Skin cancer identification using multifrequency electrical impedance--a potential screening tool

Magnetic Resonance Electrical Properties Tomography Based on Modified Physics- Informed Neural Network and Multiconstraints

This paper presents a novel method based on leveraging physics-informed neural networks for magnetic resonance electrical property tomography (MREPT). MREPT is a noninvasive technique that can retrieve the spatial distribution of electrical properties (EPs) of scanned tissues from measured transmit radiofrequency (RF) in magnetic resonance imaging (MRI) systems. The reconstruction of EP values in MREPT is achieved by solving a partial differential equation derived from Maxwell's equations that lacks a direct solution. Most conventional MREPT methods suffer from artifacts caused by the invalidation of the assumption applied for simplification of the problem and numerical errors caused by numerical differentiation. Existing deep learning-based (DL-based) MREPT methods comprise data-driven methods that need to collect massive datasets for training or model-driven methods that are only validated in trivial cases. Hence we proposed a model-driven method that learns mapping from a measured RF, its spatial gradient and Laplacian to EPs using fully connected networks (FCNNs). The spatial gradient of EP can be computed through the automatic differentiation of FCNNs and the chain rule. FCNNs are optimized using the residual of the central physical equation of convection-reaction MREPT as the loss function ( L) . To alleviate the ill condition of the problem, we added multiconstraints, including the similarity constraint between permittivity and conductivity and the l1 norm of spatial gradients of permittivity and conductivity, to the L . We demonstrate the proposed method with a three-dimensional realistic head model, a digital phantom simulation, and a practical phantom experiment at a 9.4T animal MRI system.

Electrical Impedance Dermography: Background, Current State, and Emerging Clinical Opportunities

Electrical impedance dermography (EID), based on electrical impedance spectroscopy, is a specific technique for the evaluation of skin disorders that relies upon the application and measurement of painless, alternating electrical current. EID assesses pathological changes to the normal composition and architecture of the skin that influence the flow of electrical current, including changes associated with inflammation, keratinocyte and melanocyte carcinogenesis, and scarring. Assessing the electrical properties of the skin across a range of frequencies and in multiple directions of current flow can provide diagnostic information to aid in the identification of pathologic skin conditions. EID holds the promise of serving as a diagnostic biomarker and potential to be used in skin cancer detection and staging. EID may also be useful as a biomarker in monitoring effectiveness of treatment in individual patients and in therapeutic research. This review highlights ongoing efforts to improve mechanistic understanding of skin electrical changes, study of EID in a variety of clinical contexts, and further refine the technology to find greater clinical use in dermatology and dermatologic research.

A 3 MHz Low-Error Adaptive Howland Current Source for High-Frequency Bioimpedance Applications

Bioimpedance is a diagnostic sensing method used in medical applications, ranging from body composition assessment to detecting skin cancer. Commonly, discrete-component (and at times integrated) circuit variants of the Howland Current Source (HCS) topology are employed for injection of an AC current. Ideally, its amplitude should remain within 1% of its nominal value across a frequency range, and that nominal value should be programmable. However, the method's applicability and accuracy are hindered due to the current amplitude diminishing at frequencies above 100 kHz, with very few designs accomplishing 1 MHz, and only at a single nominal amplitude. This paper presents the design and implementation of an adaptive current source for bioimpedance applications employing automatic gain control (AGC). The "Adaptive Howland Current Source" (AHCS) was experimentally tested, and the results indicate that the design can achieve less than 1% amplitude error for both 1 mA and 100 µA currents for bandwidths up to 3 MHz. Simulations also indicate that the system can be designed to achieve up to 19% noise reduction relative to the most common HCS design. AHCS addresses the need for high bandwidth AC current sources in bioimpedance spectroscopy, offering automatic output current compensation without constant recalibration. The novel structure of AHCS proves crucial in applications requiring higher β-dispersion frequencies exceeding 1 MHz, where greater penetration depths and better cell status assessment can be achieved, e.g., in the detection of skin or breast cancer.

A non-invasive approach to skin cancer diagnosis via graphene electrical tattoos and electrical impedance tomography

Objective.Making up one of the largest shares of diagnosed cancers worldwide, skin cancer is also one of the most treatable. However, this is contingent upon early diagnosis and correct skin cancer-type differentiation. Currently, methods for early detection that are accurate, rapid, and non-invasive are limited. However, literature demonstrating the impedance differences between benign and malignant skin cancers, as well as between different types of skin cancer, show that methods based on impedance differentiation may be promising.Approach.In this work, we propose a novel approach to rapid and non-invasive skin cancer diagnosis that leverages the technologies of difference-based electrical impedance tomography (EIT) and graphene electronic tattoos (GETs).Main results.We demonstrate the feasibility of this first-of-its-kind system using both computational numerical and experimental skin phantom models. We considered variations in skin cancer lesion impedance, size, shape, and position relative to the electrodes and evaluated the impact of using individual and multi-electrode GET (mGET) arrays. The results demonstrate that this approach has the potential to differentiate based on lesion impedance, size, and position, but additional techniques are needed to determine shape.Significance.In this way, the system proposed in this work, which combines both EIT and GET technology, exhibits potential as an entirely non-invasive and rapid approach to skin cancer diagnosis.

A Review of Recent Advancements in Sensor-Integrated Medical Tools

A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.

Biosensors for melanoma skin cancer diagnostics

Skin cancer is a critical global public health concern, with melanoma being the deadliest variant, correlated to 80% of skin cancer-related deaths and a remarkable propensity to metastasize. Despite notable progress in skin cancer prevention and diagnosis, the limitations of existing methods accentuate the demand for precise diagnostic tools. Biosensors have emerged as valuable clinical tools, enabling rapid and reliable point-of-care (POC) testing of skin cancer. This review offers insights into skin cancer development, highlights essential cutaneous melanoma biomarkers, and assesses the current landscape of biosensing technologies for diagnosis. The comprehensive analysis in this review underscores the transformative potential of biosensors in revolutionizing melanoma skin cancer diagnosis, emphasizing their critical role in advancing patient outcomes and healthcare efficiency. The increasing availability of these approaches supports direct diagnosis and aims to reduce the reliance on biopsies, enhancing POC diagnosis. Recent advancements in biosensors for skin cancer diagnosis hold great promise, with their integration into healthcare expected to enhance early detection accuracy and reliability, thereby mitigating socioeconomic disparities.

Multi-Modal Spectroscopic Assessment of Skin Hydration

Human skin acts as a protective barrier, preserving bodily functions and regulating water loss. Disruption to the skin barrier can lead to skin conditions and diseases, emphasizing the need for skin hydration monitoring. The gold-standard sensing method for assessing skin hydration is the Corneometer, monitoring the skin's electrical properties. It relies on measuring capacitance and has the advantage of precisely detecting a wide range of hydration levels within the skin's superficial layer. However, measurement errors due to its front end requiring contact with the skin, combined with the bipolar configuration of the electrodes used and discrepancies due to variations in various interfering analytes, often result in significant inaccuracy and a need to perform measurements under controlled conditions. To overcome these issues, we explore the merits of a different approach to sensing electrical properties, namely, a tetrapolar bioimpedance sensing approach, with the merits of a novel optical sensing modality. Tetrapolar bioimpedance allows for the elimination of bipolar measurement errors, and optical spectroscopy allows for the identification of skin water absorption peaks at wavelengths of 970 nm and 1450 nm. Employing both electrical and optical sensing modalities through a multimodal approach enhances skin hydration measurement sensitivity and validity. This layered approach may be particularly beneficial for minimising errors, providing a more robust and comprehensive tool for skin hydration assessment. An ex vivo desorption experiment was carried out on fresh porcine skin, and an in vivo indicative case study was conducted utilising the developed optical and bioimpedance sensing devices. Expected outcomes were expressed from both techniques, with an increase in the output of the optical sensor voltage and a decrease in bioimpedance as skin hydration decreased. MLR models were employed, and the results presented strong correlations (R-squared = 0.996 and p-value = 6.45 × 10-21), with an enhanced outcome for hydration parameters when both modalities were combined as opposed to independently, highlighting the advantage of the multimodal sensing approach for skin hydration assessment.

Dielectric Spectroscopy Shows a Permittivity Contrast between Meningioma Tissue and Brain White and Gray Matter-A Potential Physical Biomarker for Meningioma Discrimination

The effectiveness of surgical resection of meningioma, the most common primary CNS tumor, depends on the capability to intraoperatively discriminate between the meningioma tissue and the surrounding brain white and gray matter tissues. Aiming to find a potential biomarker based on tissue permittivity, dielectric spectroscopy of meningioma, white matter, and gray matter ex vivo tissues was performed using the open-ended coaxial probe method in the microwave frequency range from 0.5 to 18 GHz. The averages and the 95% confidence intervals of the measured permittivity for each tissue were compared. The results showed the absence of overlap between the 95% confidence intervals for meningioma tissue and for brain white and gray matter, indicating a significant difference in average permittivity (p ≤ 0.05) throughout almost the entire measured frequency range, with the most pronounced contrast found between 2 GHz and 5 GHz. The discovered contrast is relevant as a potential physical biomarker to discriminate meningioma tissue from the surrounding brain tissues by means of permittivity measurement, e.g., for intraoperative meningioma margin assessment. The permittivity models for each tissue, developed in this study as its byproducts, will allow more accurate electromagnetic modeling of brain tumor and healthy tissues, facilitating the development of new microwave-based medical devices and tools.

Advances in TEER measurements of biological barriers in microphysiological systems

Biological barriers are multicellular structures that precisely regulate the transport of ions, biomolecules, drugs, cells, and other organisms. Transendothelial/epithelial electrical resistance (TEER) is a label-free method for predicting the properties of biological barriers. Understanding the mechanisms that control TEER significantly enhances our knowledge of the physiopathology of different diseases and aids in the development of new drugs. Measuring TEER values within microphysiological systems called organ-on-a-chip devices that simulate the microenvironment, architecture, and physiology of biological barriers in the body provides valuable insight into the behavior of barriers in response to different drugs and pathogens. These integrated systems should increase the accuracy, reproducibility, sensitivity, resolution, high throughput, speed, cost-effectiveness, and reliable predictability of TEER measurements. Implementing advanced micro and nanoscale manufacturing techniques, surface modification methods, biomaterials, biosensors, electronics, and stem cell biology is necessary for integrating TEER measuring systems with organ-on-chip technology. This review focuses on the applications, advantages, and future perspectives of integrating organ-on-a-chip technology with TEER measurement methods for studying biological barriers. After briefly reviewing the role of TEER in the physiology and pathology of barriers, standard techniques for measuring TEER, including Ohm's law and impedance spectroscopy, and commercially available devices are described. Furthermore, advances in TEER measurement are discussed in multiple barrier-on-a-chip system models representing different organs. Finally, we outline future trends in implementing advanced technologies to design and fabricate nanostructured electrodes, complicated microfluidic chips, and membranes for more advanced and accurate TEER measurements.

Electrical Bioimpedance Analysis for Evaluating the Effect of Pelotherapy on the Human Skin: Methodology and Experiments

BACKGROUND

Pelotherapy is the traditional procedure of applying curative muds on the skin's surface-shown to have a positive effect on the human body and cure illnesses. The effect of pelotherapy is complex, functioning through several mechanisms, and depends on the skin's functional condition. The current research objective was to develop a methodology and electrodes to assess the passage of the chemical and biologically active compounds of curative mud through human skin by performing electrical bioimpedance (EBI) analysis.

METHODS

The methodology included local area mud pack and simultaneous tap water compress application on the forearms with the comparison to the measurements of the dry skin. A custom-designed small-area gold-plated electrode on a rigid printed circuit board, in a tetrapolar configuration, was designed. A pilot study experiment with ten volunteers was performed.

RESULTS

Our results indicated the presence of an effect of pelotherapy, manifested by the varying electrical properties of the skin. Distinguishable difference in the measured real part of impedance (R) emerged, showing a very strong correlation between the dry and tap-water-treated skin (r = 0.941), while a poor correlation between the dry and mud-pack-treated skin (r = 0.166) appeared. The findings emerged exclusively in the frequency interval of 10 kHz …1 MHz and only for R.

CONCLUSIONS

EBI provides a promising tool for monitoring the variations in the electrical properties of the skin, including the skin barrier. We foresee developing smart devices for promoting the exploitation of spa therapies.

A review of bio-impedance devices

Bio-impedance measurement analysis primarily refers to a safe and a non-invasive technique to analyze the electrical changes in living tissues on the application of low-value alternating current. It finds applications both in the biomedical and the agricultural fields. This paper concisely reviews the origin and measurement approaches for concepts and fundamentals of bio-impedance followed by a critical review on bio-impedance portable devices with main emphasis on the embedded system approach which is in demand due to its miniature size and present lifestyle preference of monitoring health in real time. The paper also provides a comprehensive review of various bio-impedance circuits with emphasis on the measurement and calibration techniques.

Design of electrical impedance spectroscopy sensing surgical drill using computational modelling and experimental validation

Electrical Impedance Spectroscopy (EIS) sensing surgical instruments could provide valuable and real-time feedback to surgeons about hidden tissue boundaries, therefore reducing the risk of iatrogenic injuries. In this paper, we present an EIS sensing surgical drill as an example instrument and introduce a strategy to optimize the mono-polar electrode geometry using a finite element method (FEM)-based computational model and experimental validation. An empirical contact impedance model and an adaptive mesh refinement protocol were developed to accurately preserve the behaviour of sensing electrodes as they approach high impedance boundaries. Specifically, experiments with drill-bit, cylinder, and conical geometries suggested a 15%-35% increase in resistance as the sensing electrode approached a high impedance boundary. Simulations achieved a maximum mean experiment-to-simulation mismatch of +1.7% for the drill-bit and +/-11% range for other electrode geometries. The simulations preserved the increase in resistance behaviour near the high impedance boundary. This highly accurate simulation framework allows us a mechanism for optimizing sensor geometry without costly experimental evaluation.

A Low-Power Single-Path Bio-Impedance Measurement System Using an Analog-to-Digital Converter for I/Q Demodulation

In this paper, a low power single-path bio-impedance (Bio-Z) measurement system for early detection of acute myocardial ischemia is presented. The fully integrated system consists of a current source, an amplifier, and an analog-to-digital converter (ADC). The system utilizes the in-phase and quadrature (I/Q) components to obtain the real and imaginary parts of the tissue impedance. To achieve this goal, the ADC has been used to separate the I/Q components in addition to digitizing the samples. This can lead to power and silicon area reduction. The proposed circuit exploits the benefits of capacitively-coupled instrumentation amplifier, including inherent DC cancellation, low power, low noise, and high linearity and is implemented in 0.18 µm CMOS technology with a 1 V power supply. This system is designed and tested using a pseudo-sine 2 µA_P-P current with a frequency of 1 kHz. The system can measure an input impedance that varies over a range from 0.03-7.5 kΩ with a resolution of 0.766 Ω_rms while consuming 2 µW power from the supply. The operation of the system is also shown in the recording of impedance variation with respiration and heartbeat.

Reflectance Confocal Microscopy and Electrical Impedance Spectroscopy in the Early Detection of Melanoma in Changing Lesions during Long-term Follow-up of Very High-risk Patients

Electrical impedance spectroscopy has clinical relevance in diagnosing malignancy in melanocytic lesions. Sixty-eight lesions with changes during digital follow-up of patients at very high risk of developing melanoma were prospectively included in this study from February to December 2016. Electrical impedance spectroscopy and reflectance confocal microscopy were performed to evaluate their performance in this subset of difficult lesions. Forty-six lesions were considered suspicious on reflectance confocal microscopy and were excised, of these, 19 were diagnosed as melanoma. Fifteen melanomas were detected by electrical impedance spectroscopy, while 4 received a score lower than 4, which suggested no malignancy. The addition of reflectance confocal microscopy improves accuracy while maintaining the same sensitivity. In the case of electrical impedance spectroscopy scores <4, lesions exhibiting changes in follow-up may need short-term monitoring or excision if dermoscopy shows criteria for melanoma. Results of electrical impedance spectroscopy in this subset of very early lesions should be carefully considered due to the risk of false negatives.

Electrical Impedance Analysis for Lung Cancer: A Prospective, Multicenter, Blind Validation Study

Hypothesis

Patients with cancer have different impedances or conductances than patients with benign normal tissue; thus, we can apply electrical impedance analysis (EIA) to identify patients with cancer.

Method

To evaluate EIA’s efficacy and safety profile in diagnosing pulmonary lesions, we conducted a prospective, multicenter study among patients with pulmonary lesions recruited from 4 clinical centers (Zhongshan Hospital Ethics Committee, Approval No. 2015-16R and 2017-035(3). They underwent EIA to obtain an Algorithm Composite Score or ‘Prolung Index,’ PI. The classification threshold of 29 was first tested in an analytical validation set of 144 patients and independently validated in a clinical validation set of 418 patients. The subject’s final diagnosis depended on histology and a 2-year follow-up.

Results

In total, 418 patients completed the entire protocol for clinical validation, with 186 true positives, 145 true negatives, 52 false positives, and 35 false negatives. The sensitivity, specificity, and diagnostic yield were 84% (95% CI 79.3%-89.0%), 74% (95% CI 67.4%-79.8%), and 79% (95%CI 75.3%-83.1%), respectively, and did not differ according to age, sex, smoking history, body mass index, or lesion types. The sensitivity of small lesions was comparable to that of large lesions (p = 0.13). Four hundred eighty-four patients who underwent the analysis received a safety evaluation. No adverse events were considered to be related to the test.

Conclusion

Electrical impedance analysis is a safe and efficient tool for risk stratification of pulmonary lesions, especially for patients with a suspicious lung lesion.

On-Chip Sinusoidal Signal Generators for Electrical Impedance Spectroscopy: Methodological Review

This paper reviews architectures and circuit implementations of on-chip sinusoidal signal generators (SSGs) for electrical impedance spectroscopy (EIS) applications. In recent years, there have been increasing interests in on-chip EIS systems, which measure a target material's impedance spectrum over a frequency range. The on-chip implementation allows EIS systems to have low power and small form factor, enabling various biomedical applications. One of the key building blocks of on-chip EIS systems is on-chip SSG, which determines the frequency range and the analysis precision of the whole EIS system. On-chip SSGs are generally required to have high linearity, wide frequency range, and high power and area efficiency. They are typically composed of three stages in general: waveform generation, linearity enhancement, and current injection. First, a sinusoidal waveform should be generated in SSGs. The generated waveform's frequency should be accurately adjustable over a wide range. The firstly generated waveform may not be perfectly linear, including unwanted harmonics. In the following linearity-enhancement step, these harmonics are attenuated by using filters typically. As the linearity of the waveform is improved, the precision of the EIS system gets ensured. Lastly, the filtered voltage waveform is now converted to a current by a current driver. Then, the current sinusoidal signal is injected into the target impedance. This review discusses the principles, advantages, and disadvantages of various techniques applied to each step in state-of-the-art on-chip SSGs. In addition, state-of-the-art designs are compared and summarized.

Tripolar Electrode Electrochemical Impedance Spectroscopy for Endoscopic Devices toward Early Colorectal Tumor Detection

Embedded sensors for endoscopy devices have been studied toward a convenient and decision-supportive methodology in colorectal cancer (CRC) diagnosis, but no device could provide direct CRC screening with in situ measurements. In this study, we proposed a millimeter-scale electrical impedance spectroscopy (EIS) device that can be integrated into a biopsy tool in endoscopy for colorectal tumor detection. A minimally invasive tripolar electrode was designed to sense the tissue impedance, and a multilayer neural network was implemented for the classification algorithm. The sensor performance was investigated in terms of sensitivity, reliability, and repeatability using dummy tissues made of agarose hydrogels at various saline concentrations. In addition, an in vivo study was conducted in mice with an implanted CT-26 colon tumor line. The results demonstrated that the prototyped EIS device and algorithm can detect the tumor tissue in suspicious lesions with high sensitivity and specificity of 87.2 and 92.5%, respectively, and a low error of 7.1%. The findings of this study are promising for in situ CRC screening and may advance the diagnostic efficacy of CRC detection during endoscopic procedures.

Adjunctive Diagnostic Methods for Skin Cancer Detection: A Review of Electrical Impedance-Based Techniques

Skin cancer is among the fastest-growing cancers with an excellent prognosis, if detected early. However, the current method of diagnosis by visual inspection has several disadvantages such as overlapping tumor characteristics, subjectivity, low sensitivity, and specificity. Hence, several adjunctive diagnostic techniques such as thermal imaging, optical imaging, ultrasonography, tape stripping methods, and electrical impedance imaging are employed along with visual inspection to improve the diagnosis. Electrical impedance-based skin cancer detection depends upon the variations in electrical impedance characteristics of the transformed cells. The information provided by this technique is fundamentally different from other adjunctive techniques and thus has good prospects. Depending on the stage, type, and location of skin cancer, various impedance-based devices have been developed. These devices when used as an adjunct to visual methods have increased the sensitivity and specificity of skin cancer detection up to 100% and 87%, respectively, thus demonstrating their potential to minimize unnecessary biopsies. In this review, the authors track the advancements and progress made in this technique for the detection of skin cancer, focusing mainly on the advantages and limitations in the clinical setting. © 2022 Bioelectromagnetics Society.

An Impedance Readout IC with Ratio-Based Measurement Techniques for Electrical Impedance Spectroscopy

This paper presents an error-tolerant and power-efficient impedance measurement scheme for bioimpedance acquisition. The proposed architecture measures the magnitude and the real part of the target complex impedance, unlike other impedance measurement architectures measuring either the real/imaginary components or the magnitude and phase. The phase information of the target impedance is obtained by using the ratio between the magnitude and the real components. This can allow for avoiding direct phase measurements, which require fast, power-hungry circuit blocks. A reference resistor is connected in series with the target impedance to compensate for the errors caused by the delay in the sinusoidal signal generator and the amplifier at the front. Moreover, an additional magnitude measurement path is connected to the reference resistor to cancel out the nonlinearity of the proposed system and enhance the settling speed of the low-pass filter by a ratio-based detection. Thanks to this ratio-based detection, the accuracy is enhanced by 30%, and the settling time is improved by 87.7% compared to the conventional single-path detection. The proposed integrated circuit consumes only 513 μW for a wide frequency range of 10 Hz to 1 MHz, with the maximum magnitude and phase errors of 0.3% and 2.1°, respectively.

Diabetic Foot Assessment using Skin Impedance in a Custom Made Sensor-sock

Diabetic peripheral neuropathy (DPN) may lead to several changes in the skin, and some of these may influence the skin impedance spectrum. In the present study we have developed a prototype solution for skin impedance spectroscopy at selected skin sites (big toe pulp, heel and toe ball) that was tested in a pilot study on five patients with DPN and five healthy controls. At the big toe, most of the controls had markedly lower impedance than the DPN group, especially in the range of 1-100 kHz. The separation between the groups seems to be weaker at the heel and weakest at the toeball. The results may indicate that monitoring of the skin impedance spectrum may be a method for detection of skin changes associated with DPN, encouraging further studies with the big toe sensor in particular.

Extending the double-dispersion Cole-Cole, Cole-Davidson and Havriliak-Negami electrochemical impedance spectroscopy models

Double-dispersion impedance models are important for the accurate fitting of spectral impedance measurements in Electrical Impedance Spectroscopy (EIS). While the Cole-Cole model is the most widely known, it is possible to define double-dispersion Cole-Davidson and Havriliak-Negami models as well. In this work, we show that more freedom can be exercised when these three models are combined together and that this combination can be done in various forms. Experimental results using a two-stage optimization algorithm applied on the suggested models are provided.

Bioimpedance method for monitoring venous ulcers: Clinical proof-of-concept study

Evaluation of wound status is typically based on means which require the removal of dressings. These procedures are often also subjective and prone to inter-observer bias. To overcome aforementioned issues a bioimpedance measurement-based method and measurement system has been developed to evaluate the state of wound healing. The measurement system incorporated a purpose-built bioimpedance device, a measurement software and a screen-printed electrode array. The feasibility and the performance of the system and method were assessed in an open non-randomized follow-up study of seven venous ulcers. Healing of ulcers was monitored until the complete re-epithelialization was achieved. The duration of follow-up was from 19 to 106 days (mean 55.8 ± 25.2 days). A variable designated as the Wound Status Index (WSI), derived from the bioimpedance data, was used for describing the state of wound healing. The wound surface area was measured using acetate tracing for the reference. A strong correlation was found between the WSI and the acetate tracing data, r(93) = - 0.84, p < 0.001. The results indicate that the bioimpedance measurement-based method is a promising quantitative tool for the evaluation of the status of venous ulcers.

Skin Electrical Resistance as a Diagnostic and Therapeutic Biomarker of Breast Cancer Measuring Lymphatic Regions

Skin changes associated with alterations in the interstitial matrix and lymph system might provide significant and measurable effects due to the presence of breast cancer. This study aimed to determine if skin electrical resistance changes could serve as a diagnostic and therapeutic biomarker associated with physiological changes in patients with malignant versus benign breast cancer lesions. Forty-eight women (24 with malignant cancer, 23 with benign lesions) were enrolled in this study. Repeated skin resistance measurements were performed within the same session and 1 week after the first measurement in the breast lymphatic region and non-breast lymphathic regions. Intraclass correlation coefficients were calculated to determine the technique's intrasession and intersession reproducibility. Data were then normalized as a mean of comparing cross-sectional differences between malignant and benign lesions of the breast. Six months longitudinal data from six patients that received therapy were analyzed to detect the effect of therapy. Standard descriptive statistics were used to compare ratiometric differences between groups. Skin resistance data were used to train a machine learning random forest classification algorithm to diagnose breast cancer lesions. Significant differences between malignant and benign breast lesions were obtained (p<0.01), also pre- and post-treatment (p<0.05). The diagnostic algorithm demonstrated the capability to classify breast cancer with an area under the curve of 0.68, sensitivity of 66.3%, specificity of 78.5%, positive predictive value 70.7% and negative predictive value 75.1%. Measurement of skin resistance in patients with breast cancer may serve as a convenient screening tool for breast cancer and evaluation of therapy. Further work is warranted to improve our approach and further investigate the biophysical mechanisms leading to the observed changes.

Novel 3D printing-based probe for impedance spectroscopic examination of oral mucosa: design and preliminary testing with phantom models

The diagnosis of oral potentially malignant disorders currently relies on histopathological examination of surgically removed biopsies causing pain and discomfort for the patient. We hypothesise that non-invasive bioimpedance spectroscopy (BIS) method would overcome these problems and could make possible regular screening of at-risk patients. Previously several hand-made probes have been introduced in such BIS studies. However, for the first time, we aimed to design a 3D printed probe and test it with model samples (saline solutions, cucumber and porcine tongue). We found that it is extremely crucial to select proper printable materials and optimise electrode geometries to avoid electrochemical corrosion problems, short-circuiting and other signal instabilities related to miniaturised probe. However, our final prototype constructed with four high purity silver made electrodes showed a good linearity (R ² = 0.999) in diluted saline solution measurements over a wide conductivity range (0.25‒8 mS/cm), which covers well the range of values for the different biological tissues. Moreover, our data show that high reproducibility of the manufacturing and measurement is one important merit in the present 3D printed probe. However, further studies are needed to clarify the importance of fixed pressure especially when the tetrapolar 3D printed probe is used as a hand-held apparatus.

Skin hydration dynamics investigated by electrical impedance techniques in vivo and in vitro

Skin is easily accessible for transdermal drug delivery and also attractive for biomarker sampling. These applications are strongly influenced by hydration where elevated hydration generally leads to increased skin permeability. Thus, favorable transdermal delivery and extraction conditions can be easily obtained by exploiting elevated skin hydration. Here, we provide a detailed in vivo and in vitro investigation of the skin hydration dynamics using three techniques based on electrical impedance spectroscopy. Good correlation between in vivo and in vitro results is demonstrated, which implies that simple but realistic in vitro models can be used for further studies related to skin hydration (e.g., cosmetic testing). Importantly, the results show that hydration proceeds in two stages. Firstly, hydration between 5 and 10 min results in a drastic skin impedance change, which is interpreted as filling of superficial voids in skin with conducting electrolyte solution. Secondly, a subtle impedance change is observed over time, which is interpreted as leveling of the water gradient across skin leading to structural relaxation/changes of the macromolecular skin barrier components. With respect to transdermal drug delivery and extraction of biomarkers; 1 h of hydration is suggested to result in beneficial and stable conditions in terms of high skin permeability and extraction efficiency.

A Review on Electrical Impedance Tomography Spectroscopy

Electrical Impedance Tomography Spectroscopy (EITS) enables the reconstruction of material distributions inside an object based on the frequency-dependent characteristics of different substances. In this paper, we present a review of EITS focusing on physical principles of the technology, sensor geometries, existing measurement systems, reconstruction algorithms, and image representation methods. In addition, a novel imaging method is proposed which could fill some of the gaps found in the literature. As an example of an application, EITS of ice and water mixtures is used.

Microscale Biosensor Array Based on Flexible Polymeric Platform toward Lab-on-a-Needle: Real-Time Multiparameter Biomedical Assays on Curved Needle Surfaces

In vivo sensing of various physical/chemical parameters is gaining increased attention for early prediction and management of various diseases. However, there are major limitations on the fabrication method of multiparameter needle-based in vivo sensing devices, particularly concerning the uniformity between sensors. To address these challenges, we developed a microscale biosensor array for the measurement of electrical conductivity, pH, glucose, and lactate concentrations on a flexible polymeric polyimide platform with electrodeposited electrochemically active layers. The biosensor array was then transferred to a medical needle toward multiparametric in vivo sensing. The flexibility of the sensor platform allowed an easy integration to the curved surface (φ = 1.2 mm) of the needle. Furthermore, the electrodeposition process was used to localize various active materials for corresponding electrochemical sensors on the microscale electrodes with a high precision (patterning area = 150 μm × 2 mm). The biosensor array-modified needle was aimed to discriminate cancer from normal tissues by providing real-time discrimination of glucose, lactate concentration, pH, and electrical conductivity changes associated with the cancer-specific metabolic processes. The sensor performance was thus evaluated using solution samples, covering the physiological concentrations for cancer discrimination. Finally, the possibility of in vivo electrochemical biosensing during needle insertion was confirmed by utilizing the needle in a hydrogel phantom that mimicked the normal and cancer microenvironments.

Design and Development of a Low-Cost Arduino-Based Electrical BioImpedance Spectrometer

Background

Bioimpedance spectroscopy (BIS) is a device used to measure electrical impedance at frequencies from 0 Hz to 1 MHz. Many clinical diagnosis and fundamental researches, especially in the field of physiology and pathology, rely on this device. The device can be used to estimate human body composition, through the information of total body water, extracellular fluid and intracellular fluid, fat-free mass, and fat mass from its impedance. BIS analysis can provide physiological statuses such as ischemia, pulmonary edema, skin cancer, and intramuscular tumors. BIS is expected to be used even more widely, both for hospital or home-based use, particularly because BIS handy, compact, inexpensive, and less power-consuming with adequately accurate real-time. In previous research, the BIS design was based on the magnitude-ratio and phase-difference detection using the AD8302 gain-phase detector method which resulted in an operating range between 20 kHz and 1 MHz. However, the impedance was obtained from the logarithmic ratio magnitude which caused the device to have limited accuracy at frequencies <20 kHz.

Methods

In this research, we conduct design and development of a low-cost arduino-based electrical bioimpedance spectrometer.

Results

The low-cost bioimpedance spectrometry was successfully developed using AD9850 as the programmable function generator, OPA2134 as the OpAm of voltage-controlled current source, AD620A as the instrument amplifier and AD536A as the alternating current to direct current converter which could work accurately from 0 Hz to 100 kHz.

Conclusion

The multi-frequency bioimpedance device developed in this research has the capability to safely measure the impedance of the human body due to its relatively stable electric current, which is equal to (0.370 ± 0.003) mA with frequencies ranging from 5 to 200 kHz and has an accuracy of over 90% in the frequency range of 10 Hz to 100 kHz.

Design of Reconfigurable Time-to-Digital Converter Based on Cascaded Time Interpolators for Electrical Impedance Spectroscopy

This paper presents a reconfigurable time-to-digital converter (TDC) used to quantize the phase of the impedance in electrical impedance spectroscopy (EIS). The TDC in the EIS system must handle a wide input-time range for analysis in the low-frequency range and have a high resolution for analysis in the high-frequency range. The proposed TDC adopts a coarse counter to support a wide input-time range and cascaded time interpolators to improve the time resolution in the high-frequency analysis without increasing the counting clock speed. When the same large interpolation factor is adopted, the cascaded time interpolators have shorter measurement time and smaller chip area than a single-stage time interpolator. A reconfigurable time interpolation factor is adopted to maintain the phase resolution with reasonable measurement time. The fabricated TDC has a peak-to-peak phase error of less than 0.72° over the input frequency range from 1 kHz to 512 kHz and the phase error of less than 2.70° when the range is extended to 2.048 MHz, which demonstrates a competitive performance when compared with previously reported designs.

Use of Electrical Impedance Spectroscopy for Intraoperative Tissue Differentiation During Thyroid and Parathyroid Surgery

BACKGROUND

Electrical impedance (EI) measures tissue resistance to alternating current across several frequencies and may help identify tissue type. A recent rabbit model demonstrated that electrical impedance spectroscopy (EIS) may facilitate identification of parathyroid glands and potentially improve outcomes following surgery. This study looks at the EI patterns of soft tissues in the human neck to determine whether parathyroid tissue can be accurately identified.

METHODS

This was a phase 1, single-arm interventional study involving 56 patients undergoing thyroid and/or parathyroid surgery. Up to 12 EI readings were taken from in vivo and ex vivo thyroid and parathyroid glands, adipose tissue and muscle of each patient. Each reading consists of a series of measurements over 14 frequencies from each tissue. EI patterns were analysed. Two patients were excluded due to data loss due to device malfunction.

RESULTS

The median age of participants was 53.5 (range 20-85) years. Thirty-five participants had surgery for thyroid pathology, 17 for parathyroid pathology and four for both. Six hundred and six EIS spectra were reviewed for suitability. One hundred and eighty-four spectra were rejected leaving 422 spectra for analysis. The impedance patterns of the soft tissues differed by histological type. The EI ratio of low (152 Hz) to high (312 kHz) frequencies demonstrated a significant difference between the soft tissues (p = 0.006). Using appropriate thresholds, parathyroid tissue can be distinguished from thyroid tissue with a sensitivity of 76% and specificity of 60%.

CONCLUSIONS

This study demonstrates the feasibility of using EIS to aid parathyroid identification and preservation. Further changes to the device and modelling of the EI patterns across the range of frequencies may improve accuracy and facilitate intraoperative use.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02901873).

Very Low Resource Digital Implementation of Bioimpedance Analysis

Bioimpedance spectroscopy consists of measuring the complex impedance of biological tissues over a large frequency domain. This method is particularly convenient for physiological studies or health monitoring systems. For a wide range of applications, devices need to be portable, wearable or even implantable. Next generation of bioimpedance sensing systems thus require to be implemented with power and resource savings in mind. Impedance measurement methods are divided into two main categories. Some are based on "single-tone" signals while the others use "multi-tone" signals. The firsts benefit from a very simple analysis that may consist of synchronous demodulation. However, due to necessary frequency sweep, the total measurement may take a long time. On the other hand, generating a multi-frequency signal allows the seconds to cover the whole frequency range simultaneously. This is at the cost of a more complex analysis algorithm. This makes both approaches hardly suitable for embedded applications. In this paper, we propose an intermediate approach that combines the speed of multi-tone systems with a low-resource analysis algorithm. This results in a minimal implementation using only adders and synchronous adc. For optimal performances, this small footprint digital processing can be synthesized and embedded on a mixed-mode integrated circuit together with the analog front-end. Moreover, the proposed implementation is easily scalable to fit an arbitrary frequency range. We also show that the resulting impact on noise sensitivity can be mitigated.

A Harmonic Error Cancellation Method for Accurate Clock-Based Electrochemical Impedance Spectroscopy

Electrochemical impedance spectroscopy (EIS) is a widely used method to characterize the biological materials. In traditional methods for EIS, a sinusoidal current is used to excite the material under test and the measured voltage across that material is demodulated by a linear multiplication with quadrature sinusoidal signals. From the resulting demodulated output, the impedance (magnitude and phase) can be calculated. Although this sine-wave-based impedance measurement method can produce accurate impedance measurements, it requires bulky components and suffers from poor power efficiency due to sinusoidal waveform generation and linear multiplication. Alternatively, a method using square-wave signal, which is simply a clock, for both excitation and demodulation can be much more area and power efficient, but inherently suffers from substantial errors in the result due to significant harmonics in square waves. In this paper, we propose a technique to cancel out the errors caused by such harmonics of the square-wave-based excitation and demodulation. The proposed technique, based on the fact that the magnitude ratio of all the harmonics of a square wave are known, cancels out harmonic errors by subtracting or adding the square-wave-based measured results at higher harmonic frequencies as a simple post-processing calculation. Simulations on specific and also generic impedance models demonstrate the applicability of this technique to various impedance models. Experimental results using a discrete circuit model show that this technique can provide a precise measurement of the impedance with 1% magnitude error and 0.5° phase error considering just five terms. In addition, measurements with a biological tissue show an average magnitude and phase error of 0.7% and [Formula: see text], respectively, using the proposed error cancellation. Because this method replaces sinusoidal signal generation and linear multiplication with clock generation and simple switching, it has great potential to be integrated in a wearable and implantable health monitoring device at low area and power consumption.

Bioimpedance Sensor Array for Long-Term Monitoring of Wound Healing from Beneath the Primary Dressings and Controlled Formation of H2O2 Using Low-Intensity Direct Current

Chronic wounds impose a significant financial burden for the healthcare system. Currently, assessment and monitoring of hard-to-heal wounds are often based on visual means and measuring the size of the wound. The primary wound dressings must be removed before assessment can be done. We have developed a quasi-monopolar bioimpedance-measurement-based method and a measurement system to determine the status of wound healing. The objective of this study was to demonstrate that with an appropriate setup, long-term monitoring of wound healing from beneath the primary dressings is feasible. The developed multielectrode sensor array was applied on the wound area and left under the primary dressings for 142 h. The impedance of the wounds and the surrounding intact skin area was measured regularly during the study at 150 Hz, 300 Hz, 1 kHz, and 5 kHz frequencies. At the end of the follow-up period, the wound impedance had reached the impedance of the intact skin at the higher frequencies and increased significantly at the lowest frequencies. The measurement frequency affected the measurement sensitivity in wound monitoring. The skin impedance remained stable over the measurement period. The sensor array also enabled the administration of periodical low-intensity direct current (LIDC) stimulation in order to create an antimicrobial environment across the wound area via the controlled formation of hydrogen peroxide (H₂O₂).

The Effect of UVB Irradiation and Oxidative Stress on the Skin Barrier-A New Method to Evaluate Sun Protection Factor Based on Electrical Impedance Spectroscopy

Sunlight is vital for several biochemical processes of the skin organ. However, acute or chronic exposure to ultraviolet radiation (UVR) has several harmful effects on the skin structure and function, especially in the case of the failing function of antioxidative enzymes, which may lead to substantial tissue damage due to the increased presence of reactive oxygen species (ROS). The aim of this work was to investigate the combined effect of ultraviolet B (UVB) irradiation and oxidative stress on the skin barrier integrity. For this, we employed electrical impedance spectroscopy (EIS) to characterize changes of the electrical properties of excised pig skin membranes after various exposure conditions of UVB irradiation, oxidative stress, and the inhibition of antioxidative enzymatic processes. The oxidative stress was regulated by adding hydrogen peroxide (H₂O₂) as a source of ROS, while sodium azide (NaN₃) was used as an inhibitor of the antioxidative enzyme catalase, which is naturally present throughout the epidermis. By screening for the combined effect of UVB and oxidative stress on the skin membrane electrical properties, we developed a new protocol for evaluating these parameters in a simple in vitro setup. Strikingly, the results show that exposure to extreme UVB irradiation does not affect the skin membrane resistance, implying that the skin barrier remains macroscopically intact. Likewise, exposure to only oxidative stress conditions, without UVB irradiation, does not affect the skin membrane resistance. In contrast to these observations, the combination of UVB irradiation and oxidative stress conditions results in a drastic decrease of the skin membrane resistance, indicating that the integrity of the skin barrier is compromised. Further, the skin membrane effective capacitance remained more or less unaffected by UVB exposure, irrespective of simultaneous exposure of oxidative stress. The EIS results were concluded to be associated with clear signs of macroscopic tissue damage of the epidermis as visualized with microscopy after exposure to UVB irradiation under oxidative stress conditions. Finally, the novel methodology was tested by performing an assessment of cosmetic sunscreen formulations with varying sun protection factor (SPF), with an overall successful outcome, showing good correlation between SPF value and protection capacity in terms of skin resistance change. The results from this study allow for the development of new skin sensors based on EIS for the detection of skin tissue damage from exposure to UVB irradiation and oxidative stress and provide a new, more comprehensive methodology, taking into account both the influence of UVB irradiation and oxidative stress, for in vitro determination of SPF in cosmetic formulations.

Concentric Ring Probe for Bioimpedance Spectroscopic Measurements: Design and Ex Vivo Feasibility Testing on Pork Oral Tissues

Many oral diseases, such as oral leukoplakia and erythroplakia, which have a high potential for malignant transformations, cause abnormal structural changes in the oral mucosa. These changes are clinically assessed by visual inspection and palpation despite their poor accuracy and subjective nature. We hypothesized that non-invasive bioimpedance spectroscopy (BIS) might be a viable option to improve the diagnostics of potentially malignant lesions. In this study, we aimed to design and optimize the measurement setup and to conduct feasibility testing on pork oral tissues. The contact pressure between a custom-made concentric ring probe and tissue was experimentally optimized. The effects of loading time and inter-electrode spacing on BIS spectra were also clarified. Tissue differentiation testing was performed for ex vivo pork oral tissues including palatinum, buccal mucosa, fat, and muscle tissue samples. We observed that the most reproducible results were obtained by using a loading weight of 200 g and a fixed time period under press, which was necessary to allow meaningful quantitative comparison. All studied tissues showed their own unique spectra, accompanied by significant differences in both impedance magnitude and phase (p ≤ 0.014, Kruskal-Wallis test). BIS shows promise, and further studies are warranted to clarify its potential to detect specific pathological tissue alterations.

Assay based on electrical impedance spectroscopy to discriminate between normal and cancerous mammalian cells

In this work we present an assay to discriminate between normal and cancerous cells. The method is based on the measurement of electrical impedance spectra of in vitro cell cultures. We developed a protocol consisting on four consecutive measurement phases, each of them designed to obtain different information about the cell cultures. Through the analysis of the measured data, 26 characteristic features were obtained for both cell types. From the complete set of features, we selected the most relevant in terms of their discriminant capacity by means of conventional statistical tests. A linear discriminant analysis was then carried out on the selected features, allowing the classification of the samples in normal or cancerous with 4.5% of false positives and no false negatives.

Skin cancer detection using non-invasive techniques

Skin cancer is the most common form of cancer and is globally rising. Historically, the diagnosis of skin cancers has depended on various conventional techniques which are of an invasive manner. A variety of commercial diagnostic tools and auxiliary techniques are available to detect skin cancer. This article explains in detail the principles and approaches involved for non-invasive skin cancer diagnostic methods such as photography, dermoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis. The characteristics of an ideal screening test are outlined, and the authors pose several points for clinicians and scientists to consider in the evaluation of current and future studies of skin cancer detection and diagnosis. This comprehensive review critically analyses the literature associated with the field and summarises the recent updates along with their merits and demerits.

MR-based electrical property tomography using a modified finite difference scheme

Magnetic resonance electrical property tomography (MR-EPT) reconstructs electrical properties (EPs) from measured magnetic fields in magnetic resonance imaging (MRI) systems. In this study, an MR-EPT method was proposed that utilized a new finite difference approximation of the involved differential wave equation. Compared with existing MR-EPT approaches, the construction of the system matrix involves applying the first derivative twice based on a larger number of neighbouring finite-difference grids, which is different from a standard Laplacian operator on a regular grid structure, leading to a better conditioned linear inverse problem. With improved noise robustness, more faithful EPs can be obtained by the proposed method, particularly at tissue boundaries and regions with a poorly measured magnetic field (low signal-to-noise ratio). Numerical simulations with a specially designed multi-slice phantom and an anatomically accurate head model (Duke) have demonstrated that the proposed method can provide a more faithful reconstruction of EPs compared to existing methods, which usually offer unreliable solutions associated with traditional finite difference approximation of the central wave equation and unrealistic assumptions. Experiments on a 9.4 T MRI system have been conducted to validate the simulations.

The Development of a Four-Electrode Bio-Impedance Sensor for Identification and Localization of Deep Pulmonary Nodules

Identifying and localizing of deep pulmonary nodules are among the main challenges that thoracic surgeons face during operations, particularly in thoracoscopic procedures. To facilitate this, we have tried to introduce a non-invasive and safe method by measuring the lung electrical bio-impedance spectrum with a four-electrode array sensor. To study the feasibility of this method, since any change in the depth or diameter of the nodule in the lung tissue is not practical, we used the finite element modeling of the lung tissue and pulmonary nodule to allow changes in the depth and diameter of the nodule, as well as the distance in between the injection electrodes. Accordingly, a bio-impedance sensor was designed and fabricated. By measuring the electrical impedance spectrum of pulmonary tissues in four different specimens with a frequency band of 50 kHz to 5 MHz, 4 pulmonary nodules at four different depths were identified. The obtained bio-impedance spectrum from the lung surface showed that the magnitude and phase of electrical bio-impedance of the tumoral tissue at each frequency is smaller than that of the healthy tissue. In addition, the frequency characteristic varies in the Nyquist curves for tumoral and healthy lung tissues.

Biopsy Needle Integrated with Electrical Impedance Sensing Microelectrode Array towards Real-time Needle Guidance and Tissue Discrimination

A biopsy needle with electrical impedance sensor array based on stainless steel microelectrodes (EIS needle) was developed for real-time four electrode measurement and multi-spot sensing of tissues during the biopsy process. The sensor performance was characterized by using saline solutions with various concentrations, which proved accurate, stable and reliable electrical impedance measurement. The capability of impedance-based tissue sensing was verified by the conductivity measurement of agarose hydrogel based phantom mimicking cancer tissue. Furthermore, multi-spot impedance sensing during needle insertion was demonstrated using porcine meat with muscle and fat layers, which exhibited a clear discrimination between different types of tissues. Also, the electrical impedance difference between normal and fatty livers of mouse model was measured by the EIS needle. We could successfully demonstrate that the EIS needle can provide localized and accurate characterization of biological tissues at the needle tip.

Use of a Conical Conducting Layer with an Electrical Impedance Probe to Enhance Sensitivity in Epithelial Tissues

Tetra-polar electrical impedance measurement (TPIM) with a square geometry of electrodes is useful in the characterization of epithelial tissues, especially in the detection of cervical cancer at precancerous stages. However, in TPIM, the peak planar sensitivity just below the electrode surface is almost zero and increases to a peak value at a depth of about one third to one half of the electrode separation. To get high sensitivity for the epithelial layer, having thicknesses of 200 μm to 300 μm, the electrode separation needed is less than 1 mm, which is difficult to achieve in practical probes. This work proposes a conical conducting layer in front of a pencil like probe with a square geometry of TPIM electrodes to create virtual electrodes with much smaller separation at the body surface, thus increasing the sensitivity of the epithelial tissues. To understand the improvements, if any, 3D sensitivity distribution and transfer impedance were simulated using COMSOL Multiphysics software for a simplified body tissue model containing a 300 μm epithelial layer. It has been shown that fractional contribution of an epithelial layer can be increased several times placing a cylindrical conducting layer in between the tissue surface and the electrodes, which can further be enhanced using a conical conducting layer. The results presented in this paper can be used to choose an appropriate electrode separation, conducting layer height and cone parameters for enhanced sensitivity in the epithelial layer.