IS FO

Too Much
SU C
E US
FE ED
AT
UR

Pressure E

Usmah Kawoos, Xu Meng,

Mohammad-Reza Tofighi, and Arye Rosen

I
ntracranial pressure (ICP) is the pressure exerted management. There is a conspicuous need for a wireless
by the components of the cranial vault, which are implantable ICP-monitoring system as several chronic
the brain, cerebrospinal fluid (CSF), and blood. diseases are associated with ICH. Accurate monitoring
An elevation of ICP results in a reduction of of the ICP following a neurosurgical procedure is
blood flow to the brain [1]. The brain a basic requirement for adequate treatment
can cope with intracranial hypertension [10]–[12]. Since the intracranial contents
(ICH) to a certain extent, after which exist within a rigid vault (the skull),
a slight increase in the cerebral direct ICP measurements require
volume results in a rapid rise of neurosurgical intervention, with
ICP [2]. A significant reason for its attendant risks. An implant
death and long-term disabil- placed during surgery, for the
ity due to head injuries and underlying cause of neural
pathological conditions disorder, would be a useful
is an elevation in ICP. adjunct to patient care.
An ICP > 20 mmHg is
considered a significant Anatomy and
threshold and demands Possible Positioning
an immediate control of the Implant
measure [3]. ICP moni- Within the bony cranial
toring can assist in the vault, three concentric
management of patients membranes, also called
with a variety of brain “men i nges,” envelop
diseases and injuries. the brain and the spinal
The technique has proven cord. The outermost mem-
valuable, indeed often life- brane is the dura mata, the
saving, in the acute care of arachnoid mater is the mid-
traumatic brain injury (TBI) [4], dle layer, and the pia mata is
hydrocephalus [5], drowning [6], the innermost membrane that
inflammatory and related cerebral runs along the brain parenchyma.
diseases such as Reye’s syndrome The organization of the meninges is
[7], intracranial hemorrhage [8], and shown in Figure 1. The dura mata is a
postoperative suboccipital brain tumors [9]. image licensed
by ingram publishing
tough, fibrous membrane that is separated
Most patients have headaches and other symptoms from the skull by a narrow extradural space, ex-
suggestive (but not always indicative) of raised ICP; con- cept in certain regions like the midline of the cranial
tinuous access to ICP levels would greatly facilitate their roof, where it tightly adheres to the skull. The arachnoid

Usmah Kawoos is with the Department of Neurotrauma, Naval Medical Research Center, Silver Spring, Maryland, United States.
Xu Meng is with CareFusion, Yorba Linda, California, United States. Mohammad-Reza Tofighi is with the School of Science, Engineering, and
Technology, Pennsylvania State University, Harrisburg, Middletown, Pennsylvania, United States. Arye Rosen is with the Department of Electrical
Engineering, Drexel University, Philadelphia, Pennsylvania, United States.
Digital Object Identifier 10.1109/MMM.2014.2377585
Date of publication: 6 February 2015

March 2015 1527-3342/15©2015IEEE 39

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 An elevation of ICP results in a Wireless Technology in ICP Measurement
The application of wireless technology in health care
reduction of blood flow to the brain. is becoming ubiquitous, if not already so. The thera-
peutic and diagnostic applications of radio-frequency
(RF) and microwave technology in medicine have
IP IV been a subject of extensive studies in the past [14]–[16].
SD
Medical implants for the transfer of information at
these nonionizing frequencies have been developed
Skull
[17]. The research accomplishments of using data
ED
Scalp communication links at ultrahigh frequencies (UHF,
300–3,000 MHz) and microwave frequencies between
SAS a medical implant and an external unit were reported
Arachnoid by many researchers. The resonance characteristics of
Parenchyma
Dura Mata implantable antennas operating at a frequency band of
Lateral Ventricle 402–405 MHz and their radiation pattern outside the
Pia Mata body have been shown to be favorable for short-range
medical implants [18]. Gosalia et al. [19] demonstrated
Figure 1. A diagrammatic representation of the device a novel approach to establishing a data telemetry link
placement for IP, SD, IV, and ED ICP measurements. between an implant and an external unit at the 1.45- and
2.45-GHz band for a retinal prosthesis.
Such medical implants are the basic components for
mater is a soft, translucent membrane that loosely enve- the success of telemedicine, which points to the utiliza-
lopes the brain. The innermost layer, the pia mata, is a tion of telecommunication technologies in health care.
highly vascular microscopic membrane that closely ad- Telemedicine not only facilitates medical treatment
heres to the brain while following all of its concavities and care but is also gaining popularity in posthospi-
and convexities. The space between the pia mata and tal patient care [20]. It provides expert consultation in
arachnoid mater is the subarachnoid space (SAS). Within remote, understaffed locations and advanced emer-
the brain, the ventricular system comprises four com- gency care via modern telecommunication techniques
municating CSF-filled ventricles: two lateral ventricles, [21]. Mobile patient monitoring systems using wireless
the third ventricle, and the fourth ventricle [13]. CSF fills implants have been developed to maintain records of
the ventricles, the SAS, and the spinal canal of the central patients’ vital signs and history [22], [23]. These sys-
nervous system. tems are useful during intrahospital patient transport,
The site of the pressure measurement determines the intraoperative procedures, or posthospital manage-
positioning of the implant. An epidural (ED) implant ment of patients. Figure 2 shows a block diagram of a
measures pressure as a function of the dural deflec- mobile telemetric monitoring system.
tion when a pressure sensor rests on the dura mata. In UHF and low microwave frequencies have certain
a subdural (SD) implant, the pressure sensor is exposed advantages for medical implant communications for a
to the CSF beneath the SAS. In the intraventricular (IV) few reasons. First, the electronic components can now
and intraparenchymatous (IP) pressure measurement be made small in size at these frequencies, which is
system, the sensor is placed in one of the lateral ven- an important parameter in the miniaturization of any
tricles or in the parenchyma (brain tissue), respectively. implant. Second, unlike inductive coupling methods,
The current IV- and IP-type monitors have a pressure- the signal transmitted by a small antenna inside the
sensor-tipped catheter or a fluid-filled catheter with the implant can be detected from a significant distance from
pressure sensor placed outside of the body. Figure 1 the patient. Third, these frequencies are high enough to
shows the possible positioning of the sensor at different be efficiently radiated by a small antenna, while they
sites of pressure measurement. are low enough to avoid significant absorption by the
implant package and
skin [16].
Both low-frequency
Sensor Signal TX inductive coupling and
Processing
high-frequency radia-
tion using an implant-
Display Interface to able antenna have been
Signal
RX Trend Analysis Network employed for ICP moni-
Conversion
Data Logging (Telemedicine)
toring. Frischholz et al.
[24] and Hodgins et al.
Figure 2. The block diagram of a wireless ICP-monitoring system. [25] have presented a

40 March 2015
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 telemetric implant for short- and long-term ICP mea-
A significant reason for death and
surements (Campus Micro Technologies, Germany).
The batteryless implant has a catheter-tipped absolute long-term disability due to head
capacitive pressure sensor and a readout integrated injuries and pathological conditions is
circuit with ultralow power consumption. The sensor
an elevation in the ICP.
transmits pressure data transcutaneously (through
the skin) via inductive coupling to an external device
while it is being powered from the outside via RF. The rechargeable battery (ML302S, 11 mAh, 3 V) or a larger
external reader device compensates for the absolute battery (CR2032, 220 mAh, 3 V, 20-mm diameter). How-
pressure data by measuring and subtracting the baro- ever, for the duration of long-term experiments, an
metric pressure and displaying data representative of external 3-V battery was used to supply power to the
intracranial fluid pressure. ISSYS Sensing Systems, Inc., device, while it operates at a regulated voltage of 2.5 V.
Michigan, has developed a batteryless microelectrome- A detailed description of the operating principles of
chanical system (MEMS) wireless ICP system [26] with piezoresisitive (PZR) and capacitive AICP implants is
a telemetry antenna. The power and data transmission presented in [30] and [31].
are conducted through magnetic telemetry to/from A digital version of the capacitive AICP device (DICP)
the implant. RAUMEDIC, Germany, has developed a is described by Meng et al. [29]. A prototype for wire-
telemetric pressure implant, NEUROVENT-P-tel. The less ICP measurement based on the Texas Instruments
implant is composed of a catheter, which penetrates into CC2500 2.4-GHz transceiver and MSP430 ultralow-
the brain tissue, and a body, which is fully implanted power microcontroller is designed, investigated, and
below the scalp on the cranial bone [27]. It measures tested. An increase in power (0 dBm) along with a modi-
ICP using microchip technology that transfers pres- fied antenna design utilizing an annular slot antenna
sure values over the closed scalp (without requiring a allows an extended detection range of about 18 m in a
cable) using the validated RFID principles to an external hallway for 8-mm-deep implantation in water [29].
reader (Reader TDT readP). The Millar telemetry system
(TRM54P pressure telemeter, Millar Instruments, Texas) Features of ICP Implants
provides digital data transmission and has a wireless This section summarizes the desired features of an
inductive power supply [28]. The TRM54P comprises a implant and the choice of pressure sensors.
solid-state pressure sensor at the tip of a catheter. The
catheter is connected to the body of the implant, which Desired Features of the Implant
is surgically placed in the abdomen of rats. The system The desired ICP-monitoring system [33] should
also contains battery backup charging that enables data • be simple, reliable, and able to function effi-
transmission (in the range of 5 m) for up to 4 h in the ciently over a long period of time and under a
absence of the inductive power supply. variety of conditions, either continuously or
Unlike the devices based on inductive coupling, the intermittently
utilization of microwave antennas allows the detection • cause no significant discomfort or risk to the
of ICP at an extended range of 10 m or beyond, as dem- patient
onstrated by Meng et al. [29]. A few versions of battery- • minimize trauma or irritation of intracranial
operated microwave analog ICP (AICP) implants are structures
described in [30]–[32], which operate at the 2.4-GHz • cause no leakage through the link between the
industrial, scientific, and medical (ISM) band. In [31], a ventricle or the point of interest and the monitor-
MEMS sensor is used as the pressure sensor, and the ing apparatus
data are transmitted through a commercially available • allow for ease of disconnection from the patient to
chip antenna or an in-house-designed planar inverted-F permit other investigational procedures or the pos-
antenna (PIFA). A voltage-controlled oscillator [(VCO), sibility of recording pressure measurements during
Max 2753, Maxim Integrated Products, Inc., Sunny- various diagnostic or therapeutic procedures
vale, California] is directly coupled to the antenna for • provide maximum information about variations
wireless pressure transmission. The VCO implementa- of the ICP.
tion could conveniently provide enough power (about The ICP implants (AICP and DICP) that will be de-
−20 dBm) [31] for reliable signal monitoring within the scribed in this article have the following characteristics:
range of about 1 m, for a moderate receiver sensitiv- • Small: The devices can be implanted by a com-
ity of around −80 dBm. One of the power sources for mon neurosurgical procedure, which can be per-
AICP implants is a regulated supply of 2.5 V. Simple formed either during primary surgery or through
power management is employed by switching the main a burr hole.
circuitry on and off with a period of 10 ms and for a • Stable: They produce an insignificant drift over
duration of approximately 25 ns (0.25% duty cycle). Two the usage time of the device. The device should
variations of the implant structure can host a small have a maximum error of !2 mmHg in the range

March 2015 41
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 The application of wireless technology ter sensitivity and higher resistance to environmental
temperature variation compared with PZR sensors.
in health care is becoming ubiquitous, The fiber-optic-based pressure sensor is a light mod-
if not already so. ulator, which quantifies changes in light properties
(such as amplitude, optical power, phase, and opti-
cal frequency) due to the effect of external pressure.
of 0–20 mmHg or !10% of the full scale in the Fiber-optic sensing has some advantages over con-
range of 20–100 mmHg, as per American National ventional electric pressure sensors. In comparison
Standard Institute specifications [34]. with the conventional sensors, such sensors benefit
• Compatible with imaging systems: There is no from biocompatibility, a low thermal expansion coef-
damage to the device and minimal impact on ficient, immunity to electromagnetic interference, and
image quality when conducting modern inves- small size and weight. The application of the sensors is
tigational procedures, including magnetic reso- investigated and applied for measuring intravascular
nance imaging, computed tomography, and pressure, intracardiac pressure, intramuscular pres-
ultrasound. sure, ICP, and intra-articular pressure.
• Biocompatible: They cause no adverse effects for The most suited sensor should 1) be small in size,
the patient over the lifetime of the device. 2) require minimal circuitry and design processing,
• Rugged: They are likely to survive any nonfatal 3) be relatively insensitive to atmospheric variations,
injury to the patient. and 4) be easily incorporated in the main circuitry
and packaging of the implant. The important issues
Choice of Pressure Sensor of ICP monitoring with an implant—i.e., biocompat-
Pressure sensors are widely applied in the biomedical ibility, implant sealing, integrity, pressure sensitivity,
field. A variety of pressure sensors are available and temperature sensitivity, trans-scalp wireless trans-
can be utilized in developing pressure-monitoring mission, scar tissue formation (histopathology) at the
implants. These include piezoelectric, PZR, capaci- implant and sensor site, and transdural versus sub-
tive, fiber-optic, and strain gauge sensors. The piezo- arachnoid pressure sensing—were addressed in our
electric sensor has high linearity but is very sensitive studies, as described in [31]. The schematics of the
to temperature change, and temperature compensa- physical structures of a few of the ICP implants devel-
tion circuits have to be employed. Furthermore, the oped by our group are shown in Figure 3.
piezoelectric sensor is more vulnerable to electrical
noise and presents a pressure drifting issue, which Microwave Transmission and Antennas
requires calibration after a short period of time and
makes the measurement difficult for in vivo study. Implantable Device Radiation
We have found that the capacitive sensors have bet- in Biological Tissues
Biological tissues absorb the electromagnetic waves at
microwave frequencies. Until relatively recently, the
10–11-mm interest in antennas radiating from inside a dissipating
Silicone Coating Diameter
PIFA medium was mostly limited to the theoretical evalua-
Coaxial Cable,
Power Supply tion of the performance of well-known antennas, such
8 mm Long,
0.86-mm Power Management as dipoles [35]–[37], embedded in an infinite lossy
Diameter Circuit medium. Conversely, the majority of studies on practi-
Ground Circuitry on Top cal biomedical antennas directly in contact with tissue
Open at Sensor at Bottom were centered on therapeutic applications such as abla-
Base
tion or hyperthermia [38], [39], for which the microwave
(a)
energy is used to heat the tissue. It is only since the
26 mm Epoxy late 1990s that we have witnessed a growing interest
22 mm 26 mm
Mold
in the performance evaluation and design of implant-
10 mm able antennas for biotelemetry [19], [40]–[43], [32]. This
10 mm
Coaxial Battery has coincided with rapid technological advancements
Sensor
Nozzle in low-cost RF/microwave front-end electronics, the
Titanium Circuitry Antenna
Silicone development of implantable miniaturized sensors, and
(b) (c) the recognition of the potential that they offer in medi-
cal device technologies for biotelemetry by engineering
Figure 3. The schematics of three versions of ICP implants: and medical professionals.
(a) the assembled circuitry of an ED and SD AICP implant Current trends and developments in the design
[31], (b) a schematic view of a DICP implant, and (c) the and performance characterization of implantable
layers of a DICP implant [68]. devices and antennas are covered in some recent

42 March 2015
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 review articles [44]–[47]. In this section, we highlight
A variety of pressure sensors are
some of the key performance characteristics related
to the interaction of microwaves with tissue, particu- available and can be utilized in
larly with respect to ICP monitoring at a frequency developing pressure-monitoring
of 2.4 GHz. Moreover, further emphasis is placed on
implants.
the transmission performance of implantable anten-
nas, i.e., their gain and radiation efficiency, and their
method of characterization. 2) The penetration depth is reduced by increasing
the frequency.
Implant Operating Frequency 3) The commonly used antennas (e.g., dipole) could
Similar to other communication services in the United have smaller sizes as the frequency increases.
States, the frequency bands for medical device and An almost sixfold decrease in the antenna size is
implant communications are regulated by the U.S. expected by operating at 2.45 GHz compared with
Federal Communications Commission (FCC). A sum- 400 MHz, while the plane-wave penetration depth is
mary of FCC-allocated frequency ranges for medical also reduced by more than half. A word of caution,
use is provided in [46]. The two popular frequency however, is that one should not conclude a corre-
bands for RF implant devices have been the Medi- sponding reduction in gain and radiation efficiency.
cal Implant Communications Service (MICS) band of Smaller electrical size antennas may have increased
402–405 MHz and the ISM band of 2.4–2.4835 GHz. The near-field electric energy trapped in the surround-
MICS band was established in 1999 by the FCC specifi- ing lossy tissue, which would correspond to a higher
cally for medical implant communication and was later absorption in the near-field and counteract the ben-
replaced by the Medical Device Radiocommunication efit gained by the smaller absorption of the propagat-
Service (MedRadio). The MedRadio band was initially ing component of the wave. A review of the literature
adopted by the FCC in 2009 and was expanded to other reveals a reported maximum gain value in the range
frequency bands in 2011 [48]. MedRadio extends the of -10 to -45 dB for the MICS band [44], [45], and the
MICS frequency range to 401–406 MHz and also intro- values also fall within this range for the 2.45-GHz
duces new frequency allocations for emerging wearable ISM band [32], with no clear advantage for one versus
implant communications. the other. The factors dictating the gain and radiation
An advantage of the MedRadio band is the lower efficiency can be summarized as
tissue loss factor (imaginary permittivity) and con- • the electrical size of the antenna and device,
ductivity compared with that of higher microwave where less near-field absorption is expected for a
frequency bands. Moreover, dedicated transceiver larger electrical size
chips for implant devices at this band are now avail- • the insulation material and its thickness, where a
able (e.g., from Zarlink Semiconductor Inc., now under low-loss and thick insulation would imply more
Microsemi Corporation), and the interference from non- near-field inside the low-loss packaging than the
medical consumer products is low. On the other hand, lossy tissue, leading to less absorption [51]
ISM bands such as 902–928 MHz, 2.4–2.4835 MHz, and • the depth of implantation, where a thicker tis-
5.725–5.875 GHz are prone to interference from non- sue layer would correspond to more absorption
medical devices such as Wi-Fi routers or microwave associated with the propagating component of
ovens. Furthermore, the tissue loss factor and conduc- the wave
tivity are higher at these frequency bands. Nonethe- • the type of antenna or whether electric or mag-
less, the availability of diverse products from many netic current is the source of radiation (some
manufacturers would make the ISM bands appealing
for research and proof-of-concept applications needing
Table 1. The parameters for electromagnetic wave
rapid prototyping of implants from low-cost and off- propagation in muscle tissue.
the-shelf components.
A better insight could be provided by comparing 400 MHz 900 MHz 2.45 GHz 5.8 GHz
some fundamental characteristics of electromagnetic
fl - jf m 57.1−j35.8 55.0−j18.8 52.7−j12.8 48.5−j15.4
waves at the mentioned frequencies. Table 1 illustrates
the complex permittivity (fl - jf m ) and the conductiv- v ^S/m h 0.80 0.94 1.74 4.96
ity ^vh of the muscle tissue [49] as well as the plane-
wave penetration depth ^d h in muscle and wavelength d ^mm h 52.6 42.4 22.3 7.5

in muscle ^mh and air ^m 0 h . Three important issues are m ^mm h 95.0 44.3 16.7 7.3
highlighted by this table.
1) There is a seven- to eightfold reduction of the m 0 ^mm h 750.0 333.3 122.4 51.7
wavelength in tissue that implies a significantly 7.9 7.5 7.3 7.1
m 0 /m
smaller antenna size in tissue compared with air.

March 2015 43
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 studies have shown that for electrically small the antenna trace [19], [32], [41], [42], [54], [55]; using a
antennas, magnetic antennas surpass electric shorting pin between the antenna and ground metalli-
antennas [50], and slot antennas outperform loop zation [41], [32], [54]–[57]; and employing stacked (mul-
and meandered microstrip antennas [51]). tilayered) metallization [58]–[60].
One may intuitively conclude that for deeper Some creative methods may also be used for size
implants (under a few centimeters of tissue) and with reduction. For instance, in [61], meandered slots are
a larger size, such as a pacemaker, the MICS band is etched away from the sides of a 2.4-GHz implantable
clearly advantageous in terms of the gain and radia- patch antenna, which serves as capacitive loading to
tion efficiency. On the other hand, this advantage may reduce the antenna’s overall size. Three-dimensional
not be as clear for shallower and smaller-physical- conformal antennas have also been proposed, such
sized implants. as an antenna composed of strip-type metallization
wrapped around rectangular box-shaped implants
Implantable Antenna Types (MICS band) [62], a conformal antenna on a flex-
It is well known that the performance of an antenna ible substrate formed on a capsule (dual band: MICS
embedded in tissue is significantly different from its and 2.45-GHz ISM) [63], and a broadband grounded
performance in air. Figure 4 shows the reflection coef- monopole antenna conforming to the shape of an im-
ficient for a 2.45-GHz chip antenna (LINX Technology planted central venous catheter (CVC) operating at the
Inc., Merlin, Oregon) in air and loaded by a polyacryl- MedRadio band for implant communication and the
amide gel phantom [52] with f r = 50 and v = 2.2 S/m at 2.45-GHz ISM band for electronics wake-up [64].
2.45 GHz, mimicking muscle [53]. Because of phantom While the majority of implantable antennas found
loading, the resonance frequency is shifted down from in the literature are of the wire type (e.g., patch, mean-
2.6 to 1.25 GHz. dered PIFA, spiral, and loop), slot-type antennas have
Due to the performance deviations that occur as also received attention in recent years. Examples
a function of the antenna environment, implantable include an implantable slot dipole [65], a cavity slot
antennas should be designed based on their specific antenna [66], a stripline-fed slot [67], meandered slots
application, device size, implantation site (depth, sur- [43], [51], and annular slots [51], [68]. Some recent simu-
rounding tissue, etc.), and operating frequency. Often, lation studies reveal that slot-type antennas surpass
because of size limitations, particularly at the lower- the strip-type antennas with complementary metal-
frequency MIICs band, the need for miniaturization lization in terms of their radiation efficiency [51], [68].
may arise [44], [45]. Practical implantable antennas are
planar, etched on a dielectric substrate, or conformal, Antenna Design and Modeling
i.e., laid out on the body of the device conforming to Implantable antennas are often designed for achiev-
its curvature and shape. As summarized in [45], meth- ing a minimum S 11 at certain frequencies or frequency
ods for the miniaturization (size reduction) of planar ranges and are modeled using numerical methods such
antennas may include the use of higher-dielectric- as the finite-difference time domain or finite-element
constant substrate; meandering, spiraling, or folding method [45], [46]. Although a realistic human body
model [46] may be needed to accurately characterize
far-field radiation properties such as radiation pattern
and gain, it would make the design stage very time-
S11 of the Chip Antenna consuming. It is known that an antenna’s S 11 is primar-
0
ily dictated by the tissue immediately surrounding the
antenna. Therefore, an implantable antenna embed-
-5
With Phantom ded in a simplified tissue block is often considered for
antenna design. Examples include a meandered PIFA
-10 0.26"
in a skin tissue block [55] [Figure 5(b)]; folded PIFA
S11 (dB)

(6.5) No
Phantom antennas for implantation in the human chest, with one
-15 AF 2.4 and three layers [41] [Figure 6(a)]; and planar antennas
encapsulated in an insulating material with a backplane
0.09"
-20 0.04" [Figure 6(b)]. The latter is used for modeling an ICP-
(2.2)
(1.0) monitoring device to compare the radiation efficiency
2.45-GHz Version
of various implanted antenna designs in [51].
-25
1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8 3 Electrically small tissue blocks such as those shown
Frequency (Hz) # 109 in Figures 5(b) and 6(a) may be sufficient for S 11 analy-
sis. However, for evaluating radiation parameters such
Figure 4. The reflection coefficient (S11) of a commercially as gain and radiation efficiency [Figure 6(b)], the lateral
available chip antenna with and without loading from the and backside tissue extent should be large enough to
muscle phantom. guarantee sufficient radio wave attenuation in those

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 directions. The selection of the tissue block dimensions, been used, and the S 11 is measured using a vector net-
considering the lateral and backside dimension of a few work analyzer (VNA) connected to the antenna through
penetration depths (Table 1), can be prescribed. Another a coaxial cable. Examples of liquids include a mixture
approach is to progressively increase the tissue block of deionized water, sugar, salt, and cellulose ^f r = 46.7
dimensions in preliminary simulations until no further and v = 0.69 S/m at 402 MHz, similar to skin) for chest-
changes in radiation efficiency and gain are observed. implantable antennas [41]; a mixture of water, sugar,
and salt for investigating the data telemetry link for ret-
Implantable Antenna Characterization inal prosthesis (eye) implantable antennas at microwave
frequencies of 1.45 and 2.45 GHz [19]; and a skin-tissue-
Materials and Methods simulating liquid at 402 MHz [58]. Often, a gelling agent
Implantable antennas are characterized by immersing is added to the mixture of water, sugar, and salt. TX-151
them in tissue phantoms with similar complex permit- powder mixed with sugar, salt, and water is used in
tivity to body tissues at the frequency of interest [19], [42] with f r = 48.9 and v = 0.71 S/m, for testing PIFAs
[32], [41], [42], [45], [54], [55]. Both liquid and gel have at the MICS band. Agarose (agar) is a readily available

Ground
Pin
Grounding 1.75 mm 0.5 mm
Via
ad
Feed Pad
0.5
mm 22.5
4 mm mm
m
1 mm Feed
y

0.8
8 mm x
5 mm
22.5 mm

3 mm
d Superstrate (Silicone) fr = 10.2 Superstrate
h Substrate (FR4)
Antenna Metallization fr =10.2
Ground Plane 4 cm Substrate 4 cm
Feed Via Grounding Via
Skin 3 mm
(0.5-mm Diameter)
(a) (b)

Y Feed Point
Y Y rb
(0 mm, 4mm)
Fu
D1 Du
X B1 X Bu X rur
A1 Au
Shorting C1 Cu
E1 Eu
Pin hc
(xs, ys)

Z 12 mm
Short Circuit
Sh
1.8 mm
to Ground
Y
Feed Point
Poin
nt

(c) (d)

Figure 5. Examples of implantable antennas found in the literature. (a) A folded PIFA antenna for ICP monitoring at
2.45 GHz [32] on FR4 ( f r = 4.25 and tan d = 0.01) with h = 0.787 mm (31 mils). Supersaturate is commercially available silicone
( f r = 3.7 and tan d = 0.003). (b) A dual-band (MICS and ISM bands) implantable antenna in skin [55]. (c) A parametric stacked
PIFA for MICS and ISM bands [59]. (d) A shorted conformal monopole for an implanted CVCs operating at MedRadio band for
implant communication and 2.45 ISM band for electronics wake-up [64].

March 2015 45
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 Coaxial Feeder

4 mm
8 mm
Muscle
4 mm Skin 16 mm
Fat
Skin 4 mm 4 mm

Designed Antennas
(a)
Implant

Dt d de
z Insulation
Dz Db
Back Metal Antenna
x/y Substrate

Dx/Dy
(b)

Figure 6. (a) A simplified model for the design of folded PIFA antennas at the MICS band for implantation in the human chest,
with one and three layers [41]. (b) A 2.45-GHz planar antenna encapsulated in an insulating material with a backplane, modeling
an ICP-monitoring device, for the study of radiation efficiency of various implanted antenna designs [51]. The implant is embedded
in a rectangular block of D x # D y # D z mm 3 ^D x = D y = 144 mm h, where D z = D t + D b and D b = d + 40.8 mm, D t is the
implantation depth, and d (variable) and d e (= 1 mm) are the insulation layer thickness at the top and edges, respectively.

gelling agent that is quite popular. In [55], agar-based with varying coating thicknesses in an experimental
skin-mimicking gel recipes for the MICS and 2.4-GHz setup, as explained in the next section.
ISM bands are presented.
Polyacrylamide gel [52] is an alternative phantom that Implantable PIFAs
has been used for testing ICP implants and antennas Characterization Test Setup
in [32] and [53]. The complex permittivity for the recipe The majority of the papers describing implantable an-
given in [30] is measured as f r = 50 and v = 2.2 S/m at tenna measurements have mainly provided experimen-
2.45 GHz, mimicking the muscle (scalp) [30]. tal characterization of the reflection coefficient ^S 11 h
[41], [42], [44], [45], [54], [55], [57], [63], [64]. Nonetheless,
2.45-GHz ICP Antenna Design simulation methods have been frequently used to char-
Two types of implantable transmitting antennas were acterize the transmission performance such as gain,
embedded in various prototypes of the implant. In radiation pattern, received power, and transmission co-
the preliminary work, a commercially available chip efficient ^S 21 h [41], [55], [59], [61], [63], [66]. Conducting
antenna (Figure 3) was used [30]. The chip antenna’s the measurements of radiation pattern and gain is more
coating with biograde silicone and its loading with involved and requires embedding the antenna in a tis-
tissue have a drastic effect on the antenna resonance sue environment that accurately replicates the radiation
frequency (Figure 4). Thus, the design and character- in a realistic setting. Received power and S 21 measure-
ization of a low-profile folded PIFA [Figure 5(a)] for the ments can be performed by placing an implantable de-
ICP implant had to be performed [32]. The folded PIFA vice or antenna in tissue phantom and measured by a
consists of a rectangular planar element located above spectrum analyzer or a VNA [32], where a standard di-
a ground plane, a short-circuiting pin, and a feeding pole, chip, or patch antenna in air can be used at the re-
coaxial cable connecting it to the implant electronics ceiving end. Such measurements have been conducted
in the actual setting or a VNA for performance char- in the past [19] and are now more common [65], [69]. To
acterization. Through preliminary simulation using the best of our knowledge, our group is the first to pro-
Ansoft Designer, for silicone thickness ^d h varied from vide the direct measurement of the gain of implantable
0 to 0.508 mm (20 mils), an overall PIFA trace length of antennas, measured for the PIFAs mentioned above [32].
around 14.3 mm [Figure 5(a)] was found appropriate for Measurements of implantable antennas’ gain and radia-
setting the resonance frequency fr, although the coat- tion pattern have started to appear in the past few years
ing thickness may also strongly influence the resonance [60], [64]. The measurement setup and methods for per-
frequency. Further studies were done by testing PIFAs forming measurement of S 11 and S 21 and gain of the

46 March 2015
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 ICP PIFAs, along with some of the results, are presented
here [32], to demonstrate the process. VNA Port 1
An 8-mm-thick polyacrylamide gel (8 # 5 # 0.8 cm) Semirigid
was used as the scalp phantom. The setup for conduct- Coax
ing the experiments is shown in Figure 7. The trans- (Cable_Tx) Cling Wrap
mission and reflection measurements (based on the Saline
standard 50-X reference) were conducted using a VNA (Height~20 mm)
PIFA
(Agilent 8722). The VNA was calibrated using the stan-
dard short-open-load-through two-port calibration. Phantom
Opening (Gel)
The setup consisted of a Plexiglas chamber resting on a 30.5 cm
metallic stand that is 91.5 cm (3 in) high. The inner walls
30.5 cm Plexiglass
of the chamber were covered with absorbers (1–3 GHz, Chip
ECCOSORB-SF, Emerson & Cuming Microwave Prod- Antenna
ucts, Inc., Randolph, Massachusetts) over all surfaces Absorbers
except the top. The PIFA, mounted at one end of a semi- 61 cm
rigid coaxial cable (Cable_TX, Pasternack Enterprises,
Irvine, California), was resting against a scalp phantom.
The dielectric at one end of the cable (with 2.16-mm outer Cable_Rx
diameter) was partially removed, and the inner conduc-
tor penetrating from the back (PIFA’s ground plane) fed VNA Port 2 (Cable 1)
the PIFA. The receiving antenna was the linearly polar-
Figure 7. The experimental setup for the PIFA antenna
ized 2.45-GHz chip antenna of Figure 4, mounted on
reflection and transmission measurements [43].
an FR4 substrate connected to a semirigid coaxial cable
(Cable_Rx, Pasternak Enterprises, Irvine, California).
The VNA reference planes were set at the end of Cable1 An understanding of the effective isotropic radi-
and Cable_RX, as illustrated in Figure 7. The PIFA was ated power (EIRP) from a transmitting antenna is use-
suspended vertically inside a 15.2 # 15.2 # 15.2 cm (6 # ful in comparing the radiation against the regulatory
6 # 6 in) acrylic cube (Figure 7). A small square opening limits set by FCC. The EIRP for 2.4-GHz ISM-band
(3 # 3 cm) at the bottom of the cube allowed the PIFA short-range communications is -1.25 dBm. We also
to make contact with the phantom inserted between the have EIRP = PD G t, where PD is delivered (accepted)
bottom surface of the cube and the top of the chamber. power to the antenna and G t is its gain. To measure G t,
Another square opening (3 cm # 3 cm) at the top of the the following equation is used, where S 11 and S 22 are
chamber allowed PIFA irradiation into it. The cube was the reflection coefficients of the implanted PIFA and
filled with 0.9% saline, with a depth of 18–20 mm. Due to receiving chip antenna, S 21 is the transmission ratio,
the lower mass density of the polyacrylamide gel phan- and G r is the chip antenna’s gain:
tom compared with saline, the gel was placed outside
S 21 2 = G t G r m2 ^1 - S 11 2 h^1 - S 22 2 h . (1)
2
the cube (under the opening at its bottom) to prevent it
from floating inside the saline medium. To prevent leak- ^4rD h
age, the gel was wrapped around the bottom of the cube
with cling wrap. The temperature in the saline was 20 cC G r is measured by three-antenna method of
during measurements, with a maximum temperature gain measurement [70], [71] as detailed in [72]. G t at
variation of 0.2 cC.
A comparison of five PIFAs differed by the thick-
ness of their silicone superstrate coating ^d h, along with S21 = -58.3 dB
silicone curing time ^t ch, resonance frequency ^ fr h, S 11
0 fr = 2.538 GHz -50
and S 21 at fr for a separation of D = 10 cm between the -2 -60
receiver antenna (chip) and the bottom of the gel as pro-
S11 (dB)

S21 (dB)

-4 -70
vided in [32]. Some of the results from [32] are highlight-
ed in Figures 8 and 9. From the simulation, a coating -6 -80
thickness of around d = 0.394 mm (15.5 mils) provides S11 = -9.1 dB
-8 -90
an fr of around 2.45 GHz. This agrees well with the fr = 2.537 GHz
measurements, as this value of d falls halfway between -10 -100
1 1.5 2 2.5 3 3.5 4
the fr measured for Antenna_1 and Antenna_3, with Frequency (GHz)
0.356 (14 mils) and 0.432 mm (17 mils) of silicone thick-
ness, respectively. The fr and S 11 at fr increase with the Figure 8. The S 11 and S 21 versus frequency for Antenna_2 for
increase in d. Also, with the increase in d, S 11 at fr in- a separation of D = 10 cm (4 in) between the transmitter and
creases, and the 10-dB bandwidth decreases. receiver antennas [32].

March 2015 47
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 Agarose (agar) is a readily available ICP studies in [73] using this antenna. This is also con-
sistent with the values summarized in [44] for implant-
gelling agent that is quite popular. able antennas operating at the MICS band. For the less
restrictive IEEE C95.1-2005, the maximum delivered
2.45 GHz was then evaluated with an antenna separa- power to the antenna could be up to 20–30 mW [44].
tion of D = 27.9 cm and was found to be -24.8 and
-26.7 dB for Antenna_3 and Antenna_4, with silicone Radiation Efficiency
thickness of 0.432 and 0.279 mm, respectively. The As evidenced by the relatively short history of im-
corresponding values of EIRP were 3.3 mW (5.2 dBm) plantable antennas for medical telemetry, the design
and 2.1 mW (3.2 dBm) for 1 W of the accepted antenna strategy for implantable antennas is mainly focused
power. Note that these values only correspond to an on achieving the best possible matching (to 50 X) or de-
implantation depth of 8 mm (scalp thickness). sired bandwidth, with some rare exceptions [51], [74].
This undermines an arguably more important charac-
Implantable Antenna Specific teristic, the radiation efficiency. An unimpressive re-
Absorption Rate Versus EIRP flection coefficient of −3 dB would correspond to 50%
Bearing in mind that low-power implantable devices degradation of the power delivered to the antenna and
would be very unlikely to operate at levels even close the power radiated to the air. Conversely, depending
to 1 W, the low values of EIRP per 1 W accepted power on the choice of the antenna [51], the variation in ra-
obtained above suggest that the regulatory EIRP lim- diation efficiency could be over an order of magnitude
its would likely not be an issue for implant commu- higher for the same device packaging [Figure 6(b)].
nication. On the contrary, the specific absorption rate One main difference between the two types of power
(SAR) limits would likely dictate the maximum device degradation is that a mismatch could be remedied by
power. Among restrictions often used to evaluate SAR automatic tuning methods incorporated in the im-
compliance are the IEEE C95.1-1999 standard speci- planted electronics, while radiation efficiency degra-
fying a maximum SAR average over 1 g of tissue of dation is a more fundamental limitation and cannot be
1.6 W/kg and a later and more relaxed IEEE C95.1-2005 compensated after the incorporation of the antenna in
standard specifying a maximum SAR average over the implant.
10 g of tissue of 2 W/kg [44], [45]. These SAR levels can Further simulations in [51] illustrate that slot-type
be evaluated through simulation. For example, for the antennas generally outperform strip-type antennas in
ICP Antenna_3, the 1-g averaged SAR of 1.6 W/kg was terms of radiation efficiency, which is typically within
reached with 6 dBm (4 mW) of power delivered to the the range of 0.2–2% for 8-mm-deep implantation for
PIFA. This is much lower than what was the case for the muscle tissue.

Considerations in
0
Designing and
Testing ICP Implants
In designing biomedical
implants, careful consid-
-5 eration should be given to
Antenna_1 the reliability of their per-
Antenna_2 formance and the various
S11 (dB)

Antenna_3 factors that may influence

-10 Antenna_4 it. The evaluation criteria
Antenna_3SIM fr = 2.537 GHz, S11 = -9.1 dB include, but are not lim-
fr = 2.496 GHz, S11 = -11.7 dB ited to, sensitivity to pres-
Antenna_1SIM
sure and temperature,
-15 fr = 2.488 GHz, S11 = -12.2 dB
repeatability, drift, and
fr = 2.387 GHz, S11 = -13.4 dB
integrity in water medi-
fr = 2.420 GHz, S11 = -15.1 dB
um. Some of the methods
fr = 2.254 GHz, S11 = -18.1 dB and considerations are
-20
1.5 2 2.5 3 3.5 presented here.
Frequency (GHz)
Device Calibration
Figure 9. S 11 versus frequency measured for Antenna_1–Antenna_4 and simulated for One of the methods
Antenna_1 (Antenna_1SIM) and Antenna_3 (Antenna_3SIM) [32]. The coating thicknesses for for calibrating the ICP-
Antenna_1, Antenna_2, Antenna_3, and Antenna_4 are 0.356, 0.457, 0.432, and 0.279 mm, monitoring systems is
respectively. to calibrate the implant

48 March 2015
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 against the gold standard (e.g., the Camino ICP cath-
The general surgical procedures
eters, Integra LifeSciences, Plainsboro, New Jersey). A
hydrostatic pressure setup was developed with a pro- involved the drilling of a burr hole in
vision for taking parallel pressure measurements with the skull for access to the site of ICP
the implant (being characterized) and the Camino cath-
measurement.
eter [31]. A graduated water column was connected to a
bottle, which acted as a pressure chamber. The implant
was fitted in the pressure chamber, which was held sta- • able to handle stresses in a corrosive body environment
tionary inside a temperature-controlled water bath. The • able to be fabricated into the desired form.
implant in the water chamber was positioned in such a Polymeric coatings are applied to medical devices
way that the overlying confining surface was 1 cm away for a variety of reasons, which include enhancing bio-
from the silicone-covered embedded PIFA. This space compatibility and biostability, thromboresistance, anti-
was filled by a closely fitted polyacrylamide gel phan- microbial action, dielectric strength, and lubricity [76].
tom [31] or water, emulating the biological environment. Parylene (polyxylylene or its derivatives) is a vapor-
The pressure in the system was varied by adjusting deposited polymer that is heavily used in the medical
the height of the water in the column. The implant was device industry. The process does not use any solvents,
tested in the pressure range of 0–40 mmHg during plasticizers, or surface enhancers and is carried out at
hydrostatic tests. To determine the temperature sensi- room temperature. Parylene coatings are completely
tivity of the implant in a water medium, the temperature conformal, produce uniform thickness, and are pinhole-
of the water bath was varied from room temperature to free. The advantage of this process is that the coating
40 °C. The temperature-sensitivity measurements were forms from a gaseous monomer without an interme-
taken while increasing and decreasing the temperature diate liquid stage. As a result, component configura-
and maintaining a fixed pressure. tions with sharp edges, points, flat surfaces, crevices, or
exposed internal surfaces are coated uniformly without
Materials Used in the Fabrication voids [82]. Parylene coatings can resist chemical attack
of the Implant from organic solvents and inorganic reagents and acids
The safety of a medical device in a biological medium and also offer high dielectric strength. Parylene can be
begins with the choice of materials that are used in used to coat diverse types of surfaces, such as metals,
building the implant. In January 2000, the U.S. National glass, paper, plastics, ceramics, silicon, and so on. These
Institutes of Health reported that 8–10% of Americans coatings are also deemed to be resistant to the damag-
have some type of implant in their body [75]. The ing effects of corrosive body fluids, proteins, enzymes,
surface of an implant that comes in contact with the electrolytes, and lipids. The coating also acts as a barrier
body should be composed of biomaterials. Metals like to the passage of any contaminants from the coated sur-
stainless steel, aluminum, titanium, gold, cobalt-based face to the external environment.
alloys, and nickel–titanium alloys have long been used To make our ICP implants robust, the casings were
as biomaterials and are also approved by the U.S. Food machined out of metals such as implant-grade alu-
and Drug Administration for use in medical implants minum, stainless steel, or titanium. Alternatively, the
[76]–[79]. Polymeric materials [76] like polymethyl implants can also be encased in biograde silastic mate-
siloxane (silicone rubber and silastics) have been used rial. Cyanoacrylate and silicone rubber were used as
in joint replacement, polymethyl methacrylate as adhesives and sealants for the implant. Silicone (e.g.,
cement (grout), polyurethane in hip joints, and so on. Factor II Inc., Lakeside, Arizona) was preferred due
Silicones are applicable at a wide range of temperatures to the ability to easily rework it during the fabrication
(-50 °C to 260 °C) and can mechanically adhere to a process. The electronics and the printed circuit board
wide range of materials. They have low tensile and traces were sealed in silicone to provide electrical iso-
surface peel strengths, which indicate they are suitable lation as well as to act as a barrier for any moisture.
as structural sealants than structural adhesives. Typi- This process may either exclude the antenna top coat-
cal silicone applications include bonding and sealing ing, which may already have a silicone superstrate [31],
of silicone-based assemblies, coating of components to or antenna (superstrate), and device coating/sealing
minimize rough edges, and coating of highly flexible can be done together in one step. As performed in [68],
assemblies such as endotracheal tubes [80], [81]. Cya- employing a medical-grade epoxy (EPO-TEK 302-3M)
noacrylates (e.g., Krazy Glue) and epoxies are known as the superstrate and sealant. The last step in the fab-
to be effective adhesives, and they bond well with rication of the ICP implant was to coat it with Parylene.
many materials. In considering materials for a medical Thick coatings are prone to peeling from the surface of
implant, several factors are of significance. The mate- the implant. Due to its good adhesion to the surface of
rial should be the implant and negligible effect on the sensitivity of
• nontoxic and noncarcinogenic, cause no or little the capacitive pressure sensor, 2.5-µm-thick Parylene
foreign body reaction, and chemically stable was deemed to be optimal.

March 2015 49
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 Wireless monitoring of ICP opens up in the animal. To achieve this, sterile saline (mock CSF)
injections were administered into the brain of an anes-
the possibility of ICP monitoring in thetized dog. A cisternal needle was inserted into the
ambulatory conditions. brain to allow infusion of mock CSF to produce a range
of ICPs. For each session, more fluid was injected into
the brain to produce a range of ICPs between the normal
In Vivo Studies level and approximately 80 mmHg. For each ICP level,
Any in vivo experimentation conducted on animals has the Camino pressure was recorded and compared with
to be carried out humanely in accordance with the con- the simultaneous reading of the ICP implant.
cerned institution’s policy and guidelines. The implants
were tested in different animal models, such as swine, Head Injury
canine, and rodent models. In our acute measurement Two well-established TBI models were utilized for the
setup, the implants were compared with Camino pres- study of ICP changes in a closed-head environment. A
sure catheters. In some cases, an increase in ICP was nonimpact head acceleration model for inducing diffuse
induced to determine the implant’s performance over brain trauma in miniature swine via a rapid head rota-
a wider range of pressure. The in vivo testing allowed tional acceleration [84], [85]. Briefly, the animal’s head
for the determination of the accuracy of measurements, is attached to a pneumatic actuator via a padded snout
longevity of implants, biocompatibility, and application clamp. A custom linkage converts linear motion into
of these implants in measuring ICP in head injury mod- angular motion of the actuator, triggered by a release
els. A modification of the AICP implant was utilized in of pressurized nitrogen, into angular motion (rotational
blast-induced TBI (bTBI) in rodents, which is discussed acceleration) of the head [84]. An established bTBI model
in [83]. The DICP implants were used in swine models to is the other model utilized in the studies on rodents
determine ICP changes after rotational head injury [29]. using a compressed air-driven shock tube. This device
has been used extensively to study various aspects of
Surgery blast overpressure and bTBI [86]–[90].
The general surgical procedures involved the drilling
of a burr hole in the skull for access to the site of ICP Performance of the Implants In Vivo
measurement (ED, SD, or IV). The implants utilized in The AICP implants were tested in seven large animals
large animals (canine and swine) are either ED- or SD- (swine and canine) for their performance and were later uti-
type implants. In large animals, burr holes also serve to lized in rats during bTBI studies. The results are described
hold the implants in place. In rodent models, a modified in detail in [30] and [31]. In the large-animal studies, the ICP
AICP implant measures IV pressure, and the burr hole measurements taken on the day of implantation from the
provides access to a lateral ventricle through punctured AICP implant and the Camino catheter were compared,
dura mata. All versions of the ICP implants are secured and a correlation of 0.94 or better was calculated between
to the skull by means of anchor screws and adhesive. the two methods of measurements. As an example, Fig-
ure 10 shows the comparison between the AICP implant
Induced ICH and the Camino catheter when ICH was induced.
For the purpose of evaluating the performance of the ICP The AICP and DICP implants were also utilized in
implant over a wide range of pressure, ICH was induced measuring ICP changes in rodent (blast brain injury)

AICP Implant (SD Type) Versus Camino Monitor 125

90 Trail(1)-DICP(1)
100 Camino
Implant Pressure (mmHg)

80
Reading
70 75
Pressure (mmHg)

60 Instability
50 50 Period
40 25
30
0
20
Injury
10 -25 Time
0
0 20 40 60 80 100 -50
Camino Pressure (mmHg) 0 5 10 15 20 25 30
Time After Implantation (h)
Figure 10. The simultaneous ICP measurements taken by
the AICP implant and the Camino catheter. A correlation Figure 11. The ICP measured by a DICP implant in a pig
coefficient of 0.998 was determined. before and after inducing rotational head injury.

50 March 2015
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 and swine (rotational injury) models of TBI. Upon
Furthermore, wireless monitoring
implantation of the DICP implant in a pig, the ICP read-
ings exhibited instability (Figure 11), potentially due to will facilitate advancement in the
the effects of surgery or air trapped between the sen- home health-care system and
sor and the CSF. It took 4–5 h for the measurements to
decentralization of medicine.
attain stability in the in vivo environment, after which
the ICP readings were relatively consistent over 12 h
(15.6 ! 5.3 mmHg, mean ! standard deviation). We 3) Due to large dielectric losses in tissues, slot-type
found that closed-head rotational TBI induced a antennas may have superior performance in
rapid and extreme ICP spike occurring directly upon terms of their radiation efficiency compared with
injury (max ICP 2 115 mmHg; Figure 11). Notably, the strip-type antennas [51].
device integrity and positioning remained suitable for 4) Antennas with tilted (from broadside) far-field
dynamic postinjury ICP readings, which is impressive radiation patterns are expected to have poorer
given the forces necessary to generate the rapid head radiation efficiency, since a tilted beam may coin-
rotation in the swine (peak angular acceleration of over cide with a longer path length as the wave traverses
50,000 rad/s2). The acute elevation in ICP generally along the tissue. Correspondingly, a symmetric
lasted for 40–60 min, followed by a gradual decline to a antenna layout and feed may be more preferable
persistently elevated level over several hours postinjury. for achieving a higher radiation efficiency.
To the best of our knowledge, this trend of an imme- Wireless monitoring of ICP opens up the possibility
diate ICP spike followed by persistently elevated levels of ICP monitoring in ambulatory conditions. It also sup-
has not been observed previously following closed- ports the use of ICP implants under conditions in which it
head TBI. To confirm our measurements, the Camino is desirable to monitor the pressure for periods longer than
ICP monitor was introduced into the parenchyma 3 h can be practically realized by catheters. An understanding
after the injury (placed contralateral to the DICP device). of the ICP trends over a duration of time in patients recover-
The Camino measurements showed a pressure range of ing from TBI, cerebral hemorrhages, or brain tumors while
22–26 mmHg, and during that period, our DICP mea- they are not restricted to hospitals would aid in defining
surements recorded a mean of 23.79 mmHg with a stan- their therapy regimen and would also lead to a significant
dard deviation of ! 2.94 mmHg. improvement in the outcome. Furthermore, wireless mon-
itoring will facilitate advancement in the home health-care
Conclusions and Future Work system and decentralization of medicine.
The evaluation of ICP implants in in vivo settings pro-
vides vital details that validate their applicability in References
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