the monopole was increased in size, it would its operating frequency to, e.g., cm-wave frequencies, this
cover lower frequencies. This antenna without the body was is not a viable approach to improve the system’s overall
very wideband: ∼ 2 to > 60 GHz. With the body, the antenna performance [5]. On the other hand, implantable antennas
was reasonably well matched from ∼ 1.8 to > 6 GHz [6]. will be electrically small in the low-GHz range and subject
Note it was hard to achieve a reflection coefficient, |S11 | to the corresponding performance bounds.
below −10 dB over a wide frequency band as there are In addition to the applicable frequency range, the dielectric
resonant cavities created between the body and the antenna. properties of the human body are decisive to the radi-
The antenna was made from a conducting fabric and mea- ation properties of implant antennas [43]–[45] (see also
sured on an adult male person; the results were similar to Section II-D). First, the radiation efficiency and off-body
the simulations but the S11 magnitude was slightly worse. radiation pattern are functions of the propagation loss asso-
This was thought to be due to the sensitivity of the width ciated with the EM wave propagation inside the body and
and hence the impedance of the transmission line. The effi- the reflection of the wave that impinges the body surface.
ciency increased with larger body-antenna separation and In other words, they depend on the implant’s depth and ori-
also at higher frequencies (as the separation in wavelengths entation which are fixed by the application. In particular,
was increased). For example, at 1.8 GHz, the efficiency was the upper bound of the radiation efficiency will depend on
above 60% if the antenna was 20 mm away from the phan- the depth of the implant. Thus, the most effective way an
tom. This highlights the challenges of designing wearable antenna designer can contribute to the overall performance
antennas at 1 GHz or even 300 MHz where the antenna is of an implantable antenna is by minimizing the near-field
electrically close to the body. A wideband embroidered spiral loss and the impedance mismatch loss [45]. Since the bio-
antenna was previously designed and fabricated, which cov- logical matter is non-magnetic, antennas that store a more
ered the torso of the person [33]; as the frequency increased, significant portion of the near-field energy in the magnetic
the body became electrically larger and hence the directivity field than electric field are more favorable [43]–[45].
tended to increase. Article [44] exemplifies the computation of the contribu-
A related factor to consider is the SAR which is the RF tion of the near-field loss, propagation loss, and reflection
power absorbed per unit mass. SAR limits [34] may put loss on the radiation efficiency of an implantable antenna
constraints on the amount of power that can be transmitted, enclosed in a spherical body phantom, as shown in Fig. 3(a).
which in turn will affect the communication range. Clearly, Assuming the simulation settings summarized in the figure
there is a relationship between the power absorbed by the caption, the authors obtain the radiation efficiency shown
body and the power radiated. Generally, a ground plane that in Fig. 3(b). Towards lower frequencies, roughly below
is greater than one wavelength in size will decrease the SAR 500 MHz, the near-field loss significantly decreases the radi-
but tends to limit the bandwidth [35]. ation efficiency. As the frequency increases, propagation loss

366 VOLUME 3, 2022

 in implantable antennas through several designs summarized
in Table 2.
The recent works [47]–[51] on dual-band implant anten-
nas demonstrate several practical design approaches for
implantable antennas. The presented antennas are pla-
nar inverted-F and microstrip patch antennas, which per-
mit various miniaturization approaches. Central to all
designs [47]–[51] is the location of the shorting pin and slots
patterned to the radiator and ground plane. Together, they
modify the current path suitably to establish the two desired
resonance frequencies. In addition, all designs [47]–[51]
include a superstrate layer. It serves as a low-loss buffer
material between the radiator and the biological environ-
ment. Moreover, antennas in [47], [49], [51] use a high-
permittivity material in the superstrate and substrate to help
lower the resonance frequency of the antenna.
In addition to the innovative design of the antenna’s
internal structure that maximizes the implant’s EM
performance (e.g., dual-band operation), the external shape
of the antenna is crucial to the application. A round exterior
shape that avoids sharp corners helps to minimize the intru-
siveness of the implant [47], [49]. A bio-compatible super-
strate layer can form the encapsulation of the device [48] to
simplify manufacturing and reduce the device thickness. In
FIGURE 3. Radiation efficiency of a Hertzian dipole with rfeed = 0, rimpl = 5 mm, terms of the effective use of space, the associated electronic
and rbody = 10 cm in a spherical muscle phantom from article [44].
circuitry can be integrated with the antennas, as demon-
strated in [49], where the antenna and rectifier share the
same ground plane. For the proper system integration of
becomes the predominant loss source. Because the implant wireless implantable devices, optimizing the antenna con-
is at a deep location, the propagation loss dominates over sidering all other modules present within the same package,
the reflection loss. However, for a shallower implant, the as in [50], provides the most holistic design approach.
reflection loss would become relatively more important. Based on the design approaches discussed above, the
Whereas creating efficient sub-cm-sized implantable authors of [52] and [53] have created triple-band implantable
antennas is challenging, developing wireless medical micro- antennas based on spiral-shaped radiators. Both designs make
electronic systems in the same size range is comparatively use of a high-permittivity substrate and superstrate and
more straightforward. Thus, an implanted microsystem may slotted ground plane. In contrast to the Planar Inverted-F
contain advanced wireless communications modules. This Antenna (PIFA) [53], the antenna [52] does not include
trend has prompted the growing demand for electromag- a shorting pin and thus is not a PIFA. The sizes of
netically advanced implantable antennas that support, e.g., the antennas [52] and [53] are 7×6.5×0.377 mm3 and
the multi- or broad-band operation. For this purpose, π ×(11.2 mm)2 ×0.5 mm, respectively. The corresponding
multiple frequency bands, including the Medical Implant measured peak gain values are −30.5 | −22.6 | −18.2 dBi
Communication Service (MICS) band between 401 MHz and −23 | −20.5 | −19 dBi at the frequencies of 402 MHz,
and 406 MHz, the MedRadio comprising the multiple sub- 1600 MHz [1] / 1430 MHz [2], and 2.45 GHz. The con-
bands between 401 MHz and 457 MHz, and the Industrial, sidered implant location was 3 mm and 4 mm in the
Scientific, and Medical (ISM) bands centered at 915 MHz scalp, respectively. Relative to the size, both antennas
and 2.45 GHz, are available, depending on the geographical reach the state-of-the-art gain performance together with the
location. For example, in [46] authors report a conformal triple-band operation.
capsule slot antenna with a wide impedance bandwidth In the works [54] and [55], the authors have focused on
ranging from 1.64 to 5.95 GHz (113.6%). Authors in [42] improving the impedance bandwidth of dual-band PIFA. This
compare the performance of implantable antennas operat- was realized by using spiraled radiators divided into two
ing in these bands, highlighting how antenna miniaturization branches relative to the feed point. In [54], one of the spiral
may come at a compromise of reduced electromagnetic branches was shorted to the ground, making the radiator of
performance. In addition, circularly polarized antennas (CP) the same type used in [53]. In [55], one branch of the spi-
downsized to a clinically viable size for implantation, and the ral was shorted at its endpoint. In [54], several narrow slots
RFID-inspired implant communications have been consid- were cut in the ground plane, but in [55], a single large rect-
ered. The remainder of this section reviews the recent trends angular slot was employed. The two works demonstrated

VOLUME 3, 2022 367

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

TABLE 2. The main features of the implantable antennas discussed in Section II-A1.

the significant fractional bandwidths of 38% [54] and The authors of [56] took a different approach to bandwidth
40.8% [55] at the frequencies of 402 MHz and 2.45 GHz, enhancement. Instead of a grounded antenna, they developed
respectively. an 18×18 mm2 planar loop antenna coupled with two double

368 VOLUME 3, 2022

split-ring resonators (SRR). The structure was folded onto
the surface of a cylinder-shaped implantable capsule (radius
of 3.2 mm) that contains other electronics modules. The
SRRs not only had a positive influence on the impedance
matching, but they also suppressed the near electric field
of the antenna. This enhanced the radiation efficiency and
reduced the specific absorption rate. In terms of the EM FIGURE 4. A generalized inductive telemetry link with coils, where receiver is the
implantable side, typically operates below 50 MHz.
performance, the antenna achieved the substantial impedance
bandwidth (|S11 | < −10 dB) from 307 MHz to 3.5 GHz,
and its realized gain increased steadily from −34.3 dBi at
402 MHz to −18.4 dBi at 2.45 GHz.
The first CP implantable antenna, operating at 2.45 GHz using an inductive coupling link at low frequencies, typi-
ISM band, was presented by Liu et al. in 2014 [57]. cally below 50 MHz. At those frequencies, inductive links
The antenna (10×10×1.27 mm3 ) was developed from a have been used for short range implants applications such as
microstrip patch antenna with a square slot cut at the cen- pacemakers, intra-ocular, and muscle stimulators [70], [71].
ter of the radiating patch and truncating two corners of The principle of operation for inductive coupling is based
the slot. This produced the CP property while additional on the mutual inductance through the magnetic flux between
slots in the radiating element provided reactive loading and an implantable coil, or antenna, and wearable or close to the
increased the current path to achieve the compact size. Until body coil, or antenna (Fig. 4) [72], [73].
now, the research on implantable CP antennas has pro- When an implantable antenna is interrogated by an exte-
duced numerous advancements, such as attaining the CP rior antenna, dielectric properties of tissues result in power
operation at 902 MHz [58], [59] dual-band 902/2450 MHz absorption, particularly for the electric field [74], [75]. In
CP antennas [60]–[62], as well improvements to the axial contrast, the magnetic response is usually weak since the
ratio bandwidth [59], [63]–[65]. As a new design feature, magnetic permeability of most tissues is equivalent to free
metasurfaces were utilized in [60], [61]. space (μ = μo ) [76]. For this reason, inductive coupling is
To return to integrating antennas with the medical a favorable method for power transfer to battery-less IMDs
implants, sometimes the required electronics can be imple- (Fig. 4). The coupling is predominately achieved through
mented as microsystems instead of cm-sized modules. In magnetic field leading to reduced interaction between the
this regard, the passive ultra-high frequency (UHF) RFID EM field and the surrounding biological tissues. The read-
technology [11], [66] is considered a compelling approach to ing distance between exterior and implantable antennas falls
battery-free implants. Due to the power-efficient mechanism in the near-field region [77], [78]. Generally, the inductive
of the modulated scattering used in the uplink (tag-to-reader) coupling link between exterior and implantable antennas is
communications, RFID enables ultra-low-power microsys- modelled as a lossy two-port network. The implantable side
tems that operate on the energy they harvest from the reader’s is tuned in parallel or series to the load by a capacitor, whilst
RF signal. The articles [4], [67], [68] present two differ- the external side is normally tuned in series with a capaci-
ent antenna concepts for RFID-inspired brain implants. In tor. Increasing the coupling coefficient leads to a reduction
the first approach [4], [67], the implant within the cranial in the injected current at the external coil and reduction in
cavity comprises a circular loop connected with the RFID losses. Therefore, a high coupling coefficient is required by
microsystem. The loop couples through the EM near-field to increasing the mutual inductance of external and implantable
a larger wearable split ring resonator. Together the two parts coils [79].
form a spatially distributed antenna system with the gain Unlike far-field EM simulation, where the wireless link
of −18 dBi at 915 MHz (implant depth: 10 mm). In the can be investigated separately from antennas, the link
second approach [68], the system comprises only an elliptic between exterior and implantable antennas needs to be incor-
cylinder-shaped implant (π × (3 × 1.5) × 1 mm3 ) based porated in the modeling and design of inductive links [80].
on a double split ring antenna where the RFID microsystem The generally used metric to quantify the performance of the
connects to one of the rings, and a capacitor loads the other wireless power link is the power transfer gain, which is the
one. The gain of the antenna at 915 MHz was −25.7 dBi ratio of the power delivered to the load and the power sup-
(implant depth: 16 mm). In both approaches, the housing of plied to the exterior coil, i.e., accepted power. When the input
the implant was formed by a low-permittivity bio-compatible impedance and output impedance are conjugately matched
material. to the source and load respectively, the maximum operating
power gain is achieved [81]. The difference between oper-
2) INDUCTIVE TELEMETRY ating and maximum operating power gain is that the latter
The data communication link in implantable medical neglects the mismatch between the implantable coil and an
devices (IMD) encompasses a downlink from a base sta- integrated load [82]. However, in practice, fabrication inaccu-
tion (BS) to an IMD and uplink in the reverse direction [69]. racies alter the conjugate matching and impedance mismatch
Traditionally, data communication for IMDs is achieved loss occurs.

VOLUME 3, 2022 369

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

TABLE 3. Summary of some reported inductive coupling for sub-1 GHz links
Merging data communication and WPT in the same (100 MHz-1 GHz).
frequency can lead to interference. In turn, either maximizing
WPT or data communication as simultaneous optimization
is cumbersome. The requirements for WPT and inductive
telemetry are paradoxical [83]. High power efficiency can
be achieved with resonant coils at low frequencies, which
hinders achieving high data rate by limiting the available
bandwidth [84]. Therefore, different techniques have been
used to support high data rate and high WPT by using differ-
ent coils, mainly arranged in an orthogonal way to support
high data rate and efficient power transfer [85], [86]. In
this case, the requirements for data rate and WPT can be
addressed separately [86]. Alternatively, using same coils for
data rate and WPT can be achieved by optimizing the design
requirements which can be a challenging procedure. In [87],
the authors propose using two pairs of coils for inductive
wireless link and pair of antennas for back telemetry. In this
regard, the requirements of data rate and power efficiency
are not compromised at the expense of increasing the overall
footprint of the IMD.
The modulation techniques for data communication often
employ constant amplitude modulations (i.e., frequency or
phase modulations) to provide uninterrupted power flow for head tissues that was considered in [94]. A multi-turn 3D
IMDs [88]. However, an onboard clock and carrier syn- implantable coil was optimized in [95] using a single tis-
chronization are necessary for accurate data retrieval, which sue model for the operation at 100 MHz at the expense of
increases the power consumption for IMDs. On the other increasing the exterior antenna dimension. Using a mm-size
hand, amplitude modulation has the advantage of simplicity implantable antenna necessitates the use of matching circuits
with less power requirements as clock and data retrieval are to properly feed the antenna, hence, the design of matching
achieved by data sequencing [89]. circuits should be optimized in order not to adversely affect
Recently, there has been significant research into the the bandwidth.
potential of increasing the operating frequency of inductive It is worth mentioning that inductive telemetry is therefore
link to above 100 MHz. Those investigations aimed at uti- not standardized, and the choice of the operating frequency is
lizing the advantage of high frequencies for high data rate, dictated by the design requirements and application instead
small antenna size (mm-size) and improved power transfer of well-defined guidelines [71]. Table 3 shows a summary of
efficiency by operating in the radiating near-field rather the recently reported inductive coupling links operating at sub-
reactive near-field [90]. At such high frequencies, anten- 1 GHz band (100 MHz-1 GHz) [9], [93], [94], [96]–[101].
nas are designed instead of coils for inductive telemetry to
operate efficiently at high frequencies. B. WIRELESS POWER TRANSFER
When designing a mm-size implantable antenna, the input The mode of operation for IMDs can be broadly classi-
high reactive impedance is matched to a high capacitive fied based on the power source into three categories: active,
input impedance of an integrated chip/load to maximize the passive, and semi-active [102]. IMDs which have embed-
power transfer efficiency [91]. However, it is challenging to ded batteries fall in the first category, while passive IMDs
achieve a perfect conjugate matching between the antenna operate from an exterior power source via WPT [103]. The
and chip/load, hence, the mismatch loss needs to be consid- semi-passive, or often named semi-active, IMDs use a hybrid
ered when calculating the power transfer efficiency. In [92], combination of an on-board battery and exterior interroga-
an inductive coupling link was proposed for an 8 mm3 3D tor, which modulates the antenna input impedance via a
cube implantable antenna coupled to an exterior copper fab- switch [104].
ric and embroidered loop antennas. The link was designed at As an IMD is located inside biological tissues, EM radi-
300 MHz and measured in a head-equivalent liquid phantom. ation is absorbed and converted into heat [105]. Therefore,
In vitro tests of the inductive coupling link for a 1 mm2 pla- safety precautions limit the input power to IMDs, which in
nar antenna were reported in [80] with a simple multilayer turn affect the communication range. Moreover, EM radi-
tissue model used in the simulation. ation is governed by the dielectric properties of tissues.
In [93], a 1 mm3 3D cube antenna was designed at Hence, accurate dielectric characterization and modelling of
400 MHz, however, the measurement of the wireless link biological tissues have a great significance in understand-
was performed in air only, which does not reflect the actual ing and simulating EM radiation of IMDs in the human
link losses exhibited by the high relative permittivity of body [106], [107] (please refer to Section II-D).

370 VOLUME 3, 2022

 (Fig. 5) [112]. Capacitive coupling is created by displacement
and conduction currents when exterior capacitive patches are
driven by a time-varying voltage source and placed near
implantable capacitive patches [113]. In biological tissues,
the capacitive reactance between exterior and implantable
patches is high, which limits currents and WPT. Hence, it
is not a preferable WPT modality for IMDs, as it needs a
higher rate of electric field change or a wide surface area for
FIGURE 5. Inductive versus capacitive coupling through biological tissue. The coupling patches [114]. In fact, capacitive coupling is equiv-
coupling in inductive link is achieved via magnetic field, whereas in capacitive link is alent to a parallel capacitor with a sandwiched tissue as a
achieved via electric field.
dielectric. The dielectric loss resistance varies proportionally
with the separation distance (i.e., tissue thickness) between
exterior and implantable capacitors. Furthermore, IMDs can
To permit long-term implantation and reduce subsequent suffer from a large size due to the size of capacitor patches.
surgeries for drained battery replacement in IMDs, WPT Hence, it is primarily used for near-surface transcutaneous
through a power link is becoming increasingly popular [103]. implant communication and not for deep implants [114].
There are different modalities for WPT in battery-less IMDs, This principle is different from inductive coupling, which
namely near-field resonant inductive, capacitive, galvanic, takes the advantage of non-magnetic response of tis-
mid-field, far-field WPT links. Besides that, there are other sues. For mid-field WPT, the frequency is optimized to
modalities utilizing ultrasound, optical waves, and molecular achieve higher coupling for miniature implantable antennas
communication [70]. (i.e., in mm-range) [110]. The separation between exte-
To achieve higher efficiency for resonant inductive WPT, rior and implantable antennas is around one wavelength.
the quality factor of used coils or antennas should be high The frequency of weakly-coupled antennas is obtained in
to condense the power in the near-field, which limits the low-GHz and GHz range depending on the size of the
data rate. It is necessary to operate inductive coupling exterior antenna [90].
at lower frequencies (Fig. 5), especially when the link is Galvanic coupling based on volume conduction theory
designed for efficient power transfer to IMDs [108]. The (propagation of the electric field in lossy conducting tis-
losses of the propagation channel due to biological tissues sues by induction current) is particularly used for intra-body
are in consonance with frequency [109]. On the other hand, communication and not IMDs [115]. Galvanic coupling still
higher frequencies aid the miniaturization of the antenna poses a high path loss (in order of more than 40 dB) in
as compared to the high frequency (HF) range used exten- muscle tissue at 13.56 MHz, while the receiver is placed at
sively in inductive coupling for IMDs. Recently, there has a distance of around 5 mm in air [115]. Placing an exterior
been a considerable attempt to extend the inductive cou- receiver for an IMD in air is prone to fade the conduction
pling operating frequency to UHF [88]. Miniaturization of current, which in turn increases the path loss.
the antenna by means of a higher frequency is obtained, In far-field WPT, the exterior and implantable antennas
yet impedance matching is achieved using lumped com- are far apart from each other by at least two wavelengths.
ponents [8]. As evident from the analytical and numerical Hence, the radiated EM fields will be plane waves [78].
simulations in [90], for mm-size implantable antennas, sub- On the contrary, the near-field propagation in biological
GHz and low GHz range provide the optimal frequency to tissues is complex as EM field also consists of non-
maximize the link gain depending on the dimension of the radiating waves, i.e., standing waves. This can facilitate
exterior antenna. In this case, the inductive coupling oper- the study of far-field WPT as antenna gain is defined
ates in the mid-field WPT, which is regarded as a holistic for the far-field case and the path loss follows Friis’
combination of a typical inductive near-field and radiative equation, which can simplify the study of far-field WPT
far-field for mm-size implantable antennas [103]. Higher compared to near-field [116]. Nevertheless, far-field WPT
frequency bands are utilized to overcome the drawbacks of suffers from low power efficiency and can be made feasi-
low frequency wireless links between an exterior reader and ble with the support of focusing lenses, exterior antenna
IMDs. Therefore, near-field WPT links are envisaged for arrays or parasitic wearable conductors [117]. In partic-
mm-size implantable antennas to further reduce the overall ular, far-field WPT for IMDs requires another dimension
volume of the implantable antenna to 1 mm3 [110], [111]. of complexity to the system in order to provide adequate
In fact, the operating frequency should represent a good power to IMDs without violating the safety standards, which
compromise to obtain a compact exterior antenna, accept- is deemed impractical for IMDs. Overall, WPT based on
able penetration in tissues and satisfactory power transfer to inductive coupling is the most used WPT modality for
a miniature battery-less medical device with an acceptable IMDs due to its advantages in terms of penetration in
inductive coupling to the exterior reader [95]. biological tissues, despite its short operating distance and
In another way to realize WPT to IMDs, capacitive cou- sensitivity to misalignment between external and implantable
pling has been investigated, with a caution on safety aspects counterparts.

VOLUME 3, 2022 371

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

C. MATERIALS AND FABRICATION and hence was very similar to an embroidered thread. This
1) EMERGING MATERIALS was an effective way of making a lightweight conducting
1) Emerging Materials for Wearables: textile with bespoke designs. However, further work would
Fabric Substrates and Conducting Elements: The prop- be required to test the robustness to bending and stretching.
erties of dielectrics and fabrication methodologies for con- Anisotropic Substrates and Superstrates: The term
ducting textiles have been reviewed in [118]. Textiles tend anisotropy describes materials which have different relative
to have low relative permittivity (εr ∼ 2 – 3) and have permittivity, relative permeability, loss tangents, or conduc-
low losses. Therefore, they do not assist in miniaturiz- tivity values in two or three different axes. Recently, there
ing the antenna and they do not have an adverse effect has been increased research interest in the physics and design
on the efficiency. Another problem arises if the fabric of anisotropic or extremely anisotropic structures. However,
antenna is expected to operate in rainy or wet conditions studies on modelling, characterization, and practical appli-
as this will absorb water and affect antenna efficiency cations of anisotropic artificial dielectrics at microwave
by changing the substrate’s effective permittivity and loss frequencies are limited. Until recently, commercial EM soft-
tangent [119], [120]. ware was unable to consider anisotropy of homogeneous
Embroidered antennas generally use fabric and conductive materials. It is increasingly important to measure anisotropy
threads to form the antenna structure [121], [122]. These at higher frequencies where the internal feature size of con-
can be aesthetically or covertly integrated into clothing and ventional materials becomes more significant [128]. Several
manufactured as individual unique elements or mass manu- articles discuss the potential advantages and applications of
factured. This leads to an embroidered antenna design that exploiting anisotropy including control of the frequency and
is quite flexible and unobtrusive to the wearer. Embroidery bandwidth, modifying the radiation patterns, lenses, beam-
lends itself to antennas where the metallization is linear forming, microwave resonators, reducing surface waves, and
rather than covering a large continuous area. These con- minimizing the antenna profile [128]–[130]. Textiles are
ducting threads are difficult to embroider and a specialist naturally anisotropic, and the relative permittivity is differ-
embroidery machine is required to control the different ent parallel to and perpendicular to the thread direction.
tensions [123], [124]. The stitch spacing and direction is However, the difference for most materials is less than
important, as this changes the sheet resistance and thus 10% and hence the effects of the anisotropy are not very
influences antenna efficiency [121], [122]. significant [131].
However, the antenna efficiency is compromised as the Tuovinen et al. have considered anisotropic substrates
metallization has a limited conductivity and thickness [122]. via simulation [132]. In [132], vertical strips rotated by
For example, some of the most popular threads consist of a 45 degrees were used to create anisotropic substrates for
polymer core with a 1-micron thick metalized exterior. To ultra-wideband (UWB) on-body antennas. The anisotropic
enable the metal layer to adhere to the polymer core, a mix- substrates increased the gain at boresight and removed the
ture of metals is used. It is noteworthy that each thread nulls and smoothed the radiation patterns. Structures were
contains multiple filaments. By comparing the measured simulated as homogeneous anisotropic substrates and also as
results to simulations, the conductivity has been ascertained thin strips. This anisotropy could be achieved via 3D print-
to be approximately 1 MS/m. The skin depth effect of ing the layers and could be used to minimize the pattern
the embroidered thread that reduces the antenna efficiency nulls of a wearable antenna on the human body.
becomes more significant at lower frequencies and hence Metamaterials: Metamaterials and metasurfaces can be
the antenna efficiency decreases at lower frequencies (even designed to prevent the propagation of waves. They are
before the body is considered). The electromagnetic behavior also used in some wearable applications to reduce the back
can be improved by increasing the number of embroidered radiation and, hence reduce the absorption in the body and
layers or the stitch density, however, this comes at the cost improve the antenna efficiency [133]–[135]. Artificial mag-
of increased weight, reduced physical flexibility / comfort, netic conductors (AMCs) control the phase of the reflection
and increased cost of raw materials. from the surface, hence reducing the destructive interference
Similar issues exist with other conducting textiles as their of the reflected. This enables the profile of the antenna to
fabrication is inherently optimized for flexibility and man- be reduced while maintaining a high efficiency [136]. The
ufacturability rather than the RF performance. Conductive example in [135] showed a gain improvement of 1.9 dB and
fabric sheets are available; one example is “Nora Dell” from a backward radiation reduction by 8 dB with the introduc-
Hitek Ltd. [125] which is a three-layer fabric composite with tion of an AMC. The disadvantages of this are that (i) the
a quoted sheet resistance of 0.009 /m2 . In other cases, system requires an extra layer of conductor and dielectric,
antennas on textiles have been created by screen printing (ii) the bandwidth is limited, and (iii) the ground plane typ-
an interface layer onto cotton and then inkjet printing the ically needs to be two wavelengths across which makes
conducting layer [126], [127]. The dielectric interface layer the overall antenna size quite large, especially at 1 GHz
provided a flat surface for the conducting ink and hence was or below. In [137], authors describe an electrically small
required to achieve conducting lines. The metallization was antenna employing an AMC substrate, both fabricated by
approximately 1 μm thick with a conductivity of ∼ 1 MS/m using an inkjet-printed solution, for sub-GHz applications.

372 VOLUME 3, 2022

In another case [138], the use of metamaterials is explored from body tissues, isolate individual electrical components,
to improve the penetration of the electric field inside the and protect the conductive materials from biological cor-
human body for diagnostic/therapy applications. The work rosion [144], [145]. This section describes existing and
addresses the problem of designing a thin matching layer emerging materials for bioelectronic applications.
based on a metasurface to increase the electric field pen- Both conductive and insulating implantable materials
etration into muscle tissue for various scenarios. A wider need to be biocompatible for chronic or acute applica-
literature review on AMCs for wearable antennas can be tions. The definition of biocompatibility is highly depen-
found in [139]. dent on the application. For chronically implantable (long
Textile antennas which incorporate metamaterials have term) electronics, materials must be chemically inert under
been considered [22], [140]. In addition to the challenges physiological conditions throughout the lifetime of the
of rigid metamaterials, these flexible versions also suffer in implant. Recent developments in transient implantable elec-
practice as bending or compressing the layers further reduces tronics have raised interest in materials that can be
the bandwidth. An example is shown in [141] which uses biodegraded under physiological conditions without creat-
an AMC with a wideband “windmill-like” antenna which ing toxic byproducts [146]–[149]. Insulating materials are
provides a wide return loss bandwidth of 5.7 – 11 GHz (frac- typically polymeric or ceramic materials, both of which
tional bandwidth, FBW: 63.4%) with a peak gain of 8 dBi (at have been FDA approved [150]. For conductive materi-
7 GHz). The efficiency values of 90.6 %, 83.8 % and 85.5 % als, noble metals [151], [152], such as titanium and gold,
are achieved at 7 GHz, 8.5 GHz and 10 GHz respectively. are often used for chronic applications. Non-toxic and
The size of this AMC is 0.874 λmax × 0.874 λmax ; when biodegradable metals such as magnesium, silicon, iron, car-
scaled to 1 GHz the AMC would be 26.2 cm × 26.2 cm. bon nanotubes [153], [154], and graphene [154] have also
A different metamaterial antenna concept for wearables been used. Other creative approaches may use natural body
has been discussed in [28]. The concept is to use the AMC fluids as part of the material. Compatibility with MRI
in the frequency range where the reflection phase is + 90◦ so scans also needs to be considered, requiring the use of
that it behaves like an inductive surface. A monopole is then non-magnetic particles.
placed near the AMC layer and designed to operate below In addition to biochemical compatibility, mechanical
its fundamental mode and hence the monopole impedance is compatibility between the tissue and the implant can be
capacitive. Therefore, the reactances cancel out and a good improved by making them soft and compliant rather than
impedance match can be achieved for the overall system. The stiff and hard. Conventional metallic materials have a high
key point is to locate the main electric fields on the edges mechanical mismatch with biological tissues. Alternative
of the monopole and in the slots of the AMC. These gaps soft conductive materials proposed for medical electron-
behave like slot antennas (magnetic sources) and these can be ics include biocompatible versions of paints [155], [156],
located close to the ground plane due to image theory. Here conductive adhesives [157], polymers [151], [158], [159],
the AMC itself becomes the main radiator. Several slots can hydrogels [151], inks [160] and fluidic conductors [161].
be used to create an array with a tapered amplitude with the The effective conductivity of the material is controlled by
central slot providing the strongest radiation. This concept the conductivity of the material (fluid, ink, etc.), as well
is advantageous over conventional AMCs as the footprint as how it interacts with the body. Some tattoo inks, for
can be reduced to only require a 2 × 2 array which can instance, are highly conductive [162], but the tattoo itself
be much smaller than 2 λ as typically required for AMCs. may not be, as the different cellular components uptake the
The antenna had a high front to back ratio; hence exhibited ink nanoparticles, placing insulating cell walls between the
robustness to placing objects nearby, low SAR and high conductive particles [163]. Materials also need to be thick
efficiency. This antenna in [28] was designed for 2.4 GHz enough to accommodate the electrical skin effect, which can
and achieved a 6% fractional bandwidth. The size including be a problem for inks and paints. Some of these materials can
the AMC was 0.5 λmax × 0.3 λmax × 0.028 λmax [28]. It potentially be injected as fluids and converted to soft solids
used an anisotropic AMC to save space as the monopole with heat (either from natural body heat or heat provided
was linearly polarized and the AMC was only required to by a coaxial applicator). This could open up the possibility
operate in one axis. of producing new types of antenna structures directly in the
2) Emerging Materials for Implants: Implantable medi- body [12], [151].
cal electronics require materials with appropriate electrical,
mechanical, and biological properties. High electrical con- 2) ADDITIVE MANUFACTURING
ductivity materials are used for transducing electrical signals Despite revolutionary developments in the fields of wearables
between the biological tissues and electronics, such as and IoT technologies (Fig. 6), the design of wireless wear-
wires, antennas, ground planes, etc. Typically conductivi- able systems remains challenging, and largely dependent on
ties at least on the order of 104 – 105 S/m are needed for several factors such as device size, manufacturing methods,
medical electronics [142], although antennas with conduc- material compatibility and, most importantly, the available
tivities as low as 5 x 102 S/m have been proposed [143]. source of power. Additive manufacturing techniques (AMTs),
Insulating materials separate these conductive materials such as inkjet and 3D printing, offer a surprising wealth of

VOLUME 3, 2022 373

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

FIGURE 6. The enabling role of low-cost additive manufacturing techniques in the development of wireless wearable systems.

solutions for the aforementioned needs of wearable devices. and the potential powering of IoT and wearable sensors at
While traditional lithographic manufacturing techniques are >100 m away from a 5G base station [164]–[166]. With the
the main contributor to the growing wireless electronics need for power sources remaining the centerpiece in the hard-
industry, they suffer from multiple drawbacks such as long ware design of wearable devices, and the use of batteries
turnaround times, extensive design verification requirements, critically restricting the extent and scope of the applica-
and the production of harmful waste. A new industrial rev- tion of such valuable devices, wireless power transfer offers
olution is seeking environmentally-friendly solutions, fast an environmentally-friendly, efficient, and non-interrupted
prototyping and 3D complex structures. 3D printing is con- operation. Moreover, origami-infused EM structures - impos-
sidered a key enabler of this movement, with its ability sible to realize with conventional manufacturing processes
to unlock the use of two additional dimensions, and the - were fabricated on paper substrate achieving a combi-
introduction of features that are otherwise unreachable using nation of low cost, reconfigurability, flexibility and ease
traditional manufacturing methods. 3D printing is known as of fabrication [167]. These shape-shifting electromagnetic
an additive technique since the designs are typically built up, structures offer shielding, filtering and reconfigurability,
rather than etched or milled, leading to a large reduction in required for wearable systems in an on-body setting. On the
waste material and tooling: only the material that is necessary package and die levels, hybrid manufacturing - inkjet and
is printed. With the continuous improvements in 3D printing 3D - has enabled the implementation of smart multi-function
technologies such as micro stereolithography, high precision System on Package (SoP), System in Package (SiP) modules
and resolutions down to several microns can now be realized, with intelligent interconnects and encapsulation, demonstrat-
making it compatible for applications requiring mm-wave ing a performance superiority over traditional packaging
and beyond. Another important feature required for the real- methods such as ribbon bonds and wire bonds [168]. On
ization of printed wireless electronics at RF and mm-wave the component level, the multilayer deposition of materials
frequencies is multi-material (conductors, semi-conductors, with different conductive properties allowed the realization
and dielectrics) capability. Inkjet printing, a subset of addi- of fully-printed passive and active devices in additive to ultra-
tive manufacturing, operates based on a Drop on Demand sensitive chemical, gas, humidity, and temperature sensors
concept, where the ink is disposed onto the substrate using based on printed functionalized carbon-nanotubes (CNTs)
an ink cartridge consisting of an array of nozzles with ink [9].
individual piezoelectric elements. Combined in one system, These breakthrough implementations enabled by addi-
inkjet and 3D printing enable the development of smart het- tive manufacturing techniques unlock the ability to develop
erogeneous architectures involving antennas, RF/mm-wave low-cost, zero-power, smart and responsive health and bio-
circuits, interconnects, sensors, microfluidic channels and monitoring devices capable of communicating real-time
more [9], [10]. health data at long-ranges while being completely conformal,
AMTs are not limited to specific materials or substrates bendable, and compatible with the human skin.
and have been demonstrated to be successful and often supe-
rior on multiple scales ranging from systems, to packages D. EVALUATION
to dies and finally individual components. On the system 1) EVALUATION TECHNIQUES AND TISSUE PROPERTIES
scale, cutting-edge mm-wave structures were realized on Experiments with human-body physical phantoms are indis-
flexible Kapton polyimide, Liquid Crystal Polymer (LCP), pensable to validate the results of numerical simulation or
and Teflon/PTFE substrates, with printed silver nanopar- to avoid animal experiments particularly for implantable
ticles (SNP), gold, graphene, and polymer-based inks, antennas. The validation and testing of antennas used in
demonstrating ultra-low power communications at km ranges bioelectromagnetics applications are done using materials

374 VOLUME 3, 2022

that mimic the electrical properties (εr and σ ) of the human
tissues [14]. The human body is complex and heterogeneous
with different tissues, all of which have unique dielectric
properties.
Specifically, the dielectric properties of tissues are
frequency- and tissue-dependent. Tissues of higher water
content such as muscle and cerebral spinal fluid are more
conductive than dryer or oily tissues such as bone and
fat, and some tissues such as bone and nerve tissues have
elongated cells and can be anisotropic. There is also sub-
stantial variation in the measured properties within a given
organ, as a function of age, and across individuals and
species [169], [170].
There is a wide range of measured data on tissue
properties [74]. The most commonly-used data for healthy FIGURE 7. (a) Implantable Antenna testing using 3-layer muscle-fat-skin gel,
(b) Construction of complex tissues using layered gels, (c) Adjustable gel thickness
tissues is [171]. Data is also available for many types of can- and color using different formulas in [192]-[196] (d) Gels mimicking various tissues
including Kidney, Pancreas, Brain, Liver, Tumor, Fat, Muscle and Skin.
cerous tissues, as well. When homogeneous models are used,
for quick approximation of whole-body exposures to far-field
sources, it is standard to use 2/3 muscle for the tissue prop-
erties. This means the permittivity and conductivity are each Whether liquid, solid or semi-solid all phantoms tend to
multiplied by 2/3. More recent data includes the variability enable reasonable performance evaluation in terms of effi-
and uncertainty of the measurements [171], which results in ciency and radiation patterns. At higher frequencies (e.g.,
variation in electromagnetic dosimetry results [172], [173]. above 6 GHz), the EM waves do not penetrate deeply into
the body and hence the internal structure is less critical. At
lower frequencies, wearable antennas will be affected by the
2) EXPERIMENTAL EVALUATION
muscle and bone below the skin and the fat. Therefore, these
Tissue mimicking phantoms have been designed and char- semi-solid phantoms are more suitable for lower frequencies.
acterized in several studies [174]–[178]. The core ingredient For example, semi-solid layered (skin-fat-muscle) phan-
varies with each phantom causing the material to acquire toms were developed at 950 MHz band [205] and at 20 MHz
three different forms: liquid, solid, and semi-solid. Most liq- band [206]. Semi-solid phantoms are suitable to the exper-
uid phantoms are composed of water and saline mixtures iments for implantable antennas, in particular, because it is
since the human body is mostly water. These phantoms quite easy to embed antennas at the right position in the
have been used in several applications testing wearable phantoms and to fix them without any additional support.
and implantable antenna and RF components [174]–[178]. Another example of semi-solid phantoms is a so-called
Although easy to develop, liquid phantoms cannot be used “UWB phantom” [207]. A single phantom is required for the
to emulate complex tissues where the testing is done using evaluation of UWB antennas over the entire wide frequency
multiple layers of tissues such as skin/muscle/fat composi- range. By adjusting its composition properly, the UWB
tion. In addition, liquid phantoms lose their initial electrical phantom [207] covers the frequency range from 2 GHz to
properties due to evaporation and the environmental condi- 10 GHz. Other publications utilizing semi-solid and solid
tions they are kept in. For these reasons, the most popular phantoms consider also more sophisticated heterogenous
and easy to use phantoms are made of solid or semi-solid phantoms. These phantoms are suitable for applications
materials. In addition, testing the device in liquids can be that require the representation of heterogeneous tissues and
messy and quite cumbersome. The solid phantoms synthe- organs. For instance, depending on the frequency of opera-
sized in previous research consisted of plastics, polyethylene tion, one approach is to use effective electrical properties of
powder and saline, silicon rubber, ceramic powder and resin, a specific tissue like skin at low frequencies, while at higher
and strontium titanite powder and resin [33], [179]–[185]. frequencies, the layers of the skin need to be individually
Solid body phantoms have longer shelf life, are easier fabricated to better mimic the overall electrical properties
to handle and test. However, they are not suitable for which semi-solid and solid phantoms offer a good solution.
SAR measurements where the access inside the phantom is Although there are many ways to measure the electrical
required [33], [183]–[187]. The solid phantoms are mainly properties of phantoms, the most commonly used technique
constructed using the average dielectric properties among is to utilize an open-ended coaxial cable that allows the
various tissues rather than of each individual tissue. As measurement of dielectric constant and conductivity for a
a result, phantoms with multiple layers of tissue cannot wide variety of frequencies [39], [176], [177], [193]. These
be synthesized. To tackle this issue, semi-solid phantoms reflection coefficient-based measurements allow the prop-
are introduced that utilize various materials as described erties of interest to be measured from 50 MHz to 50 GHz
in [188]–[204], Fig. 7. covering the majority of microwave frequency bands. This is

VOLUME 3, 2022 375

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

extremely important since mm-wave 5G deployment, which

covers 26-28 GHz bands and above, is in the near hori-
zon. This next generation of mm-wave 5G will require the
deployment of more antennas, transmitters, and receivers
which will increase the need for research on human body
– mm-wave interaction. Besides implantable and wearable
applications, the development of high-frequency tissue mim-
icking phantoms will play a crucial role for the study of these FIGURE 8. Distribution of the 1-g averaged SAR generated by an implanted antenna
inside five head models [239].
interactions.
There are many challenges to human-body physical phan-
toms such as a dynamic phantom and a transparent phantom,
to just name a few. A dynamic phantom is needed to sim- canonical/spherical and three anatomical) is shown in Fig. 8.
ulate movement of the human body or internal blood flow. Indeed, high resolution models of specific parts of the body
If a semi-solid phantom is transparent, it would be easy to such as the head [229], heart, lungs, thorax [230], [231],
locate implantable antennas and to confirm their conditions breast [232], [233] are available. Models of mice and rats,
from outside of the phantom. In addition, every human has crabs, fish, frogs, dogs, bees, deer, ducks, worms, goats,
a different shape of head and different composition of tis- pigs, and rabbits also exist [229], [234]. When the electro-
sues. It is important to carry out electromagnetic simulations magnetic effects are highly localized, as with many near-field
with the different available anatomical models which account sources, only the impacted portions of the model need to be
for age (e.g., adults vs. children) and other inter-subject used, thus saving computational time.
variability [208]. Specific details of the model can make a profound dif-
Overall, the phantom development for medical appli- ference on the fields produced in and around the body.
cations continues to evolve as 3D printing technologies Height [235], size (e.g., adult vs. child, size of head, torso, or
improve. We anticipate that, in the near future, more realistic other parts of the body) [236], shape, tissue properties, etc. all
personalized human body phantoms will become a reality. impact the fields. Even individual portions of the body such
as the head have their own size-dependent resonances [237].
3) COMPUTATIONAL EVALUATION Here, we note that challenges with creating good anatomi-
1) Models of the body and sources: There are numerous cal models for electromagnetic dosimetry include a shift in
models of the body at various levels of detail. Simple models the apparent location of fat and water-based tissues such as
such as prolate spheroids [209], simple block models [210], muscle by as much as 4-5mm in MR-derived images [211],
and layered models [211] that were commonly used through- deflation of the lungs, heart, and other organs when deceased
out the 1970s-1990s are surprisingly good at estimating the bodies are modeled [30], changes in shape from models
total field exposure in the body due to a plane wave, and lying prone (such as feet resting in a toes-pointed position
can be used for quick estimates. Simple models may also be rather than flat) [220], blur or jitter from moving organs
useful for very near-field applications, where the fields do such as beating heart and breathing lungs, and a general
not reach other parts of the body, and hence, they have little difficulty in characterizing the material in regions between
or no effect. To predict detailed distributions of the fields in major organs [220].
and around the body from near-field sources more detailed For electromagnetic sources that are in or very near the
anatomical models are used. body (medical implants, cell phones, wearables, etc.) the
Anatomical models based on Magnetic Resonance exact placement and orientation of the source significantly
Imaging (MRI) or Computed Tomography (CT) scans or impacts the field distribution [172], [238]. Near-field sources
X-rays/visual images, are often used for both nuclear such as cell phones, medical implants, etc., require great
radiation and bioelectromagnetic dosimetry [212]. These precision in their modeling. X-rays [221] and CAD models
include the GSF family of models (adults, children, have been used to provide detailed modeling [239]. How
infants) [143], [212], the Yale Voxelman [213], [214], the source is placed in/near the body also has a significant
NORMAN man model [215], [216] and NAOMI woman impact on the fields [172], [236]. Far-field sources typically
model [217], RPI VIP Man [218], [219], the Utah Man require somewhat less precision.
Model [220], [221] and Utah Head Model [211], the Visible 2) Computational methods: Computational methods use
Man and Woman project from the National Institutes of approximations of electromagnetic wave propagation to
Health [222], Japanese Computational Phantoms that include determine how the fields propagate from internal and/or
adults, children, infants, and pregnant women at various external sources and reflect, propagate, and absorb within the
stages of gestation [223], voxel [224] and polygonal [225] voxel models of the body as described earlier in Section II-
male and female models based on CT scans, Korean D3 (with each voxel having defined tissue properties). The
adult models [226], [227], pregnant models in different fields can be approximated in either the frequency domain
positions [228]. An example SAR distribution generated by (as with the impedance method, method of moments [240],
an implanted antenna within five different head models (two or finite-element method (FEM) [240]) or in the time

376 VOLUME 3, 2022

domain using the finite-difference time-domain (FDTD) electromagnetic fields without significantly perturbing them.
method [241] or finite element time domain method [242]. The first two of these were discussed in Section II-D, and
In the frequency domain the fields are treated as being sinu- the measurement methods are discussed below.
soidal steady state, where any transient effects have died Specific absorption rate (SAR) is a widely-used dosimetric
away. The magnitude and phase of the sinusoidal field is measure, due to its use in regulations and guidelines [248].
calculated in each voxel in the model. In the time domain With a semi-solid phantom, two-dimensional SAR distribu-
the transient fields are calculated in each voxel as a function tion can be quickly evaluated by use of the thermographic
of time. method [249]. This technique utilizes measured temperature
The FDTD method is widely used in bioelectromagnet- rise on the phantom surface caused by short-time EM expo-
ics due to its efficiency and versatility. It has been used to sure. The SAR on the observation plane is figured by the
model fields in the human body with high resolution (1 mm following equation:
or less) for a wide variety of sources from 60 Hz [243]
through optical frequencies [241]. FDTD solves the time SAR = c · T/t[W/kg] (1)
domain Maxwell’s equations for the six vector compo-
where c is the specific heat of the phantom, T is the
nents of the electric and magnetic fields in a voxel model
temperature rise, and t is the EM exposure time. When
of the body. The voxel size () is most often chosen
the exposure time is short enough, the above equation gives
based on the size of the physical structure being evalu-
reasonable results. Another advantage this method is that it
ated. This then determines the maximum frequency for that
can be easily applied to a system with multiple frequencies
model, as  should be < λmin /10. The FDTD method has
or wide spectrum, because it is independent of frequency.
been extended to very low frequency simulations (down
SAR is also measured by using electric field probes to
to 60 Hz) [243], broad band models where the electrical
measure the electric field E, and then calculating it from:
properties of the tissues vary with frequency [244], and mod-
els where the electrical [173], [245] and geometric [246] σ |E|2  
properties of the tissues vary statistically. SAR = W/kg (2)
2ρ
4) DOSIMETRY where σ is the electrical conductivity [S/m), and ρ is the tis-
Bioelectromagnetic dosimetry predicts the dose and nature sue density [kg/m3 ]. SAR is typically averaged over 1-gram
(polarization, frequency spectrum, etc.) of electromagnetic or 10-gram sections of tissue, and today’s guidelines require
fields in the body. It is important for device design, eval- inclusion of a variation budget to account for expected
uation of the interaction between electromagnetic sources variability in the models and measurements [250], [251].
and the body, and understanding or controlling the natural
electric fields of the body. This can be done with either sim- III. EMERGING BIOELECTROMAGNETICS
ulations or measurements [247]. The application of interest APPLICATIONS
controls whether the dosimetry is needed in the frequency A. MICROWAVE ABLATION
domain, time domain, or both, and it is common to transform Therapeutic applications of microwave energy include abla-
between these two domains. The application also controls tion, diathermy and hyperthermia. These techniques are often
the frequency band of interest. Broad-band measurements called as thermal therapies, which basically employ temper-
and simulations can be difficult. It is generally more effi- ature elevation in human tissue. Unlike hyperthermia that
cient to simulate single frequencies and combine them for is usually required to heat the tumor up to the temperature
broader band applications. The bandwidth of measurements between 42 and 45 ◦ C, ablation heats up the tumor/tissue
can also be limited by how well-matched tissue simulant over 60 ◦ C. Microwave Ablation (MWA) utilizes a thin
materials can be to real tissues over broad bands, and the antenna or an applicator which is inserted directly into the
accuracy of measurement equipment over broad bands. For target tissue to be treated [16]. Typical operating frequencies
both simulations and measurements, it is common to evalu- are 915 MHz and 2.45 GHz. Fig. 9 shows some examples of
ate individual frequencies or narrower bands, and combine typical antennas for MWA. In Fig. 9(c), a quarter-wavelength
them computationally as needed. sleeve is attached to suppress the electric currents flowing
Numerical dosimetry requires: (1) an appropriate model back on the outer conductor as described later in this section.
of the body and the electromagnetic source, (2) dielectric Coaxial-slot antennas [252] shown in Fig. 9(d) and (e) have
properties of the tissues and materials at the frequencies of been widely employed for clinical use.
interest, and (3) a computational method that can simulate Recently, with the advent of various medical imag-
the electromagnetic fields. Each of these have been discussed ing technologies and an increasing demand for improving
earlier in Section II-D. Experimental dosimetry requires (1) QOL (quality of life) of patients, image-guided MWA has
an appropriate phantom model of the body, including mate- emerged as a minimally invasive therapeutic modality for
rials with appropriate materials to represent the body tissues the treatment of unresectable tumors and cardiac arrhyth-
at the frequencies of interest, (2) an appropriate electromag- mias, neuromodulation, and other applications. One of the
netic source, (3) a measurement method that can measure the key techniques to MWA is how to guide an antenna to the

VOLUME 3, 2022 377

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

been changed to control heating patterns to some degree.

Another way is to attach a tapered slot balun which achieved
localized heating patterns and good impedance matching over
a wide frequency range [261].
Traditionally, RF current or ultrasonic vibration have been
widely applied to surgical devices for cutting or coagulat-
ing biological tissues during surgery. However, they have
some drawbacks such as generating unwanted excessive
high temperature or creating mist and spray [262]. Recently,
FIGURE 9. Examples of typical antennas for MWA: (a) Monopole antenna,
(b) Extended monopole antenna, (c) Sleeve antenna, (d) Coaxial-slot antenna [252], microwave energy has been successfully applied to mod-
(e) Coaxial-slot antenna with multiple slots [252], (f) Helical antenna. ern surgical devices which are necessary for laparoscopic
surgery [262], [263].
There are still many challenges to microwave abla-
right position for treatment. MWA has been widely per- tion. In this section, two important challenges are
formed under the guidance of computed tomography (CT). addressed. Specifically, it is essential for the development
Alternatively, ultrasound (US) has been used as the guid- of MWA antennas and clinical treatment planning to numer-
ance to avoid exposure to ionizing radiation and to reduce ically evaluate distributions of SAR as well as temperature
the cost [253]. However, for these imaging techniques, in tissues generated by the antennas. For such numeri-
image contrast may be sometimes insufficient and there- cal evaluation, biological tissues are modelled with their
fore treatment may not be perfect. More recently, magnetic physical properties including dielectric and thermal parame-
resonance (MR) guidance has been developed as a promising ters. Unlike hyperthermia, a significant change of dielectric
modality, although the cost is rather high [254]. and thermal parameters must be considered during abla-
In terms of electromagnetic ablation, besides MWA, tion treatment, because the targeted tissue gets desiccated
RFA (Radio Frequency Ablation) and LA (Laser Ablation) or charred with temperature well exceeding 60 ◦ C. It is
have been widely applied to clinical use. RFA has two differ- obvious that the water content ratio over the targeted tissue
ent systems, namely, monopolar and bipolar systems. Typical significantly affects physical properties of the tissue. Several
operating frequency range for RFA is about 400 kHz to groups have studied and reported numerical modelling and
500 kHz. A monopolar RFA system requires an external experimental validation of microwave ablation incorporating
electrode to form an electric current path. Both MWA and water vaporization or dehydration [264], [265]. For further
RFA have advantages and disadvantages in clinical treatment. improvement, other factors such as a change of blood flow
Comparison between MWA and RFA has been discussed rate and tissue contraction should be incorporated as well.
and summarized in, for example, [255] and [256] from clin- The term “theranostics” is used as a combination of “thera-
ical viewpoint. LA is another type of minimally invasive peutics” and “diagnostics” that are combined simultaneously
therapeutic modality using the laser light and an optical or sequentially in a clinical situation. For example, a com-
fiber [257]. MR-guided LA is an option for the treatment pact and thin microwave theranostic device was developed
of brain tumors, in particular. It may further reduce certain and reported in [266] which can act as an applicator for ther-
risks associated with traditional open brain surgery. mal ablation and as a sensor to detect malignant tissue. The
Antennas used in MWA systems should ensure efficient device employs oval-shaped Split Ring Resonators (SRRs)
power transfer to the targeted tissue, through a heating working in a frequency range between 8 GHz and 12 GHz.
pattern well matched to the size and shape of the target. In the treatment mode, SRRs perform microwave ablation.
Most MWA antennas generate axisymmetric heating pat- For the detection mode, resonance frequency changes due to
terns around the antennas in homogenous tissue because of abnormalities are evaluated. Although further work should
their axisymmetric structure. However, a directional heating be done to realize such theranostic devices, they would be
pattern may be required for some specific scenarios where, quite beneficial not only to hospitals but also to patients.
for example, a target tumor is close to the bowel which
should not be ablated. Different types of MWA antennas
with directional heating patterns have been developed and B. MICROWAVE IMAGING
reported [258]–[260]. Microwave imaging for biomedical applications has a long
Most MWA antennas are made of thin coaxial cables and history. It started with the idea of extending to diffracted
designed with some mechanism to suppress the electric cur- radiation (at radiofrequencies and microwaves) the diagnostic
rents flowing back on the outer surface of the coaxial cables. approaches originally based on ray propagation. Microwave
These outer-surface electric currents may cause unwanted imaging aims at providing qualitative or quantitative maps of
heating of healthy tissue along the antennas. Different tech- the dielectric properties of the body under test (e.g., dielec-
niques have been proposed to control or localize heating tric permittivity and electric conductivity), correlating them
patterns along the antennas. For conventional coaxial-slot with the presence of any pathology. Indeed, implement-
antennas [252], the number of slots or slot positions have ing this imaging modality needs to face several problems

378 VOLUME 3, 2022

 of developing suitable reconstruction algorithms. The recent
improvements towards these issues have been thoroughly dis-
cussed in several books (see, for example, [269]–[271] and
the references therein), which delineate microwave imag-
ing methods as complementary tools with respect to more
consolidated diagnostic techniques.
One of the first proposed applications for medical imaging
at microwave frequencies is related to the detection of breast
tumors. Despite the conflicting studies about the dielectric
characterization of breast tissues and the scarcity of in vivo
measured data, several systems have been developed with
the goal of performing clinical trials. Recent results have
been summarized and compared in some detailed review
papers, such as [272]. Some systems are close to enter in
FIGURE 10. Configuration and main components of a microwave imaging system a commercialization phase. As to the inversion process,
for biomedical applications.
there is a large variety of proposed methodologies, such
as those based on tomography, radar-based approaches, and
microwave holography. Both quantitative [273] and qualita-
and challenges, which mainly derive from scattering and tive methods [274]–[276] have been proposed and applied
polarization effects of microwave radiation. to experimental systems, with pros and cons not always so
The pioneering results in this field, collected by simple to understand with respect to the real disease to be
Larsen and Jacobi [267], were achieved around 40 years detected. It is worth noting that portable and wearable imag-
ago. Compared to the historical developments of other tech- ing devices have also been designed and initially validated
niques (e.g., X-ray computerized tomography and magnetic in clinical settings. Although most systems operate between
resonance imaging), a spontaneous question raises concern- 1 and 10 GHz, recent research aims at checking the possible
ing the real-life potential of microwave imaging as an effec- diagnosis of breast tumors at higher frequencies.
tive tool for medical diagnostics. Indeed, despite a sequence Another field where microwave-based diagnostics have
of “enthusiastic” and “disillusion” phases throughout the recently shown promising outcomes is the detection of brain
years (as very well explained in [268]) this challenging stroke. In particular, along with the devices that aim at an
problem is nowadays tackled by a continuously increas- early stroke classification [277], other approaches investigate
ing number of research teams around the world and new the quantitative reconstruction of the internal dielectric prop-
optimistic perspectives seem to be opened by many recent erties of brain [278], [279]. Qualitative and hybrid imaging
developments. modalities have also been considered, also assessing the pos-
The typical configuration of a biomedical microwave sible use of flexible antenna arrays [280]. Head scanning
imaging system is illustrated in Fig. 10, which shows its systems for stroke imaging are currently undergoing clinical
main components and an example of results. Roughly, two trials with encouraging results [281], [282].
essential parts are identified: the microwave measurement In addition, other medical applications are currently
system (on the left) and the control/processing techniques pioneered by the research community. For instance, the
(on the right). The measurement system aims at collecting, detection of osteoporosis has been initially investigated some
in the most accurate way, measures of the electromagnetic years ago and is now seeing a renewed interest [283].
field or some related quantities (e.g., transmission/reflection Another application is the imaging of the chest [284], which
S-parameters) around the body under test. This is done may be interesting for detecting the fluid accumulation inside
by means of a set of custom antenna elements. A cou- and around lungs. Furthermore, portable microwave systems
pling medium (liquid or solid) is usually interposed between for knee imaging have been recently proposed [285], also
those imaging antennas and body, but discussions exist on developed as a wearable textile brace [286], with the goal
its relevance and its composition, which also depend on of detecting ligaments/tendon tears. Microwave imaging of
the proposed application. The acquired data are exploited the neck has also been considered, for the possible diagnosis
to solve a radar-based, statistical or an inverse scattering of cervical diseases [287]. Moreover, recent studies propose
problem, whose solution technique can be seen as the “core” the use of imaging techniques at microwave frequencies for
of the whole imaging methodology. The inversion process is the monitoring of thermal ablation (which is discussed in
theoretically nonlinear if no simplifying approximations are another section).
assumed [269]. In summary, while novel clinical uses of microwave
All these components require special care if medical diag- imaging are currently under investigation, such interesting
nostics are pursued. Limiting factors may arise due to the perspectives require systematic analyses from both theoreti-
possibly low dielectric contrast between tissues of interest, cal and experimental points of view. It is worth noting that, in
the achievable spatial resolution, as well as the difficulty the validation of experimental imaging systems, a key role is

VOLUME 3, 2022 379

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

played by the development of suitable phantoms of the body Given the use of inductive coupling, various versions of
region of interest [288]. Of course, a better knowledge of external and implanted loop antenna systems operating in the
the contrast in the dielectric properties of healthy and patho- frequency range of a few hundred MHz to a few GHz are
logical tissues in vivo is crucial. Considering the impressive used for the wireless link [111], [295]. For the interroga-
increase in the available computing power, as well as the tor, the primary goals are minimizing specific absorption
continuous improvements in microwave and antenna tech- rate (SAR) while maximizing power transfer. To reduce
nologies needed to develop effective imaging apparatuses, a “hotspots” on the loop antenna and therefore SAR of the
major challenge is still represented by processing and recon- tissue below, [296], [297] divided a loop antenna into two
struction methods, which – despite a plethora of proposals segments connected by capacitors, while [111] suggests tilt-
and tests – need further works and comparisons. ing the interrogator to be nonparallel to the tissue below.
Increasing the number of loops also helps maximize power
transfer [298].
C. NEUROSENSING
Though these passive devices eliminate the need for wired
1) NEUROSENSING APPLICATIONS AND NEURAL
SIGNALS connections and batteries, they still use an IC, which requires
space and power. The addition of an IC increases the size
The ability to record brain signals has the potential to of a 1 mm3 implant by at least 100%, increasing the likeli-
improve the understanding and treatment of a variety of neu- hood of initiating the body’s immune response to a foreign
rologically based conditions including Alzheimer’s, epilepsy, object [299]. Transmitting power to the implant poses a risk
depression, addiction, and more [289]–[291]. However, cur- in terms of tissue heating, and thus, SAR must be carefully
rent brain-computer interface (BCI) technology falls short of considered in the system design. Additionally, these loop
fulfilling such potential due to safety concerns, which limit antennas are sensitive to misalignment, which is almost a
the recording environment and increase patient risk. These guarantee given the antennas cannot be visually aligned.
concerns include: (1) wired connections from the implant
to the external environment, which restricts recording to 3) FULLY PASSIVE NEUROSENSORS
a laboratory setting [291], [292]; (2) reliance on batteries, To eliminate the need for an implanted IC, fully passive
which require additional surgeries for replacement [293]; and neurosensors rely on microwave backscattering and perform
(3) densely packed electronics on the implant, which can all amplification at the interrogator. The interrogator trans-
generate enough heat to damage surrounding neurons [294]. mits a carrier signal, which is then mixed by the implant
To address these shortcomings, wireless passive neural with neural signals prior to backscattering a higher order
implants were proposed [93], [111]. These passive neurosen- mixing product (i.e., second harmonic) to the interrogator
sors operate much like a RFID tag, utilizing an external for demodulation. Fully passive devices typically operate on
interrogator to transmit a signal to turn on an implant, the order of a few GHz, most with a 2.4 GHz carrier signal
which then transmits the neural signals back to the interroga- and a backscattered mixing product centered at 4.8 GHz.
tor where post-processing can occur. Given the low voltage The higher frequencies equate to smaller and more complex
of neural signals (down to 2 or 20 μVpp ), many of these antenna designs than the loops used for passive devices, but
implants still require power, typically via power harvest- tissue attenuation limits the upper frequency and therefore
ing, to amplify neural signals before transmission to the antenna size.
interrogator. Another class of BCIs, so-called wireless fully In [300], a 10 × 3.5 mm2 implant using a slot antenna
passive neurosensors, relies solely on microwave backscat- with a diode pair and chip capacitor to perform the fully
tering for transmitting the modulated signal, thus eliminating passive mixing communicated with a waveguide antenna
the need for power at the implant. Both passive and fully interrogator as a proof-of-concept. Building on the proof-of-
passive devices address the concerns with traditional BCIs, concept, [301], [302] use a slot antenna for both antennas
but likewise come with their own challenges. and detects 6 mVpp emulated neural signals from a func-
tion generator with the antennas transmitting through a skin
2) PASSIVE NEUROSENSORS and bone phantom. Aiming to improve sensitivity, [303] use
Passive devices utilize an energy harvester on the implant an anti-parallel diode pair for the mixer, an E-shaped patch
to amplify low-level neural signals prior to transmitting to antenna for the implant, and a spiral for the interrogator.
the interrogator. Unlike traditional BCIs, passive devices do The sensor detects function generator emulated neural sig-
not store energy and therefore do not require a battery. The nals as low as 63 μVpp through a 2/3-muscle phantom [35].
most successful source from which to harvest the power thus To reduce the size of the implant from 39 × 15 mm2 to
far is inductive power transfer, but harvesting the body’s 8.7 × 10 mm2 , the implant is folded in half with the circuit
glucose is also being explored [111]. For inductive power on one side, the antenna on the other, and the ground plane
transfer, the wireless link in combination with an integrated sandwiched between, and a higher permittivity substrate is
circuit (IC) on the implant serves to rectify and regulate used. Sensitivity is increased to 20 μVpp by optimizing the
the power provided for amplification. Thus, wireless link implant matching network and using a patch antenna for the
optimization is key for passive sensing. interrogator [304], [305].

380 VOLUME 3, 2022

 Challenges with fully passive devices center around the to both the very low frequency content of neural sig-
lack of power at the implant. In fact, the conductivity of nals and the traditional low frequency embodiment of
tissues is typically high, and it thus dissipates the interro- wireless power and data transfer systems. Of particular
gated power into heat. Hence, the overall power available relevance to the development of modern neurostimulators
at the implant might not be adequate to operate the system is the newly acquired capability to model electromag-
considering the amount of absorbed power by head tissues. netic signaling in complex, large, morphologically accurate,
Neural electrodes typically have very high, frequency- neural networks [315]–[318]. “Connectomics” – as it is
dependent impedances (tens of k to M), which tradi- commonly referred to – provides comprehensive, morpho-
tional BCIs match with operating amplifiers [299], but this logically accurate maps of the neural network [316]; the
technique requires power. In [18], a bipolar junction tran- ability to handle Terabyte-sized connective maps of both
sistor (BJT) passively increases the implant impedance but healthy and degenerated/diseased neural networks enables
is only able to match lower impedance electrodes (i.e., an unprecedented opportunity to understand signaling at
macro instead of microelectrodes) [306]. Additionally, the the network level, and consequently design neurostimulators
discussed passive and fully passive devices are limited to through bioelectromagnetic predictive modeling methods.
recording a single channel (i.e., one electrode, one brain Further, innovation in multi-coil wireless systems and meta-
location). In [307], [308], multichannel devices using pho- surfaces has opened the opportunity to realize wireless
todiodes for channel switching are designed but the devices neuroimplants that are smaller and more efficient than ever
are large (40 × 40 mm2 ), can only record from 8 channels, before [7], [319]–[323].
and cannot concurrently record channels. As with passive Several neuroimplants capture the innovation described
devices, antenna misalignment is also an issue [309], as is above. Examples of these systems are an artificial retina
biocompatibility of the implant [299]. to restore partial vision to the blind [324], [325] and a
hippocampal prosthetic for memory restoration [318]. The
D. NEUROSTIMULATION artificial retina attempts to restore vision in the blind affected
Electric and magnetic stimulation of neural tissues, such by progressive and relentlessly advancing retinal degener-
as transcranial magnetic stimulation and deep brain stim- ation conditions, such as Retinitis Pigmentosa (RP) and
ulation, are widely adopted in neuroengineering as an Age-Related Macular Degeneration (AMD). There is no
attempt to restore partial neural function, usually lost due known cure for these conditions; in these pathologies, pho-
to disease or traumatic injury. An increasing number of toreceptors (the neural cells converting light to electrical
medical conditions are being treated with neurostimulators, signal) progressively degenerate, ultimately resulting in fur-
and have resulted in encouraging, and sometimes dra- ther neuronal damage, functional alterations, and extensive
matic, partial restoration of function [310]. The premise for remodeling of retinal networks. Over the past 25 years,
these implants generally involves injecting current through researchers have been working on a device comprised of an
electrodes to directly stimulate downstream neurons, thus epiretinal electrode array to directly stimulate surviving reti-
bypassing the upstream diseased or damaged neural cir- nal cells and supporting system to drive such array, including
cuitry. Computational and experimental bioelectromagnetics a camera to record images in front of the patient and a wire-
methods are at the core of the development of modern less system to transfer power and image data to the implanted
neurostimulators, which are now complex systems integrat- device. The design of the epiretinal electrode array and stim-
ing multifunctional capabilities (such as recording, sensing, ulating waveforms – designed to target retinal cells with
and stimulating) [258], [259], wireless devices (for efficient specificity while avoiding undesirable effects such as direct
wireless power and data transcutaneous transmission) [312]– stimulation of axon or spontaneous firing of retinal cells –
[314] and biocompatible interfaces and packaging. The ulti- can be successfully carried out with the use of low-frequency
mate and ambitious goal is to render neurostimulators “true” computational platforms supported by pathoconnectomes of
biomimetic systems, capable to replacing the lost function- the retina (Fig. 11). These pathoconnectomes (connectomes
ality of damaged neurons in a seamless way, with safe and of the diseased retina at various stages of degeneration),
selective neuroactivation of downstream neurons, in small when utilized with low-frequency electromagnetic compu-
form factors that are compatible with surgical interventions. tational methods, have allowed for the development of
Although the complexity deriving from the multi-temporal neurostimulation signals that have greatly improved the
and multi-spatial natures of the nervous system - span- opportunity in retinal prosthetic, such as the ability to encode
ning multiple disciplines from large-scale electromagnetic “color” in the percept [315] or avoid the direct stimulation
field and thermal modeling to neuromodeling - has hin- of axons, thus avoid “streaking” vision percepts. Integration
dered the rapid progression in this field, recent advances with Computer Vision and Artificial Intelligence methods
in computational and experimental bioelectromagnetics enables improvement of image interpretation and understand-
embrace this complexity and open new doors to potential ing (e.g., object recognition) as well as image processing
treatments. tasks (e.g., segmentation) and opens up new opportunities
Low frequency bioelectromagnetics is considered partic- towards the development of novel task-based visual assistive
ularly significant for neurostimulation applications, owing systems [326], [327].

VOLUME 3, 2022 381

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

multifunctional capabilities (such as recording, sensing, and

stimulating).
The abovementioned list of challenges is by no means
limiting and research opportunities in electromagnetics,
antennas, dosimetry, sensors, electronics, and materials are
truly endless.

REFERENCES
[1] P. Momenroodaki, W. Haines, M. Fromandi, and Z. Popovic,
“Noninvasive internal body temperature tracking with near-field
microwave radiometry,” IEEE Trans. Microw. Theory Techn., vol. 66,
no. 5, pp. 2535–2545, May 2018.
[2] G. Lazzi, R. Lee, and K. S. Nikita, “Guest editorial for the special
issue on wireless real-time health monitoring technology for per-
sonalized medicine,” IEEE Trans. Antennas Propag., vol. 67, no. 8,
pp. 4946–4954, Aug. 2019.
FIGURE 11. Model of the pathoconnectome of the first stage degenerated retina [3] A. Kiourti and K. S. Nikita, “A review of in-body bioteleme-
tiled with elements of a healthy connectome to create a complete retinal network.
Accurate electrical models of the neural cells in this network, as well as the capability
try devices: Implantables, ingestibles, and injectables,” IEEE Trans.
to model extremely large computational networks, has enabled the opportunity to Biomed. Eng., vol. 64, no. 7, pp. 1422–1430, Jul. 2017.
accurately predict neural response in a diseased neural network as a result of [4] S. Ma, L. Sydänheimo, L. Ukkonen, and T. Björninen, “Split-ring res-
neurostimulation. Figure courtesy of Dr. P. Kosta, University of Southern California. onator antenna system with cortical implant and head-worn parts for
Data from the laboratory of Dr. B. Jones, the University of Utah. effective far-field implant communications,” IEEE Antennas Wireless
Propag. Lett., vol. 17, pp. 710–713, 2018.
[5] A. Kiourti and K. S. Nikita, “A review of implantable patch antennas
for biomedical telemetry: Challenges and solutions,” IEEE Antennas
Propag. Mag., vol. 54, no. 3, pp. 210–228, Jun. 2012.
[6] P. Rayner, S. Zhang, D. Cadman, J. Vardaxoglou, and W. Whittow,
IV. CONCLUSION “Wearable and meshed wideband monopole antennas and their inter-
This paper provided a comprehensive overview of enabling actions with the human body,” IET Microw. Antennas Propag.,
vol. 13, no. 14, pp. 2412–2418, 2019.
technologies for next-generation wearables and implants and [7] M. Machnoor, J. Paknahad, J. Stang, and G. Lazzi, “Wireless teleme-
illuminated some key applications of high clinical promise. try system with independent power and data frequency resonance,”
As is evident, opportunities brought forward by electromag- IEEE Antennas Wireless Propag. Lett., vol. 19, pp. 690–694, 2020.
[8] M. Manoufali, K. Bialkowski, B. Mohammed, and A. Abbosh,
netics in healthcare are exciting. It is, thus, not surprising “Wireless power link based on inductive coupling for brain
that extensive research is currently being pursued in this implantable medical devices,” IEEE Antennas Wireless Propag. Lett.,
regard and that numerous wearables and implants are being vol. 17, pp. 160–163, 2018.
[9] A. Eid et al., “Nanotechnology-empowered flexible printed wireless
commercialized and employed in applications as diverse as electronics: A review of various applications of printed materials,”
healthcare, sports, defense, consumer electronics, and more. IEEE Nanotechnol. Mag., vol. 13, no. 1, pp. 18–29, Feb. 2019.
As would be expected, a number of challenges still remain [10] A. Eid et al., “Inkjet-/3D-/4D-printed perpetual electronics and mod-
ules: RF and mm-wave devices for 5G+, IoT, smart agriculture,
to be resolved. Body area antennas need to overcome losses and smart cities applications,” IEEE Microw. Mag., vol. 21, no. 12,
associated with the tissue environment; wearables need to pp. 87–103, Dec. 2020.
be made more reliable, secure, and seamlessly embedded [11] A. Kiourti, “RFID antennas for body-area applications: From wear-
ables to implants,” IEEE Antennas Propag. Mag., vol. 60, no. 5,
in day-to-day garments; implants need to be further minia- pp. 14–25, Oct. 2018.
turized without compromising performance; efficiency of [12] F. Curry, A. M. Chrysler, T. Tasnim, J. E. Shea, C. M. Furse,
RF power harvesting needs to be improved; inductive links and H. Zhang, “Biostable conductive nanocomposite for implantable
subdermal antenna,” APL Mater., vol. 8, Oct. 2020, Art. no. 101112.
should be made more reliable and robust to misalignment; [13] T. Karacolak, A. Z. Hood, and E. Topsakal, “Design of a dual-
flexible conductors and inks need to be formulated with band implantable antenna and development of skin mimicking gels
conductivity close to copper while still being biocompati- for continuous glucose monitoring,” IEEE Trans. Microw. Theory
Techn., vol. 56, no. 4, pp. 1001–1008, Apr. 2008.
ble; phantoms should account for the frequency-dependent [14] K. Guido, C. Matos, J. Ramsey, and A. Kiourti, “Tissue-emulating
properties of tissues and maintain these properties over the phantoms for in vitro experimentation at radio frequencies: Exploring
course of time; patient safety must be ensured at all times characteristics, fabrication, and testing methods,” IEEE Antennas
Propag. Mag., vol. 63, no. 6, pp. 29–39, Dec. 2021.
and numerical/experimental evaluations should be optimized [15] IEC/IEEE International Standard—Determining the Peak Spatial-
to match real-world scenarios; high data rate transmis- Average Specific Absorption Rate (SAR) in the Human Body From
sions need to be enabled; minimally invasive technologies Wireless Communications Devices, 30 MHz to 6 GHz—Part 1:
General Requirements for Using the Finite-Difference Time-Domain
should replace traditional surgically-implanted devices; addi- (FDTD), IEC/IEEE Standard 62704-1:2017, 2017, pp. 1–86.
tive manufacturing technologies should be optimized for [16] K. Saito and K. Ito, “Preliminary investigation of numerical esti-
environmentally-friendly solutions, fast prototyping and 3D mation of coagulated region generated by interstitial microwave
antenna,” Int. J. Hyperth., vol. 33, no. 1, pp. 69–73, 2017.
complex structures; theranostic devices for microwave abla- [17] A. Fedeli, C. Estatico, M. Pastorino, and A. Randazzo, “Microwave
tion need to be refined for clinical applications; microwave detection of brain injuries by means of a hybrid imaging method,”
imaging technologies should achieve higher resolution than IEEE Open J. Antennas Propag., vol. 1, pp. 513–523, 2020.
[18] W.-C. Chen, K. Guido, and A. Kiourti, “Passive impedance matching
currently possible; neurosensors should be made wireless for implanted brain–electrode interfaces,” IEEE J. Electromagn., RF,
and batteryless; neurostimulators should be empowered with Microw. Med. Biol., vol. 3, no. 4, pp. 233–239, Dec. 2019.

382 VOLUME 3, 2022

[19] P. Kosta, J. Mize, D. J. Warren, and G. Lazzi, “Simulation-based [41] M. Zaiembashi et al., “NanoNeuroRFID: A wireless implantable
optimization of figure-of-eight coil designs and orientations for mag- device based on magnetoelectric antennas,” IEEE J. Electromagn.,
netic stimulation of peripheral nerve,” IEEE Trans. Neural Syst. RF, Microw. Med. Biol., vol. 3, no. 3, pp. 206–215, Sep. 2019.
Rehabil. Eng., vol. 28, no. 12, pp. 2901–2913, Dec. 2020. [42] A. Kiourti and K. S. Nikita, “Miniature scalp-implantable antennas
[20] Y. Rahmat-Samii and E. Topsakal, Antenna and Sensor Technologies for telemetry in the MICS and ISM bands: Design, safety consid-
in Modern Medical Applications. Hoboken, NJ, USA: Wiley, 2021. erations and link budget analysis,” IEEE Trans. Antennas Propag.,
[21] A. Kiourti, J. R. Costa, C. A. Fernandes, and K. S. Nikita, “A broad- vol. 60, no. 6, pp. 3568–3575, Aug. 2012.
band implantable and a dual-band on-body repeater antenna: Design [43] D. Nikolayev, M. Zhadobov, P. Karban, and R. Sauleau,
and transmission performance,” IEEE Trans. Antennas Propag., “Electromagnetic radiation efficiency of body-implanted devices,”
vol. 62, no. 6, pp. 2899–2908, Jun. 2014. Phys. Rev. Appl., vol. 9, no. 2, p. 12, 2018.
[22] S. Zhu and R. Langley, “Dual-band wearable textile antenna on [44] M. Gao, D. Nikolayev, M. Bosiljevac, Z. Šipuš, and A. K. Skrivervik,
an EBG substrate,” IEEE Trans. Antennas Propag., vol. 57, no. 4, “Rules of thumb to assess losses of implanted antennas,” in Proc.
pp. 926–935, Apr. 2009. Eur. Conf. Antennas Propag., vol. 5, 2021, pp. 1–5.
[23] I. Locher, M. Klemm, T. Kirstein, and G. Tröster, “Design and [45] Y. El-Saboni, D. E. Zelenchuk, G. A. Conway, and W. G. Scanlon,
characterization of purely textile patch antennas,” IEEE Trans. Adv. “Assessing the intrinsic radiation efficiency of tissue-implanted UHF
Packag., vol. 29, no. 4, pp. 777–788, Nov. 2006. antennas,” IEEE Trans. Antennas Propag., vol. 68, no. 1, pp. 491–
499, Jan. 2020.
[24] C. Hertleer, H. Rogier, L. Vallozzi, and L. Van Langenhove, “A
[46] Z. Bao, Y.-X. Guo, and R. Mittra, “An ultrawideband conformal cap-
textile antenna for off-body communication integrated into protective
sule antenna with stable impedance matching,” IEEE Trans. Antennas
clothing for firefighters,” IEEE Trans. Antennas Propag., vol. 57,
Propag., vol. 65, no. 10, pp. 5086–5094, Oct. 2017.
no. 4, pp. 919–925, Apr. 2009.
[47] L. Luo, B. Hu, J. Wu, T. Yan, and L.-J. Xu, “Compact dual-band
[25] D. P. Rose et al., “Adhesive RFID sensor patch for monitoring antenna with slotted ground for implantable applications,” Microw.
of sweat electrolytes,” IEEE Trans. Biomed. Eng., vol. 62, no. 6, Opt. Technol. Lett., vol. 61, no. 5, pp. 1314–1319, 2019.
pp. 1457–1465, Jun. 2015.
[48] F. Faisal and H. Yoo, “A miniaturized novel-shape dual-band antenna
[26] H. R. Raad, A. I. Abbosh, H. M. Al-Rizzo, and D. G. Rucker, for implantable applications,” IEEE Trans. Antennas Propag., vol. 67,
“Flexible and compact AMC based antenna for telemedicine appli- no. 2, pp. 774–783, Feb. 2019.
cations,” IEEE Trans. Antennas Propag., vol. 61, no. 2, pp. 524–531, [49] S. Bakogianni and S. Koulouridis, “A dual-band implantable rectenna
Feb. 2013. for wireless data and power support at sub-GHZ region,” IEEE Trans.
[27] G. A. Conway and W. G. Scanlon, “Antennas for over-body-surface Antennas Propag., vol. 67, no. 11, pp. 6800–6810, Nov. 2019.
communication at 2.45 GHz,” IEEE Trans. Antennas Propag., vol. 57, [50] F. Faisal, M. Zada, A. Ejaz, Y. Amin, S. Ullah, and H. Yoo,
no. 4, pp. 844–855, Apr. 2009. “A miniaturized dual-band implantable antenna system for medi-
[28] Z. H. Jiang, D. E. Brocker, P. E. Sieber, and D. H. Werner, “A com- cal applications,” IEEE Trans. Antennas Propag., vol. 68, no. 2,
pact, low-profile metasurface-enabled antenna for wearable medical pp. 1161–1165, Feb. 2020.
body-area network devices,” IEEE Trans. Antennas Propag., vol. 62, [51] S. Ding, S. Koulouridis, and L. Pichon, “Design and characteriza-
no. 8, pp. 4021–4030, Aug. 2014. tion of a dual-band miniaturized circular antenna for deep in body
[29] A. Kiourti and J. L. Volakis, Wearable Antennas and Electronics. biomedical wireless applications,” Intl. J. Microw. Wireless Technol.,
Boston, MA, USA: Artech House, 2022. vol. 12, no. 6, pp. 461–468, 2020.
[30] A. Kiourti, C. Lee, and J. L. Volakis, “Fabrication of textile antennas [52] I. A. Shah, M. Zada, and H. Yoo, “Design and analysis of a
and circuits with 0.1 mm precision,” IEEE Antennas Wireless Propag. compact-sized multiband spiral-shaped implantable antenna for scalp
Lett., vol. 15, pp. 151–153, 2015. implantable and leadless pacemaker systems,” IEEE Trans. Antennas
[31] A. Kiourti and J. L. Volakis, “High-geometrical-accuracy embroi- Propag., vol. 67, no. 6, pp. 4230–4234, Jun. 2019.
dery process for textile antennas with fine details,” IEEE Antennas [53] T.-A. L. Trong, S. I. H. Shah, G. Shin, S. M. Radha, and I.-J. Yoon,
Wireless Propag. Lett., vol. 14, pp. 1474–1477, 2014. “A compact triple-band antenna with a broadside radiation character-
[32] A. Kiourti and J. L. Volakis, “Stretchable and flexible E-fiber wire istic for head-implantable wireless communications,” IEEE Antennas
antennas embedded in polymer,” IEEE Antennas Wireless Propag. Wireless Propag. Lett., vol. 20, pp. 958–962, 2021.
Lett., vol. 13, pp. 1381–1384, 2014. [54] J. Shang, Y. Yu, and L.-J. Xu, “Compact dual-band implantable
[33] S. Zhang, A. Paraskevopoulos, C. Luxey, J. Pinto, and W. Whittow, planar inverted-F antenna with bandwidth enhancement,” Microw.
“Broad-band embroidered spiral antenna for off-body commu- Opt. Technol. Lett., vol. 62, no. 1, pp. 322–328, 2020.
nications,” IET Microw. Antennas Propag., vol. 10, no. 13, [55] A. Basir, A. Bouazizi, M. Zada, A. Iqbal, S. Ullah, and U. Naeem,
pp. 1395–1401, 2016. “A dual-band implantable antenna with wide-band characteristics at
[34] “Evaluating compliance with FCC guidelines for human exposure to MICS and ISM bands,” Microw. Opt. Technol. Lett., vol. 60, no. 12,
radio frequency electromagnetic fields,” OET Bull. FCC, Washington, pp. 2944–2949, 2018.
DC, USA, document OET Bulletin 65, 1997. [Online]. Available: [56] Z. Jiang et al., “Wideband loop antenna with split-ring resonators for
https://www.fcc.gov/general/oet-bulletins-line wireless medical telemetry,” IEEE Trans. Antennas Wireless Propag.
Lett., vol. 18, pp. 1415–1419, 2019.
[35] J. Nagel, C. Furse, D. A. Christensen, and C. H. Durney, Basic
[57] C. Liu, Y.-X. Guo, and S. Xiao, “Capacitively loaded circularly polar-
Introduction to Bioelectromagnetics, 3rd ed. Boca Raton, FL, USA:
ized implantable patch antenna for ISM band biomedical applica-
CRC Press, 2009.
tions,” IEEE Trans. Antennas Propag., vol. 62, no. 5, pp. 2407–2417,
[36] J. Andreu-Perez, D. R. Leff, H. M. D. Ip, and G.-Z. Yang, “From May 2014.
wearable sensors to smart implants—Toward pervasive and per- [58] C. Liu, Y. Zhang, and X. Liu, “Circularly polarized implantable
sonalized healthcare,” IEEE Trans. Biomed. Eng., vol. 62, no. 12, antenna for 915 MHz ISM-band far-field wireless power transmis-
pp. 2750–2761, Dec. 2015. sion,” IEEE Antennas Wireless Propag. Lett., vol. 17, pp. 373–376,
[37] J. M. Rabaey, “Towards TRUE human-centric computation,” Comput. 2018.
Commun., vol. 131, pp. 73–76, Oct. 2018. [59] Y. Zhang, C. Liu, X. Liu, K. Zhang, and X. Yang, “A wideband
[38] A. Kiourti and K. S. Nikita, “Recent advances in implantable anten- circularly polarized implantable antenna for 915 MHz ISM-band
nas for medical telemetry,” IEEE Antennas Propag. Mag., vol. 54, biotelemetry devices,” IEEE Antennas Wireless Propag. Lett., vol. 17,
no. 6, pp. 190–199, Dec. 2012. pp. 1473–1477, 2018.
[39] A. Kiourti, J. R. Costa, C. A. Fernandes, A. G. Santiago, and [60] G. Samanta and D. Mitra, “Dual-band circular polarized flexible
K. S. Nikita, “Miniature implantable antennas for biomedical teleme- implantable antenna using reactive impedance substrate,” IEEE Trans.
try: From simulation to realization,” IEEE Trans. Biomed. Eng., Antennas Propag., vol. 67, no. 6, pp. 4218–4223, Jun. 2019.
vol. 59, no. 11, pp. 3140–3147, Nov. 2012. [61] M. Zada, I. A. Shah, and H. Yoo, “Metamaterial-loaded compact
[40] S. Gabriel, R. W. Lau, and C. Gabriel, “The dielectric properties of high-gain dual-band circularly polarized implantable antenna system
biological tissues: III. Parametric models for the dielectric spectrum for multiple biomedical applications,” IEEE Trans. Antennas Propag.,
of tissues,” Phys. Med. Biol., vol. 41, no. 11, pp. 2271–2293, 1996. vol. 68, no. 2, pp. 1140–1144, Feb. 2020.

VOLUME 3, 2022 383

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

[62] S. Hayat, S. A. A. Shah, and H. Yoo, “Miniaturized dual-band circu- [84] A. K. RamRakhyani, S. Mirabbasi, and M. Chiao, “Design and
larly polarized implantable antenna for capsule endoscopic system,” optimization of resonance-based efficient wireless power delivery
IEEE Trans. Antennas Propag., vol. 69, no. 4, pp. 1885–1895, systems for biomedical implants,” IEEE Trans. Biomed. Circuits
Apr. 2021. Syst., vol. 5, no. 1, pp. 48–63, Feb. 2011.
[63] Z. Xia et al., “A wideband circularly polarized implantable patch [85] W. Liu et al., “Implantable biomimetic microelectronic systems
antenna for ISM band biomedical applications,” IEEE Trans. design,” IEEE Eng. Med. Biol. Mag., vol. 24, no. 5, pp. 66–74,
Antennas Propag., vol. 68, no. 3, pp. 2399–2404, Mar. 2020. Sep./Oct. 2005.
[64] R. Liu et al., “A wideband circular polarization implantable antenna [86] H. Ali, T. J. Ahmad, and S. A. Khan, “Inductive link design for
for health monitor microsystem,” IEEE Antennas Wireless Propag. medical implants,” in Proc. IEEE Symp. Ind. Electron. Appl., 2009,
Lett., vol. 20, pp. 848–852, 2021. pp. 694–699.
[65] L.-J. Xu, J.-P. Xu, Z.-J. Chu, S. Liu, and X. Zhu, “Circularly polar- [87] M. Ghovanloo and S. Atluri, “A wide-band power-efficient inductive
ized implantable antenna with improved impedance matching,” IEEE wireless link for implantable microelectronic devices using multiple
Antennas Wireless Propag. Lett., vol. 19, pp. 876–880, 2020. carriers,” IEEE Trans. Circuits Syst. I, Reg. Papers, vol. 54, no. 10,
[66] R. Muller et al., “A minimally invasive 64-channel wireless μECoG pp. 2211–2221, Oct. 2007.
implant,” IEEE J. Solid-State Circuits, vol. 50, no. 1, pp. 344–359, [88] A. Yakovlev, S. Kim, and A. Poon, “Implantable biomedical devices:
Jan. 2015. Wireless powering and communication,” IEEE Commun. Mag.,
[67] S. Ma, L. Sydänheimo, L. Ukkonen, and T. Björninen, “Robustness vol. 50, no. 4, pp. 152–159, Apr. 2012.
evaluation of split ring resonator antenna system for wireless [89] M. A. Hannan, S. M. Abbas, S. A. Samad, and A. Hussain,
brain care in semi-anatomical ellipsoid head model,” Appl. Comput. “Modulation techniques for biomedical implanted devices and their
Electromagn. Soc. J., vol. 33, no. 9, pp. 966–972, 2018. challenges,” Sensors, vol. 12, no. 1, pp. 297–319, 2012.
[68] S. Ma, T. Björninen, L. Sydänheimo, M. H. Voutilainen, and [90] A. S. Y. Poon, S. O. Driscoll, and T. H. Meng, “Optimal frequency
L. Ukkonen, “Double split rings as extremely small and tuneable for wireless power transmission into dispersive tissue,” IEEE Trans.
antennas for brain implantable wireless medical microsystems,” IEEE Antennas Propag., vol. 58, no. 5, pp. 1739–1750, May 2010.
Trans. Antennas Propag., vol. 69, no. 2, pp. 760–768, Feb. 2021. [91] D. Pivonka, A. Yakovlev, A. S. Y. Poon, and T. Meng, “A mm-sized
[69] M. Ghovanloo and M. Kiani, “Inductive coupling,” in Handbook of wirelessly powered and remotely controlled locomotive implant,”
Biomedical Telemetry. Hoboken, NJ, USA: Wiley, 2014. IEEE Trans. Biomed. Circuits Syst., vol. 6, no. 6, pp. 523–532,
[70] E. Romero, Powering Biomedical Devices. Boston, MA, USA: Dec. 2012.
Academic, 2013. [92] S. Amendola et al., “Design and optimization of mm-size implantable
[71] A. K. Teshome, B. Kibret, and D. T. H. Lai, “A review of implant and wearable on-body antennas for biomedical systems,” in Proc. 8th
communication technology in WBAN: Progress and challenges,” Eur. Conf. Antennas Propag. (EuCAP), 2014, pp. 520–524.
IEEE Rev. Biomed. Eng., vol. 12, pp. 88–99, Jun. 2018. [93] L. Song and Y. Rahmat-Samii, “An end-to-end implanted brain–
machine interface antenna system performance characterizations
[72] M. Haerinia and R. Shadid, “Wireless power transfer approaches for
and development,” IEEE Trans. Antennas Propag., vol. 65, no. 7,
medical implants: A review,” Signals, vol. 1, no. 2, pp. 209–229,
pp. 3399–3408, Jul. 2017.
2020.
[94] M. Manoufali, K. Bialkowski, B. J. Mohammad, P. C. Mills, and
[73] H.-J. Kim, H. Hirayama, S. Kim, K. J. Han, R. Zhang, and
A. Abbosh, “Near-field inductive-coupling link to power a three-
J.-W. Choi, “Review of near-field wireless power and communication
dimensional millimeter-size antenna for brain implantable medical
for biomedical applications,” IEEE Access, vol. 5, pp. 21264–21285,
devices,” IEEE Trans. Biomed. Eng., vol. 65, no. 1, pp. 4–14,
2017.
Jan. 2018.
[74] C. Gabriel, S. Gabriel, and E. Corthout, “The dielectric properties [95] A. Ibrahim and M. Kiani, “A figure-of-merit for design and
of biological tissues: I literature survey,” Phys. Med. Biol., vol. 41, optimization of inductive power transmission links for millimeter-
no. 11, pp. 2231–2249, 1996. sized biomedical implants,” IEEE Trans. Biomed. Circuits Syst.,
[75] J. M. Elloian, G. M. Noetscher, S. N. Makarov, and A. Pascual-Leone, vol. 10, no. 6, pp. 1100–1111, Dec. 2016.
“Continuous wave simulations on the propagation of electromagnetic [96] D. Ahn and M. Ghovanloo, “Optimal design of wireless power trans-
fields through the human head,” IEEE Trans. Biomed. Eng., vol. 61, mission links for millimeter-sized biomedical implants,” IEEE Trans.
no. 6, pp. 1676–1683, Jun. 2014. Biomed. Circuits Syst., vol. 10, no. 1, pp. 125–137, Feb. 2016.
[76] A. Ferikoğlu, O. Çerezci, M. Kahriman, and S. Ç. Yener, [97] H. Rahmani and A. Babakhani, “A dual-mode RF power harvesting
“Electromagnetic absorption rate in a multilayer human tissue model system with an on-chip coil in 180-nm SOI CMOS for millimeter-
exposed to base-station radiation using transmission line analysis,” sized biomedical implants,” IEEE Trans. Microw. Theory Techn.,
IEEE Antennas Wireless Propag. Lett., vol. 13, pp. 903–906, 2014. vol. 67, no. 1, pp. 414–428, Jan. 2019.
[77] R. Lodato, V. Lopresto, R. Pinto, and G. Marrocco, “Numerical and [98] G. Monti, P. Arcuti, and L. Tarricone, “Resonant inductive link
experimental characterization of through-the-body UHF-RFID links for remote powering of pacemakers,” IEEE Trans. Microw. Theory
for passive tags implanted into human limbs,” IEEE Trans. Antennas Techn., vol. 63, no. 11, pp. 3814–3822, Nov. 2015.
Propag., vol. 62, no. 10, pp. 5298–5306, Oct. 2014. [99] L. Li, H. Liu, H. Zhang, and W. Xue, “Efficient wireless power
[78] S. R. Khan, S. K. Pavuluri, G. Cummins, and M. P. Y. Desmulliez, transfer system integrating with metasurface for biological applica-
“Wireless power transfer techniques for implantable medical devices: tion,” IEEE Trans. Ind. Electron., vol. 65, no. 4, pp. 3230–3239,
A review,” Sensors, vol. 20, no. 12, pp. 1–58, 2020. Apr. 2018.
[79] M. Schormans, V. Valente, and A. Demosthenous, “Practical induc- [100] N. A. Quadir, L. Albasha, M. Taghadosi, N. Qaddoumi, and
tive link design for biomedical wireless power transfer: A tutorial,” B. Hatahet, “Low-power implanted sensor for orthodontic bond
IEEE Trans. Biomed. Circuits Syst., vol. 12, no. 5, pp. 1112–1130, failure diagnosis and detection,” IEEE Sensors J., vol. 18, no. 7,
Oct. 2018. pp. 3003–3009, Apr. 2018.
[80] M. Mark et al., “Wireless channel characterization for mm-size neural [101] E. Moradi et al., “Backscattering neural tags for wireless brain-
implants,” in Proc. Annu. Int. Conf. IEEE Eng. Med. Biol. Conf., machine interface systems,” IEEE Trans. Antennas Propag., vol. 63,
2010, pp. 1565–1568. no. 2, pp. 719–726, Feb. 2015.
[81] R. Sarpeshkar, Ultra Low Power Bioelectronics. Fundamentals, [102] A. B. Amar, A. B. Kouki, and H. Cao, “Power approaches for
Biomedical Applications, and Bio-Inspired Systems. Cambridge, implantable medical devices,” Sensors, vol. 15, pp. 28889–28914,
U.K.: Cambridge Univ. Press, 2010. Nov. 2015.
[82] A. Sani, M. Rajab, R. Foster, and Y. Hao, “Antennas and propagation [103] K. Agarwal, R. Jegadeesan, Y.-X. Guo, and N. V. Thakor, “Wireless
of implanted RFIDs for pervasive healthcare applications,” Proc. power transfer strategies for implantable bioelectronics,” IEEE Rev.
IEEE, vol. 98, no. 9, pp. 1648–1655, Sep. 2010. Biomed. Eng., vol. 10, no. 99, pp. 136–161, Mar. 2017.
[83] M. J. Karimi, A. Schmid, and C. Dehollain, “Wireless power and [104] A. Khaleghi, A. Hasanvand, and I. Balasingham, “Radio frequency
data transmission for implanted devices via inductive links: A sys- backscatter communication for high data rate deep implants,” IEEE
tematic review,” IEEE Sensors J., vol. 21, no. 6, pp. 7145–7161, Trans. Microw. Theory Techn., vol. 67, no. 3, pp. 1093–1106,
Mar. 2021. Mar. 2019.

384 VOLUME 3, 2022

[105] N. Vidal and J. M. López-Villegas, “Changes in electromagnetic [125] “NORA DELL.” Hitek. [Online]. Available: https://www.hitek-
field absorption in the presence of subcutaneous implanted devices: ltd.co.uk/product-page/nora-dell (Accessed: Feb. 24, 2022).
Minimizing increases in absorption,” IEEE Trans. Electromagn. [126] A. Chauraya et al., “Inkjet printed dipole antennas on textiles for
Compat., vol. 52, no. 3, pp. 545–555, Aug. 2010. wearable communications,” IET Microw. Antennas Propag., vol. 7,
[106] S. Gabriel, R. W. Lau, and C. Gabriel, “The dielectric properties of no. 9, pp. 760–767, 2013.
biological tissues: II. Measurements in the frequency range 10 Hz to [127] W. G. Whittow et al., “Inkjet-printed microstrip patch antennas real-
20 GHz,” Phys. Med. Biol., vol. 41, no. 11, pp. 2251–2269, 1996. ized on textile for wearable applications,” IEEE Antennas Wireless
[107] M. Manoufali, S. A. R. Naqvi, and A. M. Abbosh, “Accurate Fourth- Propag. Lett., vol. 13, pp. 71–74, 2014.
order debye model for the head tissues across the 0.1–1 GHz band [128] V. P. S. Neto, C. F. L. Vasconcelos, M. R. M. L. Albuquerque,
using metaheuristic genetic algorithm,” IEEE J. Electromagn., RF, and A. G. Dassuncao, “Study of annular ring patch antennas on
Microw. Med. Biol., vol. 2, no. 2, pp. 79–86, Jun. 2018. anisotropic substrates by WCIP method,” in Proc. 9th Eur. Conf.
[108] M. Kiani and M. Ghovanloo, “The circuit theory behind coupled- Antennas Propag. (EuCAP), 2015, pp. 1–4.
mode magnetic resonance-based wireless power transmission,” IEEE [129] C. S. Gurel and E. Yazgan, “Characteristics of a circular patch
Trans. Circuits Syst. I, Reg. Papers, vol. 59, no. 9, pp. 2065–2074, microstrip antenna on uniaxially anisotropic substrate,” IEEE Trans.
Sep. 2012. Antennas Propag., vol. 52, no. 10, pp. 2532–2537, Oct. 2004.
[109] Y. El-Saboni, M. K. Magill, G. A. Conway, S. L. Cotton, and [130] S. M. Yang and C.-C. Hung, “Modal analysis of microstrip antenna
W. G. Scanlon, “Measurement of deep tissue implanted antenna on fiber reinforced anisotropic substrates,” IEEE Trans. Antennas
efficiency using a reverberation chamber,” IEEE J. Electromagn., Propag., vol. 57, no. 3, pp. 792–796, Mar. 2009.
RF, Microw. Med. Biol., vol. 1, no. 2, pp. 90–97, Dec. 2017. [131] P. I. Dankov, V. P. Levcheva, and P. K. Sharma, “Influence of dielec-
[110] J. S. Ho, S. Kim, and A. S. Y. Poon, “Midfield wireless powering for tric anisotropy and bending on wearable textile antenna properties,”
implantable systems,” Proc. IEEE, vol. 101, no. 6, pp. 1369–1378, in Proc. Int. Workshop Antenna Technol. (iWAT), 2020, pp. 1–4.
Jun. 2013. [132] T. Tuovinen, M. Berg, and E. T. Salonen, “Antenna close to tissue:
[111] S. Rao et al., “Miniature implantable and wearable on-body anten- Avoiding radiation pattern minima with an anisotropic substrate,”
nas: Towards the new era of wireless body-centric systems [antenna IEEE Antennas Wireless Propag. Lett., vol. 13, pp. 1680–1683, 2014.
applications corner],” IEEE Antennas Propag. Mag., vol. 56, no. 1, [133] A. Y. I. Ashyap et al., “Compact and low-profile textile EBG-based
pp. 271–291, Feb. 2014. antenna for wearable medical applications,” IEEE Antennas Wireless
[112] F. Lu, H. Zhang, and C. Mi, “A review on the recent development Propag. Lett., vol. 16, pp. 2550–2553, 2017.
of capacitive wireless power transfer technology,” Energies, vol. 10, [134] A. Y. I. Ashyap et al., “Robust and efficient integrated antenna with
no. 11, pp. 1–30, 2017. EBG-DGS enabled wide bandwidth for wearable medical device
[113] A. I. Al-Kalbani, M. R. Yuce, and J.-M. Redouté, “A biosafety applications,” IEEE Access, vol. 8, pp. 56346–56358, 2020.
comparison between capacitive and inductive coupling in biomed- [135] A. Iqbal et al., “Electromagnetic bandgap backed millimeter-wave
ical implants,” IEEE Antennas Wireless Propag. Lett., vol. 13, MIMO antenna for wearable applications,” IEEE Access, vol. 7,
pp. 1168–1171, 2014. pp. 111135–111144, 2019.
[114] R. Jegadeesan, K. Agarwal, Y.-X. Guo, S.-C. Yen, and N. V. Thakor, [136] J. Joubert, J. C. Vardaxoglou, W. G. Whittow, and J. W. Odendaal,
“Wireless power delivery to flexible subcutaneous implants using “CPW-fed cavity-backed slot radiator loaded with an AMC reflec-
capacitive coupling,” IEEE Trans. Microw. Theory Techn., vol. 65, tor,” IEEE Trans. Antennas Propag., vol. 60, no. 2, pp. 735–742,
no. 1, pp. 280–292, Jan. 2017. Feb. 2012.
[115] A. K. Teshome, B. Kibret, and D. T. H. Lai, “Galvanically cou- [137] S. Genovesi, F. Costa, F. Fanciulli, and A. Monorchio, “Wearable
pled intrabody communications for medical implants: A unified inkjet-printed wideband antenna by using miniaturized AMC for sub-
analytic model,” IEEE Trans. Antennas Propag., vol. 64, no. 7, GHz applications,” IEEE Antennas Wireless Propag. Lett., vol. 15,
pp. 2989–3002, Jul. 2016. pp. 1927–1930, 2016.
[116] M. Manoufali, K. Bialkowski, A. T. Mobashsher, B. Mohammed, and [138] S. Genovesi, I. R. Butterworth, J. E. C. Serrallés, and L. Daniel,
A. Abbosh, “In situ near-field path loss and data communication “Metasurface matching layers for enhanced electric field penetration
link for brain implantable medical devices using software-defined into the human body,” IEEE Access, vol. 8, pp. 197745–197756,
radio,” IEEE Trans. Antennas Propag., vol. 68, no. 9, pp. 6787–6799, 2020.
Sep. 2020. [139] A. Y. I. Ashyap et al., “An overview of electromagnetic band-gap
[117] C. Liu, Y.-X. Guo, H. Sun, and S. Xiao, “Design and safety considera- integrated wearable antennas,” IEEE Access, vol. 8, pp. 7641–7658,
tions of an implantable rectenna for far-field wireless power transfer,” 2020.
IEEE Trans. Antennas Propag., vol. 62, no. 11, pp. 5798–5806, [140] C. D. Suriyakala and A. Eldhose, “Meta surface enabled wearable
Nov. 2014. antenna for medical implant applications,” in Proc. Int. Conf. Circuit
[118] A. Tsolis, W. G. Whittow, A. A. Alexandridis, and J. C. Vardaxoglou, Power Comput. Technol. (ICCPCT), 2017, pp. 1–6.
“Embroidery and related manufacturing techniques for wearable [141] X. Liu, Y. Di, H. Liu, Z. Wu, and M. M. Tentzeris, “A planar
antennas: Challenges and opportunities,” Electronics, vol. 3, no. 2, windmill-like broadband antenna equipped with artificial magnetic
pp. 314–338, 2014. conductor for off-body communications,” IEEE Antennas Wireless
[119] C. Hertleer, H. R. Van Laere, H. Rogier, and L. V. Langenhove, Propag. Lett., vol. 15, pp. 64–67, 2016.
“Influence of relative humidity on textile antenna performance,” Text. [142] A. Chrysler, K. Hall, F. Curry, Jr., and H. Zhang, “Effect of conduc-
Res. J., vol. 80, no. 2, pp. 177–183, 2009. tivity on subdermal antennas,” Microw. Opt. Technol. Lett., vol. 60,
[120] M. A. R. Osman, M. K. A. Rahim, N. A. Samsuri, M. K. Elbasheer, no. 5, pp. 1154–1160, 2018.
and M. E. Ali, “Textile UWB antenna bending and wet perfor- [143] N. Petoussi-Henss, M. Zankl, U. Fill, and D. Regulla, “The GSF fam-
mances,” Int. J. Antennas Propag., vol. 2012, pp. 1–12, May 2012. ily of voxel phantoms,” Phys. Med. Biol., vol. 47, no. 1, pp. 89–106,
[121] T. Acti et al., “Embroidered wire dipole antennas using novel copper 2002.
yarns,” IEEE Antennas Propag. Wireless Lett., vol. 14, pp. 638–641, [144] H. Zhang, “Graph theoretical design of biomimetic aramid nanofiber
2015. composites as insulation coatings for implantable bioelectronics,”
[122] R. D. Seager et al., “Effect of the fabrication parameters on MRS Bull., vol. 46, pp. 576–587, Apr. 2021.
the performance of embroidered antennas,” IET Microw. Antennas [145] J. P. Seymour, Y. M. Elkasabi, H.-Y. Chen, J. Lahann, and
Propag., vol. 7, no. 14, pp. 1174–1181, 2013. D. R. Kipke, “The insulation performance of reactive parylene films
[123] Z. Wang, L. Zhang, Y. Bayram, and J. L. Volakis, “Embroidered con- in implantable electronic devices,” Biomaterials, vol. 30, no. 31,
ductive fibers on polymer composite for conformal antennas,” IEEE pp. 6158–6167, 2009.
Trans. Antennas Propag., vol. 60, no. 9, pp. 4141–4147, Sep. 2012. [146] S.-W. Hwang, “A physically transient form of silicon electronics,”
[124] Z. Wang, L. Z. Lee, D. Psychoudakis, and J. L. Volakis, Science, vol. 337, no. 6102, pp. 1640–1644, 2012.
“Embroidered multiband body-worn antenna for GSM/PCS/WLAN [147] Q. Zheng, “Biodegradable triboelectric nanogenerator as a life-time
communications,” IEEE Trans. Antennas Propag., vol. 62, no. 6, designed implantable power source,” Sci. Adv., vol. 2, no. 3, 2016,
pp. 3321–3329, Jun. 2014. Art. no. 1501478.

VOLUME 3, 2022 385

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

[148] K. K. Fu, Z. Wang, J. Dai, M. Carter, and L. Hu, “Transient [171] C. Gabriel, “Compilation of the dielectric properties of body tissues at
electronics: Materials and devices,” Chem. Mater., vol. 28, no. 11, RF and microwave frequencies,” in Occupational and Environmental
pp. 3527–3539, 2016. Health Directorate Radiofrequency Radiation Division. San Antonio,
[149] C. M. Boutry, H. Chandrahalim, P. Streit, M. Schinhammer, TX, USA: Brooks Airforce Base, 1996.
A. C. Hänzi, and C. Hierold, “Towards biodegradable wireless [172] J. D. Johnson, “Statistical analysis of detuning effects for implantable
implants,” Philos. Trans. Roy. Soc. A, Math. Phys. Eng. Sci., vol. 370, microstrip antennas,” M.S. thesis, Dept. Electr. Comput. Eng., Univ.
pp. 2418–2432, May 2012. Utah, Salt Lake City, UT, USA, 2007.
[150] D. R. Merrill, “Materials considerations of implantable neuroengi- [173] S. M. Smith and C. Furse, “Stochastic FDTD for analysis of statistical
neering devices for clinical use,” Current Opinion Solid-State Mater. variation in electromagnetic fields,” IEEE Trans. Antennas Propag.,
Sci., vol. 18, no. 6, pp. 329–336, 2014. vol. 60, no. 7, pp. 3343–3350, Jul. 2012.
[151] F. Curry, Jr. et al., “Biostable conductive nanocomposite for subder- [174] M. Y. Ballen, M. Y. Kanda, C.-K. Chou, and Q. Balzano,
mal antenna,” APL Mater., vol. 8, no. 10, 2020, Art. no. 101112. “Formulation and characterization of tissue simulating liquids used
[152] D.-H. Kim et al., “Epidermal electronics,” Science, vol. 333, for SAR measurement,” in Proc. 23rd Annu. Bioelectromagn. Soc.
no. 6044, pp. 838–843, 2011. Meeting, vol. 14, p. 80, 2001.
[153] E. B. Malarkey and V. Parpura, “Applications of carbon nan- [175] A. Peyman and C. Gabriel, “Tissue equivalent liquids for SAR
otubes in neurobiology,” Neuro Degener. Dis., vol. 4, no. 4, measurement at microwave frequencies,” in Proc. 24th Annu.
pp. 292–299, 2007. [Online]. Available: https://search.proquest.com/ Bioelectromagn. Soc. Meeting, 2002, pp. 184–185.
docview/1069369026?fromopenview=true&pq-origsite=gscholar
[176] K. Fukunaga, S. Watanabe, and Y. Yamanaka, “Dielectric properties
[154] E. K. Wujcik and C. N. Monty, “Nanotechnology for implantable sen-
of tissue-equivalent liquids and their effects on specific absorp-
sors: Carbon nanotubes and graphene in medicine,” WIREs Nanomed.
tion rate,” IEEE Trans. Electromagn. Compat., vol. 46, no. 1,
Nanobiotechnol., vol. 5, no. 3, pp. 233–249, 2013.
pp. 126–129, Feb. 2004.
[155] A. Moscicki, J. Felba, T. Sobierajski, J. Kudzia, A. Arp, and
W. Meyer, “Electrically conductive formulations filled nano size [177] K. Fukunaga, S. Watanabe, H. Asou, and K. Sato, “Dielectric proper-
silver filler for ink-jet technology,” in Proc. 5th Int. Conf. Polym. ties of non-toxic tissue-equivalent liquids for radiowave safety tests,”
Adhesives Microelectron. Photon., 2005, pp. 40–44. in Proc. IEEE Int. Conf. Dielectr. Liquids, 2005, pp. 425–428.
[156] J. Sidén, M. Fein, A. Koptyug, and H.-E. Nilsson, “Printed antennas [178] J. Kim and Y. Rahmat-Samii, “Implanted antennas inside a human
with variable conductive ink layer thickness,” IET Microw. Antennas body: Simulations, designs, and characterizations,” IEEE Trans.
Propag., vol. 1, no. 2, pp. 401–407, 2007. Microw. Theory Thechn., vol. 52, no. 8, pp. 1934–1943, Aug. 2004.
[157] M. A. Gaynes, R. H. Lewis, R. F. Saraf, and J. M. Roldan, [179] J. T. Chang, M. W. Fanning, P. M. Meaney, and K. D. Paulsen,
“Evaluation of contact resistance for isotropic electrically conduc- “A conductive plastic for simulating biological tissue at microwave
tive adhesives,” IEEE Trans. Compon. Packag. Manuf. Technol. B, frequencies,” IEEE Trans. Electromagn. Compat., vol. 42, no. 1,
vol. 18, no. 2, pp. 299–304, May 1995. pp. 78–81, Feb. 2000.
[158] K. Bock, “Polytronics—Electronics and systems on flexible sub- [180] A. W. Guy, “Analyses of electromagnetic fields induced in bio-
strates,” in Proc. IEEE VLSI-TSA Int. Symp. VLSI Technol. (VLSI- logical tissues by thermographic studies on equivalent phantom
TSA-Tech), 2005, pp. 53–56. models,” IEEE Trans. Microw. Theory Techn., vol. TMTT-19, no. 2,
[159] A. R. Duggal and L. M. Levinson, “A novel high current den- pp. 205–214, Feb. 1971.
sity switching effect in electrically conductive polymer composite [181] L. E. Maggi, M. A. Krüger, W. C. A. Pereira, and E. E. C. Monteiro,
materials,” J. Appl. Phys., vol. 82, no. 11, pp. 5532–5539, 1997. “Development of silicon-based materials for ultrasound biological
[160] “NovaCentrix.” [Online]. Available: https://www.novacentrix.com/ phantoms,” in Proc. IEEE Int. Ultrason. Symp., 2009, pp. 1962–1965.
(Accessed: Jan. 2, 2022). [182] H. D. Choi, H. W. Shim, K. Y. Cho, H. J. Lee, C. S. Park, and
[161] M. D. Dickey, “Emerging applications of liquid metals featur- H. G. Yoon, “Electromagnetic and electromagnetic wave-absorbing
ing surface oxides,” ACS Appl. Mater. Interfaces, vol. 6, no. 21, properties of the SrTiO3 -epoxy composite,” J. Appl. Polym. Sci.,
pp. 18369–18379, 2014. vol. 72, no. 1, pp. 75–83, 1999.
[162] R. Vasold, E. Engel, B. König, M. Landthaler, and W. Bäumler, [183] Y. Nikawa, M. Chino, and K. Kikuchi, “Soft and dry phantom
“Health risks of tattoo colors,” Anal. Bioanal. Chem., vol. 391, no. 1, modeling material using silicone rubber with carbon fiber,” IEEE
pp. 9–13, 2008. Trans. Microw. Theory Techn., vol. 44, no. 10, pp. 1949–1953,
[163] E. C. Cho, Q. Zhang, and Y. Xia, “The effect of sedimenta- Oct. 1996.
tion and diffusion on cellular uptake of gold nanoparticles,” Nat. [184] C. Gabriel, “Tissue equivalent material for hand phantoms,” Phys.
Nanotechnol., vol. 6, no. 6, pp. 385–391, 2011. Med. Biol., vol. 52, no. 14, pp. 4205–4210, 2007.
[164] A. Eid, J. G. Hester, and M. M. Tentzeris, “5G as a wireless power [185] T. Kobayashi, T. Nojima, K. Yamada, and S. Uebayashi, “Dry phan-
grid,” Sci. Rep., vol. 11, no. 1, pp. 1–9, 2021. tom composed of ceramics and its application to SAR estimation,”
[165] A. Eid, J. G. D. Hester, and M. M. Tentzeris, “Rotman lens-based IEEE Trans. Microw. Theory Techn., vol. 41, no. 1, pp. 136–140,
wide angular coverage and high-gain semipassive architecture for Jan. 1993.
ultralong range mm-wave RFIDs,” IEEE Antennas Wireless Propag.
[186] S. S. Stuchly, “Specific absorption rate distributions in a heteroge-
Lett., vol. 19, pp. 1943–1947, 2020.
neous model of the human body at radiofrequencies,” Environ. Prot.
[166] J. G. D. Hester and M. M. Tentzeris, “Inkjet-printed flexible mm-
Agency, Washington, DC, USA, Rep. EPA/600/1-87/003, 1987, p. 89.
wave Van-Atta reflectarrays: A solution for ultralong-range dense
multitag and multisensing chipless RFID implementations for IoT [187] S. S. Stuchly, A. Kraszewski, M. A. Stuchly, G. W. Hartsgrove, and
smart skins,” IEEE Trans. Microw. Theory Techn., vol. 64, no. 12, R. J. Spiegel, “RF energy deposition in a heterogeneous model of
pp. 4763–4773, Dec. 2016. man: Far-field exposures,” IEEE Trans. Biomed. Eng., vol. BME-34,
[167] S. A. Nauroze and M. M. Tentzeris, “A thermally actuated fully no. 12, pp. 951–957, Dec. 1987.
inkjet-printed origami-inspired multilayer frequency selective surface [188] S. R. H. Davidson and M. D. Sherar, “Measurement of the ther-
with continuous-range tunability using polyester-based substrates,” mal conductivity of polyacrylamide tissue-equivalent material,” Int.
IEEE Trans. Microw. Theory Techn., vol. 67, no. 12, pp. 4944–4954, J. Hyperth., vol. 19, no. 5, pp. 551–562, 2003.
Dec. 2019. [189] A. Surowiec, P. N. Shrivastava, M. Astrahan, and Z. Petrovich,
[168] X. He, B. K. Tehrani, R. Bahr, W. Su, and M. M. Tentzeris, “Utilization of a multilayer polyacrylamide phantom for evaluation of
“Additively manufactured mm-wave multichip modules with fully hyperthermia applicators,” Int. J. Hyperth., vol. 8, no. 6, pp. 795–807,
printed ‘smart’ encapsulation structures,” IEEE Trans. Microw. 1992.
Theory Techn., vol. 68, no. 7, pp. 2716–2724, Jul. 2020. [190] K. Ito, K. Furuya, Y. Okano, and L. Hamada, “Development and char-
[169] C. Gabriel, “Dielectric properties of biological tissue: Variation with acteristics of a biological tissue-equivalent phantom for microwaves,”
age,” Bioelectromagnetics, vol. 26, no. S7, pp. 12–18, 2005. Electron. Commun. Jpn. I, vol. 84, no. 4, pp. 67–77, 2001.
[170] C. Gabriel and A. Peyman, “Dielectric measurement: Error analysis [191] M. W. Groch, J. A. Urbon, W. D. Erwin, and S. Al-Doohan, “An
and assessment of uncertainty,” Phys. Med. Biol., vol. 51, no. 23, MRI tissue equivalent lesion phantom using a novel polysaccharide
pp. 6033–6046, 2006. material,” Magn. Reson. Imag., vol. 9, no. 3, pp. 417–421, 1991.

386 VOLUME 3, 2022

[192] K. J. M. Surry, H. J. B. Austin, A. Fenster, and T. M. Peters, [213] I. G. Zubal. “Voxelman Phantom Data.” [Online]. Available:
“Poly(vinyl alcohol) cryogel phantoms for use in ultrasound and https://noodle.med.yale.edu/zubal/data.htm (Accessed: Jan. 2, 2022).
MR imaging,” Phys. Med. Biol., vol. 49, pp. 5529–5546, Dec. 2004. [214] I. G. Zubal, C. R. Harrell, E. O. Smith, Z. Rattner, G. Gindi, and
[193] C. Marchal, M. Nadi, A. J. Tosser, C. Roussey, and M. L. Gaulard, P. B. Hoffer, “Computerized three-dimensional segmented human
“Dielectric properties of gelatine phantoms used for simulations of anatomy,” Med. Phys., vol. 21, no. 2, pp. 299–302, 1994.
biological tissues between 10 and 50 MHz,” Int. J. Hyperth., vol. 5, [215] P. J. Dimbylow, “The development of realistic voxel phantoms for
no. 6, pp. 725–732, 1989. electromagnetic field dosimetry,” in Proc. Int. Workshop Nat. Radiol.
[194] T. Sunaga et al., “Development of a dielectric equivalent gel for Prot. Board, 1995, pp. 1–7.
better impedance matching for human skin,” Bioelectromagnetics,
[216] P. J. Dimbylow, “Electromagnetic field calculations in an anatomi-
vol. 24, pp. 725–732, Apr. 2003.
cally realistic voxel model of the human body,” in Radio Frequency
[195] M. Lazebnik, E. L. Madsen, G. R. Frank, and S. C. Hagness, “Tissue-
Radiation Dosimetry and Its Relationship to the Biological Effects
mimicking phantom materials for narrowband and ultrawideband
of Electromagnetic Fields, B. J. Klauenberg and D. Miklavčič, Eds.
microwave applications,” Phys. Med. Biol., vol. 50, pp. 4245–4258,
Cham, Switzerland: Springer, 2000, pp. 123–131.
Sep. 2005.
[196] E. L. Madsen, J. A. Zagzebski, and G. R. Frank, “Oil-in-gelatin [217] P. Dimbylow, “Development of the female voxel phantom, NAOMI,
dispersions for use as ultrasonically tissue-mimicking materials,” and its application to calculations of induced current densities and
Ultrasound Med. Biol., vol. 8, no. 3, pp. 277–287, 1982. electric fields from applied low frequency magnetic and electric
[197] A. Tsolis, A. Paraskevopoulos, A. A. Alexandridis, W. G. Whittow, fields,” Phys. Med. Biol., vol. 50, no. 6, pp. 1047–1070, 2005.
A. Chauraya, and J. C. Vardaxoglou, “Design, realisation and eval- [218] G. Xu. “RPI VIP Man: (RISCC Catalog).” [Online]. Available:
uation of a liquid hollow torso phantom appropriate for wearable https://rsicc.ornl.gov/Catalog.aspx?c=V (Accessed: Jan. 2, 2022).
antenna assessment,” IET Microw. Antennas Propag., vol. 11, no. 9, [219] X. G. Xu and C. Shi, “Preliminary development of a 4D anatomical
pp. 1308–1316, 2017. model for Monte Carlo simulations,” in Proc. Monte Carlo Topical
[198] S. Symeonidis, W. G. Whittow, M. Zecca, and C. Panagamuwa, Meeting Monte Carlo Method Versatility Unbounded Dyn. Comput.
“Bone fracture monitoring using implanted antennas in the radius, World, 2005.
tibia and phalange heterogeneous bone phantoms,” Biomed. Phys. [220] O. P. Gandhi, “Millimeter-resolution MRI-based models of the
Eng. Exp., vol. 4, no. 4, pp. 1–10, 2018. human body for electromagnetic dosimetry from ELF to microwave
[199] T. Karacolak, R. Cooper, and E. Topsakal, “Electrical properties of rat frequencies,” in Proc. Int. Workshop Voxel Phantom Develop., 1995,
skin and design of implantable antennas for medical wireless teleme- pp. 24–31.
try,” IEEE Trans. Antennas Propag., vol. 57, no. 9, pp. 2806–2812, [221] A. D. Tinniswood, C. M. Furse, and O. P. Gandhi, “Computations
Sep. 2009. of SAR distributions for two anatomically based models of the
[200] T. Yilmaz, T. Karacolak, and E. Topsakal, “Characterization and test- human head using CAD files of commercial telephones and the
ing of a skin mimicking material for implantable antennas operating parallelized FDTD code,” IEEE Trans. Antennas Propag., vol. 46,
at ISM band (2.4 GHz-2.48 GHz),” IEEE Antennas Wireless Propag. no. 6, pp. 829–833, Jun. 1998.
Lett., vol. 7, pp. 418–420, 2008.
[222] M. J. Ackerman, “Visible human project,” Proc. IEEE,
[201] M. Asili, R. Green, S. Seran, and E. Topsakal, “A small implantable
vol. 86, no. 3, pp. 504–511, Mar. 1998. [Online]. Available:
antenna for MedRadio and ISM bands,” IEEE Antennas Wireless
https://www.nlm.nih.gov/research/visible/visible_human.html
Propag. Lett., vol. 11, pp. 1683–1685, 2012.
[202] E. Topsakal, “Antennas for medical applications: Ongoing research [223] K. Saito, K. Sato, S. Kinase, and T. Nagaoka, “Japanese compu-
and future challenges,” in Proc. Int. Conf. Electromagn. Adv. Appl., tational phantoms: Otoko, Onago, JM, JM2, JF, TARO, HANAKO,
2009, pp. 890–893. pregnant woman, and deformable child,” in Handbook of Anatomical
[203] R. B. Green, M. V. Smith, and E. Topsakal, “In vitro and in vivo Models for Radiation Dosimetry. Boca Raton, FL, USA: CRC Press,
testing of implantable antennas,” in Antenna and Sensor Technologies 2010, pp. 221–253.
in Modern Medical Applications. Hoboken, NJ, USA: Wiley, 2021, [224] R. Kramer, H. J. Khoury, J. W. Vieira, and V. J. M. Lima, “MAX06
pp. 145–189. and FAX06: Update of two adult human phantoms for radiation pro-
[204] C. K. Chou, G. W. Chen, A. W. Guy, and K. H. Luk, “Formulas tection dosimetry,” Phys. Med. Biol., vol. 51, no. 14, pp. 3331–3346,
for preparing phantom muscle tissue at various radiofrequencies,” 2006.
Bioelectromagnetics, vol. 5, no. 4, pp. 435–441, 1984. [225] V. F. Cassola, V. J. M. Lima, R. Kramer, and H. J. Khoury, “FASH
[205] H.-Y. Lin, M. Takahashi, K. Saito, and K. Ito, “Performance of and MASH: Female and male adult human phantoms based on poly-
implantable folded dipole antenna for in-body wireless communica- gon mesh surfaces: I. Development of the anatomy,” Phys. Med. Biol.,
tion,” IEEE Trans. Antennas Propag., vol. 61, no. 3, pp. 1363–1370, vol. 55, no. 1, pp. 133–162, 2009.
Mar. 2013. [226] C. Lee, C. Lee, S.-H. Park, and J.-K. Lee, “Development of the
[206] R. Suga, M. Inoue, K. Saito, M. Takahashi, and K. Ito, “Development two Korean adult tomographic computational phantoms for organ
of multi-layered biological tissue-equivalent phantom for HF band,” dosimetry: Two Korean tomographic phantoms,” Med. Phys, vol. 33,
IEICE Commun. Exp., vol. 2, no. 12, pp. 507–511, 2013. no. 2, pp. 380–390, 2006.
[207] K. Ito, “Human body phantoms for evaluation of wearable and [227] C. Lee and C. H. Kim, “Korean computational phantoms: KMIRD,
implantable antennas,” in Proc. Eur. Conf. Antennas Propag., 2007, KORMAN, KORWOMAN, KTMAN-1, KTMAN-2, and HDRK-
pp. 1–6. man,” in Handbook of Anatomical Models for Radiation Dosimetry.
[208] W. G. Whittow, R. M. Edwards, C. J. Panagamuwa, and London, U.K.: Chapman Hall, 2009, p. 255.
J. C. Vardaxoglou, “Effect of tongue jewellery and orthodontist
[228] P. Dimbylow, “Development of pregnant female, hybrid voxel-
metallic braces on the SAR due to mobile phones in different anatom-
mathematical models and their application to the dosimetry of applied
ical human head models including children,” in Proc. Loughborough
magnetic and electric fields at 50 Hz,” Phys. Med. Biol., vol. 51,
Antennas Propag. Conf., 2008, pp. 293–296.
no. 10, pp. 2383–2394, 2006.
[209] J. Maitra and V. K. Shukla, “Cross-linking in hydrogels—A review,”
Amer. J. Polym. Sci., vol. 4, no. 2, pp. 25–31, 2014. [229] “OVERVIEW IT’IS Foundation.” [Online]. Available:
[210] I. Chatterjee and O. P. Gandhi, “An inhomogeneous thermal block https://itis.swiss/virtual-population/virtual-population/overview/
model of man for the electromagnetic environment,” IEEE Trans. (Accessed: Jan. 2, 2022).
Biomed. Eng., vol. BME-30, no. 11, pp. 707–715, Nov. 1983. [230] S. R. Pérez, N. W. Marshall, L. Struelens, and H. Bosmans,
[211] I. Chatterjee, M. J. Hagmann, and O. P. Gandhi, “Electromagnetic “Characterization and validation of the thorax phantom Lungman
absorption in a multilayered slab model of tissue under near- for dose assessment in chest radiography optimization studies,” J.
field exposure conditions,” Bioelectromagnetics, vol. 1, no. 4, Med. Img., vol. 5, no. 1, 2018, Art. no. 13504.
pp. 379–388, 1980. [231] W. P. Segars, “Development and application of the new dynamic
[212] M. Zankl and K. Eckerman, “The GSF voxel computational phantom NURBS-based cardiac-torso (NCAT) phantom,” Ph.D. dissertation,
family,” in Handbook of Anatomical Models for Radiation Dosimetry. Dept. Biomed. Eng., Univ. North Carolina, Chapel Hill, NC, USA,
Boca Raton, FL, USA. CRC Press, 2010, pp. 65–85. 2009.

VOLUME 3, 2022 387

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

[232] L. Vancoillie et al., “The creation of a breast cancer voxel model [250] IEC/IEEE International Standard—Determining the Peak Spatial-
database for virtual clinical trials in digital breast tomosynthesis,” Average Specific Absorption Rate (SAR) in the Human Body From
in Proc. Med. Imag. Phys. Med. Imag., vol. 11595, Feb. 2021, Wireless Communications Devices, 30 MHz to 6 GHz—Part 1:
Art. no. 115950. General Requirements for Using the Finite-Difference Time-Domain
[233] E. Zastrow, S. K. Davis, M. Lazebnik, F. Kelcz, B. D. V. Veen, (FDTD) Method for SAR Calculations, IEC/IEEE Standard 62704-
and S. C. Hagness, “Development of anatomically realistic numeri- 1:2017, 2017, pp. 1–86.
cal breast phantoms with accurate dielectric properties for modeling [251] Determining the Peak Spatial-Average Specific Absorption Rate
microwave interactions with the human breast,” IEEE Trans. Biomed. (SAR) in the Human Body From Wireless Communications Devices,
Eng., vol. 55, no. 12, pp. 2792–2800, Dec. 2008. 30 MHz to 6 GHz—Part 3: Specific Requirements for Using the Finite
[234] T. Xie and H. Zaidi, “Development of computational small animal Difference Time Domain (FDTD) Method for SAR Calculations of
models and their applications in preclinical imaging and therapy Mobile Phones, IEC/IEEE Standard 62704-3:2017, 2017, pp. 1–76.
research,” Med. Phys., vol. 43, no. 1, pp. 111–131, 2016. [252] K. Ito, M. Hyodo, M. Shimura, and H. Kasai, “Thin applicator having
coaxial ring slots for interstitial microwave hyperthermia,” in Proc.
[235] D. W. Deno, “Currents induced in the human body by high voltage
IEEE Int. Symp. Antennas Propag. Soc., 2017, pp. 1233–1236.
transmission line electric field measurement and calculation of dis-
tribution and dose,” IEEE Trans. Power App. Syst., vol. TPAS-96, [253] A. J. Yu et al., “Ultrasound-guided percutaneous microwave abla-
no. 5, pp. 1517–1527, Sep. 1977. tion of central intraductal papilloma: A prospective pilot study,” Int.
J. Hyperth., vol. 36, no. 1, pp. 605–611, 2019.
[236] O. P. Gandhi, G. Lazzi, and C. M. Furse, “Electromagnetic absorp-
[254] Z. Li et al., “Image-guided microwave ablation of hepatocellular
tion in the human head and neck for mobile telephones at 835 and
carcinoma (≤5.0 cm): Is MR guidance more effective than CT
1900 MHz,” IEEE Trans. Microw. Theory Techn., vol. 44, no. 10,
guidance?” BMC Cancer, vol. 21, no. 1, p. 366, 2021.
pp. 1884–1897, Oct. 1996.
[255] A. C. Vorländer et al., “Comparison between microwave abla-
[237] M. J. Hagmann O. P. Gandhi, J. A. D’Andrea, and I. Chatterjee, tion and bipolar radiofrequency ablation in benign thyroid nodules:
“Head resonance: Numerical solutions and experimental results,” Differences in energy transmission, duration of application and
IEEE Trans. Microw. Theory Techn., vol. TMTT-27, no. 9, applied shots,” Int. J. Hyperth., vol. 35, no. 1, pp. 216–225, 2018.
pp. 809–813, Sep. 1979. [256] A. V. Aufranca et al., “Percutaneous thermal ablation of primary
[238] O. P. Gandhi, “Yes the children are more exposed to radiofrequency and secondary lung tumors: Comparison between microwave and
energy from mobile telephones than adults,” IEEE Access, vol. 3, radiofrequency ablation,” Diagn. Interv. Imag., vol. 100, no. 12,
pp. 985–988, 2015. pp. 781–791, 2019.
[239] A. Kiourti and K. S. Nikita, “Numerical assessment of the [257] A. E. Schena, P. Saccomandi, and Y. Fong, “Laser ablation for cancer:
performance of a scalp-implantable antenna: Effects of head anatomy Past, present and future,” J. Funct. Biomater., vol. 8, no. 2, p. 19,
and dielectric parameters,” Bioelectromagnetics, vol. 34, no. 3, 2017.
pp. 167–179, 2013. [258] B. T. McWilliams, E. E. Schnell, S. Curto, T. M. Fahrbach, and
[240] F. J. Meyer, D. B. Davidson, U. Jakobus, and M. A. Stuchly, “Human P. Prakash, “A directional interstitial antenna for microwave tissue
exposure assessment in the near field of GSM base-station antennas ablation: Theoretical and experimental investigation,” IEEE Trans.
using a hybrid finite element/method of moments technique,” IEEE Biomed. Eng., vol. 62, no. 9, pp. 2144–2150, Sep. 2015.
Trans. Biomed. Eng., vol. 50, no. 2, pp. 224–233, Feb. 2003. [259] A. Y. Mohtashami, S. C. Hagness, and N. Behdad, “A hybrid
[241] A. Taflove, A. Oskooi, and S. G. Johnson, Advances in FDTD slot/monopole antenna with directional heating patterns for
Computational Electrodynamics: Photonics and Nanotechnology. microwave ablation,” IEEE Trans. Antennas Propag., vol. 65, no. 8,
Boston, MA, USA: Artech House, 2013. pp. 3889–3896, Aug. 2017.
[242] R. Hong, K. Chen, X. Hou, Q. Sun, N. Liu, and Q. H. Liu, “Mixed [260] A. J. Sebek, S. Curto, and J. Eaton-Evans, “Feasibility assessment of
finite element method for full-wave simulation of bioelectromag- microwave ablation for treating esophageal varices,” J. Med. Devices,
netism from DC to microwave frequencies,” IEEE Trans. Biomed. vol. 11, no. 3, p. 8, 2017.
Eng., vol. 67, no. 10, pp. 2765–2772, Oct. 2020. [261] A. H. Luyen, S. C. Hagness, and N. Behdad, “A minimally invasive
coax-fed microwave ablation antenna with a tapered balun,” IEEE
[243] C. M. Furse and O. P. Gandhi, “Calculation of electric fields and cur-
Trans. Antennas Propag., vol. 65, no. 12, pp. 7280–7287, Dec. 2017.
rents induced in a millimeter-resolution human model at 60 Hz using
the FDTD method,” Bioelectromagnetics, vol. 19, no. 5, pp. 293–299, [262] A. Y. Endo, K. Saito, and K. Ito, “The development of forceps-type
1998. microwave tissue coagulator for surgical operation,” IEEE Trans.
Microw. Theory Techn., vol. 63, no. 6, pp. 2041–2049, Jun. 2015.
[244] C. M. Furse, J.-Y. Chen, and O. P. Gandhi, “The use of the frequency-
[263] A. T. Tani, S. Naka, and S. Tani, “The invention of microwave
dependent finite-difference time-domain method for induced current
surgical scissors for seamless coagulation and cutting,” Surg. Today,
and SAR calculations for a heterogeneous model of the human body,”
vol. 48, pp. 856–864, Sep. 2018.
IEEE Trans. Electromagn. Compat., vol. 36, no. 2, pp. 128–133,
[264] A. J. Chiang, S. Birla, M. Bedoya, D. Jones, J. Subbiah, and
May 1994.
C. L. Brace, “Modeling and validation of microwave ablations with
[245] K. Masumnia-Bisheh and C. Furse, “Bioelectromagnetic uncertainty internal vaporization,” IEEE Trans. Biomed. Eng., vol. 62, no. 2,
analysis using geometrically stochastic FDFD method,” IEEE Trans. pp. 657–663, Feb. 2015.
Antennas Propag., vol. 69, no. 4, pp. 2433–2436, Apr. 2021. [265] A. Y. Endo, K. Saito, and K. Ito, “Temperature analysis of liver tissue
[246] K. Masumnia-Bisheh, K. Forooraghi, M. Ghaffari-Miab, and in microwave coagulation therapy considering tissue dehydration by
C. M. Furse, “Geometrically stochastic FDTD method for uncertainty heating,” IEICE Trans. Electron., vol. E99.C, no. 2, pp. 257–265,
quantification of EM fields and SAR in biological tissues,” IEEE 2016.
Trans. Antennas Propag., vol. 67, no. 12, pp. 7466–7475, Dec. 2019. [266] A. C. Reimann et al., “Planar microwave sensor for theranostic ther-
[247] IEEE Recommended Practice for Measurements and Computations apy of organic tissue based on oval split ring resonators,” Sensors,
of Electric, Magnetic, and Electromagnetic Fields With Respect to vol. 16, no. 9, pp. 1450–1462, 2016.
Human Exposure to Such Fields, 0 Hz to 300 GHz, IEEE Standard [267] J. H. Larsen and L. E. Jacobi, Medical Applications of Microwave
C95.3-2021, 2021, pp. 1–240. Imaging. New York, NY, USA: IEEE Press, 1985.
[248] IEEE Standard for Safety Levels With Respect to Human Exposure [268] J.-C. Bolomey, “Advancing microwave-based imaging techniques for
to Electric, Magnetic, and Electromagnetic Fields, 0 Hz to 300 medical applications in the wake of the 5G revolution,” in Proc. 13th
GHz—Corrigenda 2, IEEE Standard C95.1-2019/Cor2-2020, 2020, Eur. Conf. Antennas Propag., 2019, pp. 1–5.
pp. 1–15. [269] N. K. Nikolova, Introduction to Microwave Imaging. Cambridge,
[249] T. Kawamura, K. Saito, S. Kikuchi, M. Takahashi, and K. Ito, U.K.: Cambridge Univ. Press, 2017.
“Specific absorption rate measurement of birdcage coil for 3.0- [270] X. Chen, Computational Methods for Electromagnetic Inverse
T magnetic resonance imaging system employing thermographic Scattering. Hoboken, NJ, USA: Wiley, 2018.
method,” IEEE Trans. Microw. Theory Techn., vol. 57, no. 10, [271] M. Pastorino and A. Randazzo, Microwave Imaging Methods and
pp. 2508–2514, Oct. 2009. Applications. Boston, MA, USA: Artech House, 2018.

388 VOLUME 3, 2022

[272] D. O’Loughlin, M. O’Halloran, B. M. Moloney, M. Glavin, E. Jones, [293] J. Dethier, P. Nuyujukian, S. I. Ryu, K. Shenoy, and K. Boahen,
and M. A. Elahi, “Microwave breast imaging: Clinical advances and “Design and validation of a real-time spiking-neural-network decoder
remaining challenges,” IEEE Trans. Biomed. Eng., vol. 65, no. 11, for brain-machine interfaces,” J. Neural Eng., vol. 10, no. 3, 2013,
pp. 2580–2590, Nov. 2018. Art. no. 36008.
[273] P. M. Meaney, “Microwave imaging for neoadjuvant chemotherapy [294] S. Kim, P. Tathireddy, R. A. Normann, and F. Solzbacher, “Thermal
monitoring: Initial clinical experience,” Breast Cancer Res., vol. 15, impact of an active 3-D microelectrode array implanted in the brain,”
no. 2, p. R35, 2013. IEEE Trans. Neural Syst. Rehabil. Eng., vol. 15, no. 4, pp. 493–501,
[274] M. Shere, I. Lyburn, R. Sidebottom, H. Massey, C. Gillett, and Dec. 2007.
L. Jones, “MARIAM5: R A multicentre clinical study to evalu- [295] T. Bjorninen et al., “Design of wireless links to implanted brain–
ate the ability of the Micrima radio-wave radar breast imaging machine interface microelectronic systems,” IEEE Antennas Wireless
system (MARIA) R to detect lesions in the symptomatic breast,”
Propag. Lett., vol. 11, pp. 1663–1666, 2012.
Eur. J. Radiol., vol. 116, pp. 61–67, Jul. 2019.
[296] M. Mark, T. Björninen, L. Ukkonen, L. Sydänheimo, and
[275] A. Fasoula, “Pilot patient study with the Wavelia Microwave Breast
J. M. Rabaey, “SAR reduction and link optimization for mm-size
Imaging system for breast cancer detection: Clinical feasibility and
remotely powered wireless implants using segmented loop antennas,”
identified technical challenges,” in Proc. 14th Eur. Conf. Antennas
in Proc. IEEE Topical Conf. Biomed. Wireless Technol. Netw. Sens.
Propag. (EuCAP), 2020, pp. 1–5.
Syst., 2011, pp. 7–10.
[276] B. R. Lavoie, M. Okoniewski, and E. C. Fear, “Estimating the
effective permittivity for reconstructing accurate microwave-radar [297] E. Moradi, T. Björninen, L. Sydänheimo, J. M. Carmena,
images,” PLoS One, vol. 11, no. 9, 2016, Art. no. 160849. J. M. Rabaey, and L. Ukkonen, “Measurement of wireless link for
[277] A. Fhager, S. Candefjord, M. Elam, and M. Persson, “Microwave brain–machine interface systems using human-head equivalent liq-
diagnostics ahead: Saving time and the lives of trauma and stroke uid,” IEEE Antennas Wireless Propag. Lett., vol. 12, pp. 1307–1310,
patients,” IEEE Microw. Mag., vol. 19, no. 3, pp. 78–90, May 2018. 2013.
[278] A. Fedeli, V. Schenone, A. Randazzo, M. Pastorino, T. Henriksson, [298] M. W. A. Khan, T. Björninen, L. Sydänheimo, and L. Ukkonen,
and S. Semenov, “Nonlinear S-parameters inversion for stroke “Characterization of two-turns external loop antenna with mag-
imaging,” IEEE Trans. Microw. Theory Techn., vol. 69, no. 3, netic core for efficient wireless powering of cortical implants,”
pp. 1760–1771, Mar. 2021. IEEE Antennas Wireless Propag. Lett., vol. 15, pp. 1410–1413,
[279] P.-H. Tournier, “Numerical modeling and high-speed parallel com- 2016.
puting: New perspectives on tomographic microwave imaging for [299] K. Guido and A. Kiourti, “Passive RF neural electrodes,” in
brain stroke detection and monitoring,” IEEE Antennas Propag. Mag., Neural Interface Engineering: Linking the Physical World and the
vol. 59, no. 5, pp. 98–110, Oct. 2017. Nervous System, vol. 12. Dordrecht, The Netherlands: Springer, 2020,
[280] A. S. M. Alqadami, A. Trakic, A. E. Stancombe, B. Mohammed, pp. 299–319.
K. Bialkowski, and A. Abbosh, “Flexible electromagnetic cap for [300] A. Abbaspour-Tamijani, M. F. Farooqui, B. C. Towe, and J. Chae, “A
head imaging,” IEEE Trans. Biomed. Circuits Syst., vol. 14, no. 5, miniature fully-passive microwave back-scattering device for short-
pp. 1097–1107, Oct. 2020. range telemetry of neural potentials,” in Proc. 30th Annu. Int. Conf.
[281] “EMTensor.” [Online]. Available: https://www.emtensor.com/ IEEE Eng. Med. Biol. Soc., 2008, pp. 129–132.
(Accessed: Jan. 2, 2022). [301] H. N. Schwerdt, “A fully passive wireless microsystem for
[282] “EMVision Reports Very Encouraging Pilot Clinical Trial Data.” recording of neuropotentials using RF backscattering methods,”
2020. [Online]. Available: https://www.listcorp.com/asx/emv/ J. Microelectromech. Syst., vol. 20, no. 5, pp. 1119–1130, Oct. 2011.
emvision-medical-devices-limited/news/emvision-reports-very-
encouraging-pilot-clinical-trial-data-2390126.html [302] H. N. Schwerdt, F. A. Miranda, and J. Chae, “Analysis of electromag-
[283] P. M. Meaney et al., “Clinical microwave tomographic imaging of netic fields induced in operation of a wireless fully passive backscat-
the calcaneus: A first-in-human case study of two subjects,” IEEE tering neurorecording microsystem in emulated human head tissue,”
Trans. Biomed. Eng., vol. 59, no. 12, pp. 3304–3313, Dec. 2012. IEEE Trans. Microw. Theory Techn., vol. 61, no. 5, pp. 2170–2176,
[284] A. Darvazehban, S. A. Rezaeieh, A. Zamani, and A. M. Abbosh, May 2013.
“Pattern reconfigurable metasurface antenna for electromagnetic [303] C. W. L. Lee, A. Kiourti, J. Chae, and J. L. Volakis, “A high-
torso imaging,” IEEE Trans. Antennas Propag., vol. 67, no. 8, sensitivity fully passive neurosensing system for wireless brain signal
pp. 5453–5462, Aug. 2019, doi: 10.1109/TAP.2019.2916576. monitoring,” IEEE Trans. Microw. Theory Techn., vol. 63, no. 6,
[285] K. S. Sultan, B. Mohamed, M. Manoufali, and A. Abbosh, “Portable pp. 2060–2068, Jun. 2015.
electromagnetic knee imaging system,” IEEE Trans. Antennas [304] A. Kiourti, C. W. L. Lee, J. Chae, and J. L. Volakis, “A wireless
Propag., vol. 69, no. 10, pp. 6824–6837, Oct. 2021. fully passive neural recording device for unobtrusive neuropotential
[286] K. Sultan, A. Mahmoud, and A. M. Abbosh, “Textile electromagnetic monitoring,” IEEE Trans. Biomed. Eng., vol. 63, no. 1, pp. 131–137,
brace for knee imaging,” IEEE Trans. Biomed. Circuits Syst., vol. 15, Jan. 2016.
no. 3, pp. 522–536, Jun. 2021. [305] C. W. L. Lee, A. Kiourti, and J. L. Volakis, “Miniaturized
[287] C. Dachena, A. Fedeli, A. Fanti, M. B. Lodi, M. Pastorino, and fully passive brain implant for wireless neuropotential acquisi-
A. Randazzo, “Microwave imaging for the diagnosis of cervical tion,” IEEE Antennas Wireless Propag. Lett., vol. 16, pp. 645–648,
diseases: A feasibility analysis,” IEEE J. Electromagn., RF, Microw. 2017.
Med. Biol., vol. 5, no. 3, pp. 277–285, Sep. 2021. [306] K. Guido and A. Kiourti, “An in vivo-mimicking in vitro testbed for
[288] A. T. Mobashsher and A. M. Abbosh, “Artificial human phantoms: brain-computer interfaces,” IEEE J. Electromagn., RF, Microw. Med.
Human proxy in testing microwave apparatuses that have electro- Biol., vol. 4, no. 4, pp. 240–246, Dec. 2020.
magnetic interaction with the human body,” IEEE Microw. Mag.,
[307] H. N. Schwerdt, F. A. Miranda, and J. Chae, “Wireless fully pas-
vol. 16, no. 6, pp. 42–62, Jul. 2015.
sive multichannel recording of neuropotentials using photo-activated
[289] M. J. During et al., “Controlled release of dopamine from a polymeric
RF backscattering methods,” IEEE Trans. Microw. Theory Techn.,
brain implant: In vivo characterization,” Ann. Neurol., vol. 25, no. 4,
vol. 63, no. 9, pp. 2965–2970, Sep. 2015.
pp. 351–356, 1989.
[290] V. S. Polikov, P. A. Tresco, and W. M. Reichert, “Response of [308] W.-C. Chen, C. W. L. Lee, A. Kiourti, and J. L. Volakis, “A
brain tissue to chronically implanted neural electrodes,” J. Neurosci. multi-channel passive brain implant for wireless neuropotential mon-
Methods, vol. 148, pp. 1–18, Oct. 2005. itoring,” IEEE J. Electromagn., RF, Microw. Med. Biol., vol. 2, no. 4,
[291] K. D. Wise, A. M. Sodagar, Y. Yao, M. N. Gulari, G. E. Perlin, pp. 262–269, Dec. 2018.
and K. Najafi, “Microelectrodes, microelectronics, and implantable [309] K. Guido and A. Kiourti, “Real world considerations for wireless and
neural microsystems,” Proc. IEEE, vol. 96, no. 7, pp. 1184–1202, batteryless brain implants,” in Proc. Int. Workshop Antenna Technol.,
Jul. 2008. Miami, FL, USA, Mar. 2019, pp. 3–6.
[292] A. Waziri, “Initial surgical experience with a dense cortical microar- [310] W. M. Grill, S. E. Norman, and R. V. Bellamkonda, “Implanted
ray in epileptic patients undergoing craniotomy for subdural electrode neural interfaces: Biochallenges and engineered solutions,” Annu.
implantation,” Neurosurgery, vol. 64, no. 3, pp. 540–545, 2009. Rev. Biomed. Eng., vol. 11, pp. 1–24, Jul. 2009.

VOLUME 3, 2022 389

KIOURTI et al.: NEXT-GENERATION HEALTHCARE: ENABLING TECHNOLOGIES

[311] B. He et al., “Grand challenges in interfacing engineering with life [320] M. Machnoor, E. S. G. Rodríguez, P. Kosta, J. Stang, and G. Lazzi,
sciences and medicine,” IEEE Trans. Biomed. Eng., vol. 60, no. 3, “Analysis and design of a 3-coil wireless power transmission system
pp. 589–598, Mar. 2013. for biomedical applications,” IEEE Trans. Antennas Propag., vol. 67,
[312] M. Machnoor and G. Lazzi, “High-efficiency multicoil wireless no. 8, pp. 5012–5024, Aug. 2019.
power and data transfer for biomedical implants and neuropros- [321] E. S. G. Rodríguez, M. Machnoor, and G. Lazzi, “On the generation
thetics,” in Antenna and Sensor Technologies in Modern Medical of nondiffracting beams in extremely subwavelength applications,”
Applications. Hoboken, NJ, USA: Wiley, 2021, ch. 8. IEEE Trans. Antennas Propag., vol. 65, no. 10, pp. 5228–5237,
[313] A. K. RamRakhyani and G. Lazzi, “Power/data telemetry tech- Oct. 2017.
niques for implants or wearable systems,” in Electromagnetics of [322] E. S. G. Rodríguez, A. K. RamRakhyani, D. Schurig, and G. Lazzi,
Body Area Networks: Antennas, Propagation. Piscataway, NJ, USA: “Compact low-frequency metamaterial design for wireless power
Wiley, 2016, ch. 14. transfer efficiency enhancement,” IEEE Trans. Microw. Theory
[314] M. Ghovanloo and G. Lazzi, “Transcutaneous magnetic coupling Techn., vol. 64, no. 5, pp. 1644–1654, May 2016.
of power and data,” in Encyclopedia of Biomedical Engineering. [323] A. Rajagopalan, A. RamRakhyani, D. Schurig, and G. Lazzi,
Hoboken, NJ, USA: Wiley, 2006. “Improving power transfer efficiency of a short-range telemetry
[315] J. Paknahad, K. Loizos, L. Yu, M. S. Humayun, and G. Lazzi, “Color system using compact metamaterials,” IEEE Trans. Microw. Theory
and cellular selectivity of retinal ganglion cell subtypes through Techn., vol. 62, no. 4, pp. 947–955, Apr. 2014.
frequency modulation of electrical stimulation,” Sci. Rep., vol. 11, [324] E. Margalit et al., “Retinal prosthesis for the blind,” Surv.
no. 1, p. 5177, 2021. Ophthalmol., vol. 47, no. 4, pp. 335–356, 2002.
[316] P. Kosta et al., “Model-based comparison of current flow in rod [325] K. Gosalia, M. S. Humayun, and G. Lazzi, “Impedance matching
bipolar cells of healthy and early-stage degenerated retina,” Exp. and implementation of planar space-filling dipoles as intraocular
Eye Res., vol. 207, Jun. 2021, Art. no. 108554. implanted antennas in a retinal prosthesis,” IEEE Trans. Antennas
[317] J. Paknahad, K. Loizos, M. Humayun, and G. Lazzi, “Targeted Propag., vol. 53, no. 8, pp. 2365–2373, Aug. 2005.
stimulation of retinal ganglion cells in epiretinal prostheses: A [326] N. Papadopoulos, N. Melanitis, A. Lozano, C. Soto-Sanchez,
multiscale computational study,” IEEE Trans. Neural Syst. Rehabil. E. Fernandez, and K. S. Nikita, “Machine learning method for func-
Eng., vol. 28, no. 11, pp. 2548–2556, Nov. 2020. tional assessment of retinal models,” in Proc. 43rd Annu. Int. Conf.
[318] C. S. Bingham et al., “Admittance method for estimating local IEEE Eng. Med. Biol. Soc. (EMBC), 2021, pp. 4293–4296.
field potentials generated in a multi-scale neuron model of the [327] N. Papadopoulos, N. Melanitis, A. Lozano, C. Soto-Sanchez,
hippocampus,” Front. Comput. Neurosci., vol. 14, p. 72, Aug. 2020. E. Fernandez, and K. S. Nikita, “Assessing vision quality in reti-
[319] D. Brizi, J. P. Stang, A. Monorchio, and G. Lazzi, “A compact nal prosthesis implantees through deep learning: Current progress
magnetically dispersive surface for low-frequency wireless power and improvements by optimizing hardware design parameters and
transfer applications,” IEEE Trans. Antennas Propag., vol. 68, no. 3, rehabilitation,” in Proc. 43rd Annu. Int. Conf. IEEE Eng. Med. Biol.
pp. 1887–1895, Mar. 2020. Soc. (EMBC), 2021, pp. 6130–6133.

390 VOLUME 3, 2022