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Zhang Q, Zeng Y, Zhao Y, Peng X, Ren E, Liu G. Bio-Hybrid Magnetic Robots: From Bioengineering to Targeted Therapy. Bioengineering (Basel) 2024; 11:311. [PMID: 38671732 PMCID: PMC11047666 DOI: 10.3390/bioengineering11040311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Magnetic robots possess an innate ability to navigate through hard-to-reach cavities in the human body, making them promising tools for diagnosing and treating diseases minimally invasively. Despite significant advances, the development of robots with desirable locomotion and full biocompatibility under harsh physiological conditions remains challenging, which put forward new requirements for magnetic robots' design and material synthesis. Compared to robots that are synthesized with inorganic materials, natural organisms like cells, bacteria or other microalgae exhibit ideal properties for in vivo applications, such as biocompatibility, deformability, auto-fluorescence, and self-propulsion, as well as easy for functional therapeutics engineering. In the process, these organisms can provide autonomous propulsion in biological fluids or external magnetic fields, while retaining their functionalities with integrating artificial robots, thus aiding targeted therapeutic delivery. This kind of robotics is named bio-hybrid magnetic robotics, and in this mini-review, recent progress including their design, engineering and potential for therapeutics delivery will be discussed. Additionally, the historical context and prominent examples will be introduced, and the complexities, potential pitfalls, and opportunities associated with bio-hybrid magnetic robotics will be discussed.
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Affiliation(s)
- Qian Zhang
- Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China; (Q.Z.); (Y.Z.); (Y.Z.); (G.L.)
| | - Yun Zeng
- Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China; (Q.Z.); (Y.Z.); (Y.Z.); (G.L.)
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen 361005, China
| | - Yang Zhao
- Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China; (Q.Z.); (Y.Z.); (Y.Z.); (G.L.)
| | - Xuqi Peng
- Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China; (Q.Z.); (Y.Z.); (Y.Z.); (G.L.)
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen 361005, China
| | - En Ren
- Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China; (Q.Z.); (Y.Z.); (Y.Z.); (G.L.)
- Key Laboratory of Advanced Drug Delivery Systems, Zhejiang Province College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Gang Liu
- Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China; (Q.Z.); (Y.Z.); (Y.Z.); (G.L.)
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen 361005, China
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Thwaites PA, Yao CK, Halmos EP, Muir JG, Burgell RE, Berean KJ, Kalantar‐zadeh K, Gibson PR. Review article: Current status and future directions of ingestible electronic devices in gastroenterology. Aliment Pharmacol Ther 2024; 59:459-474. [PMID: 38168738 PMCID: PMC10952964 DOI: 10.1111/apt.17844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices. AIM To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract. METHODS We performed a detailed literature search to inform this narrative review. RESULTS Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real-time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment. CONCLUSIONS The development of miniaturised ingestible microelectronic-based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point-of-care medicine.
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Affiliation(s)
- Phoebe A. Thwaites
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Chu K. Yao
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Emma P. Halmos
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Jane G. Muir
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Rebecca E. Burgell
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Kyle J. Berean
- Atmo BiosciencesMelbourneVictoriaAustralia
- School of Engineering, RMIT UniversityMelbourneVictoriaAustralia
| | - Kourosh Kalantar‐zadeh
- Faculty of Engineering, School of Chemical and Biomolecular EngineeringThe University of SydneyCamperdownNew South WalesAustralia
| | - Peter R. Gibson
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
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Wang H, Cui J, Tian K, Han Y. Three-degrees-of-freedom orientation manipulation of small untethered robots with a single anisotropic soft magnet. Nat Commun 2023; 14:7491. [PMID: 37980421 PMCID: PMC10657469 DOI: 10.1038/s41467-023-42783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/20/2023] [Indexed: 11/20/2023] Open
Abstract
Magnetic actuation has been well exploited for untethered manipulation and locomotion of small-scale robots in complex environments such as intracorporeal lumens. Most existing magnetic actuation systems employ a permanent magnet onboard the robot. However, only 2-DoF orientation of the permanent-magnet robot can be controlled since no torque can be generated about its axis of magnetic moment, which limits the dexterity of manipulation. Here, we propose a new magnetic actuation method using a single soft magnet with an anisotropic geometry (e.g., triaxial ellipsoids) for full 3-DoF orientation manipulation. The fundamental actuation principle of anisotropic magnetization and 3-DoF torque generation are analytically modeled and experimentally validated. The hierarchical orientation stability about three principal axes is investigated, based on which we propose and validate a multi-step open-loop control strategy to alternatingly manipulate the direction of the longest axis of the soft magnet and the rotation about it for dexterous 3-DoF orientation manipulation.
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Affiliation(s)
- Heng Wang
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, Guangdong, China.
| | - Junhao Cui
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, Guangdong, China
| | - Kuan Tian
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, Guangdong, China
| | - Yuxiang Han
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, Guangdong, China
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4
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Qiu XO, Jiang X, Chen YZ, Xia JS, Pan J, Wang L, Liao Z, Li ZS. New US capsule endoscopy for superficial and submucosal imaging of the esophagus: the first-in-human study. Gastrointest Endosc 2023; 98:642-652. [PMID: 37356634 DOI: 10.1016/j.gie.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND AIMS EUS is essential in diagnosing and staging of esophageal subepithelial lesions and tumors. However, EUS is invasive, relies on highly trained endoscopists, and typically requires sedation. The newly developed US capsule endoscopy (USCE), which incorporates both white-light and US imaging modalities into a tethered capsule, is a minimally invasive method for obtaining superficial and submucosal information of the esophagus. This study aimed to assess the feasibility and safety of this USCE system. METHODS Twenty participants were enrolled: 10 healthy volunteers and 10 patients with esophageal lesions indicated for EUS. Participants first underwent USCE and subsequently EUS within 48 hours. The primary outcome was the technical success rate of USCE. Secondary outcomes were safety, visualization of the esophagus, and comfort assessment. RESULTS The technical success rate of USCE was 95% because 1 patient failed to swallow the capsule. No adverse events were observed. The esophagus was well visualized, and all lesions were detected under USCE optical mode in 19 participants. For healthy volunteers, the US images of normal esophageal walls were all characterized by differentiated 7-layer architecture under both USCE and EUS. For 9 patients, the features of esophageal lesions were recognized clearly under USCE, and presumptive diagnoses derived from USCE were all consistent with those from EUS. Most participants preferred USCE to EUS. CONCLUSIONS The novel USCE is feasible and safe to observe the esophageal mucosa and acquire submucosal information, which has the potential to be widely used in the clinic. (Clinical trial registration number: NCT05054933.).
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Affiliation(s)
- Xiao-Ou Qiu
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xi Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi-Zhi Chen
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jing-Song Xia
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jun Pan
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Wang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhuan Liao
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhao-Shen Li
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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5
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Li Z, Yi X, Zhu R, Yu Z, Yuan X, PourhosseiniAsl M, Dong S. A Symmetric-Actuating Linear Piezoceramic Ultrasonic Motor Capable of Producing a Scissoring Effect. RESEARCH (WASHINGTON, D.C.) 2023; 6:0156. [PMID: 37287892 PMCID: PMC10243895 DOI: 10.34133/research.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/05/2023] [Indexed: 06/09/2023]
Abstract
Conventionally, to produce a linear motion, one motor's stator is employed to drive one runner moving forward or backward. So far, there is almost no report of one electromechanical motor or piezoelectric ultrasonic motor that can directly generate two symmetrical linear motions, while this function is desired for precise scissoring and grasping in the minimally invasive surgery field. Herein, we report a brand-new symmetric-actuating linear piezoceramic ultrasonic motor capable of generating symmetrical linear motions of two outputs directly without additional mechanical transmission mechanisms. The key component of the motor is an (2 × 3) arrayed piezoceramic bar stator operating in the coupled resonant mode of the first longitudinal (L1) and third bending (B3) modes, leading to symmetric elliptical vibration trajectories at its two ends. A pair of microsurgical scissors is used as the end-effector, demonstrating a very promising future for high-precision microsurgical operations. The sliders of the prototype show the following features: (a) symmetrical, fast relative moving velocity (~1 m/s) outward or inward simultaneously; (b) high step resolution (40 nm); and (c) high power density (405.4 mW/cm3) and high efficiency (22.1%) that are double those of typical piezoceramic ultrasonic motors, indicating the full capacity of symmetric-actuating linear piezoceramic ultrasonic motor working in symmetric operation principle. This work also has enlightening significance for future symmetric-actuating device designs.
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Affiliation(s)
- Zhanmiao Li
- School of Materials Science and Engineering,
Peking University, Beijing 100871, China
| | - Xingyu Yi
- School of Materials Science and Engineering,
Peking University, Beijing 100871, China
| | - Rongqi Zhu
- School of Materials Science and Engineering,
Peking University, Beijing 100871, China
| | - Zhonghui Yu
- School of Materials Science and Engineering,
Peking University, Beijing 100871, China
| | - Xiaoting Yuan
- School of Materials Science and Engineering,
Peking University, Beijing 100871, China
| | | | - Shuxiang Dong
- School of Materials Science and Engineering,
Peking University, Beijing 100871, China
- College of Mechatronics and Control Engineering, and Institute for Advanced Study,
Shenzhen University, Shenzhen 518051, China
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Lu M, Zhang Y, Lim CM, Ren H. Flexible Needle Steering with Tethered and Untethered Actuation: Current States, Targeting Errors, Challenges and Opportunities. Ann Biomed Eng 2023; 51:905-924. [PMID: 36943414 DOI: 10.1007/s10439-023-03163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/23/2023]
Abstract
Accurate needle targeting is critical for many clinical procedures, such as transcutaneous biopsy or radiofrequency ablation of tumors. However, targeting errors may arise, limiting the widespread adoption of these procedures. Advances in flexible needle (FN) steering are emerging to mitigate these errors. This review summarizes the state-of-the-art developments of FNs and addresses possible targeting errors that can be overcome with steering actuation techniques. FN steering techniques can be classified as passive and active. Passive steering directly results from the needle-tissue interaction forces, whereas active steering requires additional forces to be applied at the needle tip, which enhances needle steerability. Therefore, the corresponding targeting errors of most passive FNs and active FNs are between 1 and 2 mm, and less than 1 mm, respectively. However, the diameters of active FNs range from 1.42 to 12 mm, which is larger than the passive steering needle varying from 0.5 to 1.4 mm. Therefore, the development of active FNs is an area of active research. These active FNs can be steered using tethered internal direct actuation or untethered external actuation. Examples of tethered internal direct actuation include tendon-driven, longitudinal segment transmission and concentric tube transmission. Tendon-driven FNs have various structures, and longitudinal segment transmission needles could be adapted to reduce tissue damage. Additionally, concentric tube needles have immediate advantages and clinical applications in natural orifice surgery. Magnetic actuation enables active FN steering with untethered external actuation and facilitates miniaturization. The challenges faced in the fabrication, sensing, and actuation methods of FN are analyzed. Finally, bio-inspired FNs may offer solutions to address the challenges faced in FN active steering mechanisms.
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Affiliation(s)
- Mingyue Lu
- The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China
- Duke-NUS Graduate Medical School, Singapore, Singapore
- The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yongde Zhang
- The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China
| | - Chwee Ming Lim
- The Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Hongliang Ren
- The Department of Electronic Engineering and the Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Hong Kong, China.
- The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
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7
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Gu H, Möckli M, Ehmke C, Kim M, Wieland M, Moser S, Bechinger C, Boehler Q, Nelson BJ. Self-folding soft-robotic chains with reconfigurable shapes and functionalities. Nat Commun 2023; 14:1263. [PMID: 36882398 PMCID: PMC9992713 DOI: 10.1038/s41467-023-36819-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
Magnetic continuum soft robots can actively steer their tip under an external magnetic field, enabling them to effectively navigate in complex in vivo environments and perform minimally invasive interventions. However, the geometries and functionalities of these robotic tools are limited by the inner diameter of the supporting catheter as well as the natural orifices and access ports of the human body. Here, we present a class of magnetic soft-robotic chains (MaSoChains) that can self-fold into large assemblies with stable configurations using a combination of elastic and magnetic energies. By pushing and pulling the MaSoChain relative to its catheter sheath, repeated assembly and disassembly with programmable shapes and functions are achieved. MaSoChains are compatible with state-of-the-art magnetic navigation technologies and provide many desirable features and functions that are difficult to realize through existing surgical tools. This strategy can be further customized and implemented for a wide spectrum of tools for minimally invasive interventions.
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Affiliation(s)
- Hongri Gu
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland. .,Department of Physics, University of Konstanz, Konstanz, Germany.
| | - Marino Möckli
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | - Claas Ehmke
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | - Minsoo Kim
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.
| | - Matthias Wieland
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | - Simon Moser
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | | | - Quentin Boehler
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.
| | - Bradley J Nelson
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.
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8
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Pittiglio G, Lloyd P, da Veiga T, Onaizah O, Pompili C, Chandler JH, Valdastri P. Patient-Specific Magnetic Catheters for Atraumatic Autonomous Endoscopy. Soft Robot 2022; 9:1120-1133. [PMID: 35312350 PMCID: PMC9805888 DOI: 10.1089/soro.2021.0090] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite increasing interest in minimally invasive surgical techniques and related developments in flexible endoscopes and catheters, follow-the-leader motion remains elusive. Following the path of least resistance through a tortuous and potentially delicate environment without relying on interaction with the surrounding anatomy requires the control of many degrees of freedom. This typically results in large-diameter instruments. One viable solution to obtain dexterity without increasing size is via multiple-point magnetic actuation over the length of the catheter. The main challenge of this approach is planning magnetic interaction to allow the catheter to adapt to the surrounding anatomy during navigation. We design and manufacture a fully shape-forming, soft magnetic catheter of 80 mm length and 2 mm diameter, capable of navigating a human anatomy in a follow-the-leader fashion. Although this system could be exploited for a range of endoscopic or intravascular applications, here we demonstrate its efficacy for navigational bronchoscopy. From a patient-specific preoperative scan, we optimize the catheters' magnetization profiles and the shape-forming actuating field. To generate the required transient magnetic fields, a dual-robot arm system is employed. We fabricate three separate prototypes to demonstrate minimal contact navigation through a three-dimensional bronchial tree phantom under precomputed robotic control. We also compare a further four separate optimally designed catheters against mechanically equivalent designs with axial magnetization profiles along their length and only at the tip. Using our follow-the-leader approach, we demonstrate up to 50% more accurate tracking, 50% reduction in obstacle contact time during navigation over the state of the art, and an improvement in targeting error of 90%.
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Affiliation(s)
- Giovanni Pittiglio
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Peter Lloyd
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Tomas da Veiga
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Onaizah Onaizah
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Cecilia Pompili
- Leeds Institute of Medical Research (LIMR), University of Leeds, Leeds, United Kingdom
| | - James H. Chandler
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Pietro Valdastri
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom.,Address correspondence to: Pietro Valdastri, STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Woodhouse, LS2 9JT Leeds, United Kingdom
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9
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Deng N, Li J, Lyu H, Huang R, Liu H, Guo C. Degradable silk-based soft actuators with magnetic responsiveness. J Mater Chem B 2022; 10:7650-7660. [PMID: 36128873 DOI: 10.1039/d2tb01328b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Soft actuators with stimuli-responsiveness have great potential in biomedical applications such as drug delivery and minimally invasive surgery. In this study, protein-based soft actuators with magnetic actuation are fabricated using naturally occurring silk proteins and synthesized Fe3O4 magnetic nanoparticles (NPs). Briefly, magnetic silk films are first prepared by solution casting of a mixture containing silk proteins, synthesized Fe3O4 NPs, and glycerol. The molecular structures of the magnetic silk films are characterized by FTIR spectroscopy, which show that the β-sheet content in the films is about 20%. The mechanical tests show that the magnetic silk films can be stretched to over 200% under wet conditions and Young's modulus is estimated to be 4.89 ± 0.69 MPa, matching the stiffness of soft tissues. Furthermore, the enzymatic degradability, good biocompatibility, and in vivo X-ray visibility of the films are demonstrated by the in vitro enzymatic degradation test, in vivo biocompatibility test, and micro-CT imaging, respectively. Degradable silk-based soft actuators with magnetic responsiveness are successfully prepared by thermal forming or plastic molding of the magnetic silk films. The fabricated soft actuators can be actuated and move with precise locomotive gaits in solutions using a magnet. In addition, the retention of the soft actuators and localized drug delivery in gastrointestinal tracts by attaching a magnet to the abdominal skin are demonstrated using model systems. The degradable silk-based soft actuators provide many opportunities for improving current therapeutic strategies in biomedicine.
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Affiliation(s)
- Niping Deng
- School of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China.,School of Engineering, Westlake University, Hangzhou 310024, China.
| | - Jinghang Li
- School of Engineering, Westlake University, Hangzhou 310024, China.
| | - Hao Lyu
- School of Engineering, Westlake University, Hangzhou 310024, China.
| | - Ruochuan Huang
- School of Engineering, Westlake University, Hangzhou 310024, China.
| | - Haoran Liu
- School of Engineering, Westlake University, Hangzhou 310024, China.
| | - Chengchen Guo
- School of Engineering, Westlake University, Hangzhou 310024, China. .,Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, China
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10
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Abstract
Abstract
For diagnostic and therapeutic applications in spacious spots of the gastrointestinal (GI) tract, the single rigid body capsule clinically applied is difficult to realize the fix-point posture adjustment function manipulated by the external permanent magnet system using the static balance control because the posture alignment and the locomotion interfere with each other. To realize this function easily, the dual hemisphere capsule robot (DHCR) is proposed, based on tracking effect—the axis of DHCR keeps tracking the normal orientation of the spatial universal rotating magnetic vector (SURMV). Since tracking effect employs dynamic balance control, dynamic stability of the DHCR system affects posture alignment performance. This paper focuses on posture alignment dynamic modeling and the influence of the magnetic flux density and the angular velocity of the SURMV, along with the damping coefficient of the GI tract surface on stability, obtaining the stability domains of parameters. Furthermore, to reduce error due to the uncertainties in complex GI tract environment, the sliding mode controller based on nominal model is proposed to achieve more accurate dynamic tracking, and Lyapunov theorem is employed to assess stability of controller. Finally, the tracking effect is verified through simulations and experiments, indicating that the fix-point posture adjustment can be realized with higher accuracy and efficiency.
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11
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Martin JW, Barducci L, Scaglioni B, Norton JC, Winters C, Subramanian V, Arezzo A, Obstein KL, Valdastri P. Robotic Autonomy for Magnetic Endoscope Biopsy. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2022; 4:599-607. [PMID: 36249558 PMCID: PMC9555223 DOI: 10.1109/tmrb.2022.3187028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Magnetically actuated endoscopes are currently transitioning in to clinical use for procedures such as colonoscopy, presenting numerous benefits over their conventional counterparts. Intelligent and easy-to-use control strategies are an essential part of their clinical effectiveness due to the un-intuitive nature of magnetic field interaction. However, work on developing intelligent control for these devices has mainly been focused on general purpose endoscope navigation. In this work, we investigate the use of autonomous robotic control for magnetic colonoscope intervention via biopsy, another major component of clinical viability. We have developed control strategies with varying levels of robotic autonomy, including semi-autonomous routines for identifying and performing targeted biopsy, as well as random quadrant biopsy. We present and compare the performance of these approaches to magnetic endoscope biopsy against the use of a standard flexible endoscope on bench-top using a colonoscopy training simulator and silicone colon model. The semi-autonomous routines for targeted and random quadrant biopsy were shown to reduce user workload with comparable times to using a standard flexible endoscope.
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Affiliation(s)
| | | | | | | | - Conchubhair Winters
- Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Keith L. Obstein
- STORM Lab USA, Vanderbilt University, Nashville, TN, USA, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Li K, Xu Y, Zhao Z, Meng MQH. External and Internal Sensor Fusion Based Localization Strategy for 6-DOF Pose Estimation of a Magnetic Capsule Robot. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3178473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keyu Li
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Yangxin Xu
- Yuanhua Robotics, Perception & AI Technologies Limited, Shenzhen, China
| | - Ziqi Zhao
- Department of Electronic and Electrical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Max Q.-H. Meng
- Shenzhen Key Laboratory of Robotics Perception and Intelligence, and the Department of Electronic and Electrical Engineering, Southern University of Science and Technology, Shenzhen, China
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13
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Deployable Tubular Mechanisms Integrated with Magnetic Anchoring and Guidance System. ACTUATORS 2022. [DOI: 10.3390/act11050124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Deployable mechanism has received more attention in the medical field due to its simple structure, dexterity, and flexibility. Meanwhile, the advantages of the Magnetic Anchoring and Guidance System (MAGS) are further highlighted by the fact that the operators can remotely control the corresponding active and passive magnetic parts in vivo. Additionally, MAGS allows the untethered manipulation of intracorporeal devices. However, the conventional instruments in MAGS are normally rigid, compact, and less flexible. Therefore, to solve this problem, four novel deployable tubular mechanisms, Design 1 (Omega-shape mechanism), Design 2 (Fulcrum-shape mechanism), Design 3 (Archway-shape mechanism), and Design 4 (Scissor-shape mechanism) in this paper, are proposed integrated with MAGS to realize the laser steering capability. Firstly, this paper introduces the motion mechanism of the four designs and analyzes the motion characterization of each structure through simulation studies. Further, the prototypes of four designs are fabricated using tubular structures with embedded magnets. The actuation success rate, the workspace characterization, the force generation and the load capability of four mechanisms are tested and analyzed based on experiments. Then, the demonstration of direct laser steering via macro setup shows that the four mechanisms can realize the laser steering capability within the error of 0.6 cm. Finally, the feasibility of indirect laser steering via a macro-mini setup is proven. Therefore, such exploration demonstrates that the application of the deployable tubular mechanisms integrated with MAGS towards in vivo treatment is promising.
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Barducci L, Scaglioni B, Martin J, Obstein KL, Valdastri P. Active Stabilization of Interventional Tasks Utilizing a Magnetically Manipulated Endoscope. Front Robot AI 2022; 9:854081. [PMID: 35494547 PMCID: PMC9047764 DOI: 10.3389/frobt.2022.854081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/17/2022] [Indexed: 01/16/2023] Open
Abstract
Magnetically actuated robots have become increasingly popular in medical endoscopy over the past decade. Despite the significant improvements in autonomy and control methods, progress within the field of medical magnetic endoscopes has mainly been in the domain of enhanced navigation. Interventional tasks such as biopsy, polyp removal, and clip placement are a major procedural component of endoscopy. Little advancement has been done in this area due to the problem of adequately controlling and stabilizing magnetically actuated endoscopes for interventional tasks. In the present paper we discuss a novel model-based Linear Parameter Varying (LPV) control approach to provide stability during interventional maneuvers. This method linearizes the non-linear dynamic interaction between the external actuation system and the endoscope in a set of equilibria, associated to different distances between the magnetic source and the endoscope, and computes different controllers for each equilibrium. This approach provides the global stability of the overall system and robustness against external disturbances. The performance of the LPV approach is compared to an intelligent teleoperation control method (based on a Proportional Integral Derivative (PID) controller), on the Magnetic Flexible Endoscope (MFE) platform. Four biopsies in different regions of the colon and at two different system equilibria are performed. Both controllers are asked to stabilize the endoscope in the presence of external disturbances (i.e. the introduction of the biopsy forceps through the working channel of the endoscope). The experiments, performed in a benchtop colon simulator, show a maximum reduction of the mean orientation error of the endoscope of 45.8% with the LPV control compared to the PID controller.
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Affiliation(s)
- Lavinia Barducci
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Bruno Scaglioni
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - James Martin
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Keith L. Obstein
- STORM Lab United States, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Pietro Valdastri
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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15
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Kim Y, Genevriere E, Harker P, Choe J, Balicki M, Regenhardt RW, Vranic JE, Dmytriw AA, Patel AB, Zhao X. Telerobotic neurovascular interventions with magnetic manipulation. Sci Robot 2022; 7:eabg9907. [PMID: 35417201 PMCID: PMC9254892 DOI: 10.1126/scirobotics.abg9907] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system's capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care.
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Affiliation(s)
- Yoonho Kim
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Emily Genevriere
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Pablo Harker
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jaehun Choe
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Robert W Regenhardt
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Justin E Vranic
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Adam A Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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16
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Xu Y, Li K, Zhao Z, Meng MQH. Autonomous Magnetic Navigation Framework for Active Wireless Capsule Endoscopy Inspired by Conventional Colonoscopy Procedures. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3141378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Abstract
In conventional classification, soft robots feature mechanical compliance as the main distinguishing factor from traditional robots made of rigid materials. Recent advances in functional soft materials have facilitated the emergence of a new class of soft robots capable of tether-free actuation in response to external stimuli such as heat, light, solvent, or electric or magnetic field. Among the various types of stimuli-responsive materials, magnetic soft materials have shown remarkable progress in their design and fabrication, leading to the development of magnetic soft robots with unique advantages and potential for many important applications. However, the field of magnetic soft robots is still in its infancy and requires further advancements in terms of design principles, fabrication methods, control mechanisms, and sensing modalities. Successful future development of magnetic soft robots would require a comprehensive understanding of the fundamental principle of magnetic actuation, as well as the physical properties and behavior of magnetic soft materials. In this review, we discuss recent progress in the design and fabrication, modeling and simulation, and actuation and control of magnetic soft materials and robots. We then give a set of design guidelines for optimal actuation performance of magnetic soft materials. Lastly, we summarize potential biomedical applications of magnetic soft robots and provide our perspectives on next-generation magnetic soft robots.
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Affiliation(s)
- Yoonho Kim
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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18
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Detection of Healthy and Diseased Pylorus Natural Anatomical Center with Convolutional Neural Network Classification and Filters. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Wang Q, Du X, Jin D, Zhang L. Real-Time Ultrasound Doppler Tracking and Autonomous Navigation of a Miniature Helical Robot for Accelerating Thrombolysis in Dynamic Blood Flow. ACS NANO 2022; 16:604-616. [PMID: 34985859 DOI: 10.1021/acsnano.1c07830] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Untethered small-scale robots offer great promise for medical applications in complex biological environments. However, challenges remain in the control and medical imaging of a robot for targeted delivery inside a living body, especially in flowing conditions (e.g., blood vessels). In this work, we report a strategy to autonomously navigate a miniature helical robot in dynamic blood flow under ultrasound Doppler imaging guidance. A magnetic torque and force-hybrid control approach is implemented, enabling the actuation of a millimeter-scale helical robot against blood flow under a rotating magnetic field with a controllable field gradient. Experimental results demonstrate that the robot (length 7.30 mm; diameter 2.15 mm) exhibits controlled navigation in vascular environments, including upstream and downstream navigation in flowing and pulsatile flowing blood with flow rates up to 24 mL/min (mean flow velocity: 14.15 mm/s). During navigation, the rotating robot-induced Doppler signals enable real-time localization and tracking in flowing and pulsatile flowing blood environments. Moreover, the robot can be selectively navigated along different paths by actively controlling the robot's orientation. We apply this autonomous strategy for localizing thrombus and accelerating thrombolysis rate. Compared with conventional tissue plasminogen activator (tPA) thrombolysis, the robot-enhanced shear stress and tPA convection near the clot-blood interface increase the unblocking and thrombolysis efficiency up to 4.8- and 3.5-fold, respectively. Such a medical imaging-guided navigation strategy provides simultaneous robot navigation and localization in complex dynamic biological environments, providing an intelligent approach toward real-time targeted delivery and diagnostic applications in vivo.
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Affiliation(s)
- Qianqian Wang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Xingzhou Du
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Dongdong Jin
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Li Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong 999077, China
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China
- Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- T Stone Robotics Institute, The Chinese University of Hong Kong, Hong Kong 999077, China
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20
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Smart pills for gastrointestinal diagnostics and therapy. Adv Drug Deliv Rev 2021; 177:113931. [PMID: 34416311 DOI: 10.1016/j.addr.2021.113931] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Ingestible smart pills have the potential to be a powerful clinical tool in the diagnosis and treatment of gastrointestinal disease. Though examples of this technology, such as capsule endoscopy, have been successfully translated from the lab into clinically used products, there are still numerous challenges that need to be overcome. This review gives an overview of the research being done in the area of ingestible smart pills and reports on the technical challenges in this field.
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21
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Zhou C, Yang Y, Wang J, Wu Q, Gu Z, Zhou Y, Liu X, Yang Y, Tang H, Ling Q, Wang L, Zang J. Ferromagnetic soft catheter robots for minimally invasive bioprinting. Nat Commun 2021; 12:5072. [PMID: 34417473 PMCID: PMC8379157 DOI: 10.1038/s41467-021-25386-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/30/2021] [Indexed: 11/09/2022] Open
Abstract
In vivo bioprinting has recently emerged as a direct fabrication technique to create artificial tissues and medical devices on target sites within the body, enabling advanced clinical strategies. However, existing in vivo bioprinting methods are often limited to applications near the skin or require open surgery for printing on internal organs. Here, we report a ferromagnetic soft catheter robot (FSCR) system capable of in situ computer-controlled bioprinting in a minimally invasive manner based on magnetic actuation. The FSCR is designed by dispersing ferromagnetic particles in a fiber-reinforced polymer matrix. This design results in stable ink extrusion and allows for printing various materials with different rheological properties and functionalities. A superimposed magnetic field drives the FSCR to achieve digitally controlled printing with high accuracy. We demonstrate printing multiple patterns on planar surfaces, and considering the non-planar surface of natural organs, we then develop an in situ printing strategy for curved surfaces and demonstrate minimally invasive in vivo bioprinting of hydrogels in a rat model. Our catheter robot will permit intelligent and minimally invasive bio-fabrication.
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Affiliation(s)
- Cheng Zhou
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Youzhou Yang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingyang Wu
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuozhi Gu
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Yuting Zhou
- The Key Laboratory of Bionic Engineering (Ministry of Education) and the College of Biological and Agricultural Engineering, Jilin University, Changchun, China
| | - Xurui Liu
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Yueying Yang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Hanchuan Tang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Wang
- CAS Key Laboratory of Mechanical Behavior and Design of Materials, Department of Modern Mechanics, University of Science and Technology of China, Hefei, Anhui, China.
| | - Jianfeng Zang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.
- The State Key Laboratory of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan, China.
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22
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Lloyd P, Koszowska Z, Di Lecce M, Onaizah O, Chandler JH, Valdastri P. Feasibility of Fiber Reinforcement Within Magnetically Actuated Soft Continuum Robots. Front Robot AI 2021; 8:715662. [PMID: 34307470 PMCID: PMC8297468 DOI: 10.3389/frobt.2021.715662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/24/2021] [Indexed: 02/03/2023] Open
Abstract
Soft continuum manipulators have the potential to replace traditional surgical catheters; offering greater dexterity with access to previously unfeasible locations for a wide range of interventions including neurological and cardiovascular. Magnetically actuated catheters are of particular interest due to their potential for miniaturization and remote control. Challenges around the operation of these catheters exist however, and one of these occurs when the angle between the actuating field and the local magnetization vector of the catheter exceeds 90°. In this arrangement, deformation generated by the resultant magnetic moment acts to increase magnetic torque, leading to potential instability. This phenomenon can cause unpredictable responses to actuation, particularly for soft, flexible materials. When coupled with the inherent challenges of sensing and localization inside living tissue, this behavior represents a barrier to progress. In this feasibility study we propose and investigate the use of helical fiber reinforcement within magnetically actuated soft continuum manipulators. Using numerical simulation to explore the design space, we optimize fiber parameters to enhance the ratio of torsional to bending stiffness. Through bespoke fabrication of an optimized helix design we validate a single, prototypical two-segment, 40 mm × 6 mm continuum manipulator demonstrating a reduction of 67% in unwanted twisting under actuation.
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Affiliation(s)
- Peter Lloyd
- Science and Technology of Robots in Medicine (STORM) Laboratory, School of Electronics and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Zaneta Koszowska
- Science and Technology of Robots in Medicine (STORM) Laboratory, School of Electronics and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Michele Di Lecce
- Science and Technology of Robots in Medicine (STORM) Laboratory, School of Electronics and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Onaizah Onaizah
- Science and Technology of Robots in Medicine (STORM) Laboratory, School of Electronics and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - James H Chandler
- Science and Technology of Robots in Medicine (STORM) Laboratory, School of Electronics and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Pietro Valdastri
- Science and Technology of Robots in Medicine (STORM) Laboratory, School of Electronics and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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23
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Szunerits S, Melinte S, Barras A, Pagneux Q, Voronova A, Abderrahmani A, Boukherroub R. The impact of chemical engineering and technological advances on managing diabetes: present and future concepts. Chem Soc Rev 2021; 50:2102-2146. [PMID: 33325917 DOI: 10.1039/c9cs00886a] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Monitoring blood glucose levels for diabetic patients is critical to achieve tight glycaemic control. As none of the current antidiabetic treatments restore lost functional β-cell mass in diabetic patients, insulin injections and the use of insulin pumps are most widely used in the management of glycaemia. The use of advanced and intelligent chemical engineering, together with the incorporation of micro- and nanotechnological-based processes have lately revolutionized diabetic management. The start of this concept goes back to 1974 with the description of an electrode that repeatedly measures the level of blood glucose and triggers insulin release from an infusion pump to enter the blood stream from a small reservoir upon need. Next to the insulin pumps, other drug delivery routes, including nasal, transdermal and buccal, are currently investigated. These processes necessitate competences from chemists, engineers-alike and innovative views of pharmacologists and diabetologists. Engineered micro and nanostructures hold a unique potential when it comes to drug delivery applications required for the treatment of diabetic patients. As the technical aspects of chemistry, biology and informatics on medicine are expanding fast, time has come to step back and to evaluate the impact of technology-driven chemistry on diabetics and how the bridges from research laboratories to market products are established. In this review, the large variety of therapeutic approaches proposed in the last five years for diabetic patients are discussed in an applied context. A survey of the state of the art of closed-loop insulin delivery strategies in response to blood glucose level fluctuation is provided together with insights into the emerging key technologies for diagnosis and drug development. Chemical engineering strategies centered on preserving and regenerating functional pancreatic β-cell mass are evoked in addition as they represent a permanent solution for diabetic patients.
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Affiliation(s)
- Sabine Szunerits
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520-IEMN, F-59000 Lille, France.
| | - Sorin Melinte
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Université catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Alexandre Barras
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520-IEMN, F-59000 Lille, France.
| | - Quentin Pagneux
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520-IEMN, F-59000 Lille, France.
| | - Anna Voronova
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520-IEMN, F-59000 Lille, France.
| | - Amar Abderrahmani
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520-IEMN, F-59000 Lille, France.
| | - Rabah Boukherroub
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520-IEMN, F-59000 Lille, France.
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24
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Zhang P, Li J, Zhang W, Hao Y, Ciuti G, Arai T, Dario P, Huang Q. Endoluminal Motion Recognition of a Magnetically-Guided Capsule Endoscope Based on Capsule-Tissue Interaction Force. SENSORS (BASEL, SWITZERLAND) 2021; 21:2395. [PMID: 33808443 PMCID: PMC8036640 DOI: 10.3390/s21072395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 12/24/2022]
Abstract
A magnetically-guided capsule endoscope, embedding flexible force sensors, is designed to measure the capsule-tissue interaction force. The flexible force sensor is composed of eight force-sensitive elements surrounding the internal permanent magnet (IPM). The control of interaction force acting on the intestinal wall can reduce patient's discomfort and maintain the magnetic coupling between the external permanent magnet (EPM) and the IPM during capsule navigation. A flexible force sensor can achieve this control. In particular, by analyzing the signals of the force sensitive elements, we propose a method to recognize the status of the motion of the magnetic capsule, and provide corresponding formulas to evaluate whether the magnetic capsule follows the motion of the external driving magnet. Accuracy of the motion recognition in Ex Vivo tests reached 94% when the EPM was translated along the longitudinal axis. In addition, a method is proposed to realign the EPM and the IPM before the loss of their magnetic coupling. Its translational error, rotational error, and runtime are 7.04 ± 0.71 mm, 3.13 ± 0.47∘, and 11.4 ± 0.39 s, respectively. Finally, a control strategy is proposed to prevent the magnetic capsule endoscope from losing control during the magnetically-guided capsule colonoscopy.
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Affiliation(s)
- Peisen Zhang
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China; (P.Z.); (Y.H.)
| | - Jing Li
- School of Electrical and Information Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100081, China;
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China; (G.C.); (T.A.); (P.D.); (Q.H.)
| | - Weimin Zhang
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China; (P.Z.); (Y.H.)
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China; (G.C.); (T.A.); (P.D.); (Q.H.)
| | - Yang Hao
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China; (P.Z.); (Y.H.)
| | - Gastone Ciuti
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China; (G.C.); (T.A.); (P.D.); (Q.H.)
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Tatsuo Arai
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China; (G.C.); (T.A.); (P.D.); (Q.H.)
| | - Paolo Dario
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China; (G.C.); (T.A.); (P.D.); (Q.H.)
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy
| | - Qiang Huang
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China; (G.C.); (T.A.); (P.D.); (Q.H.)
- Key Laboratory of Biomimetic Robots and Systems, Beijing Institute of Technology, Ministry of Education, Beijing 100081, China
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25
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Martin JW, Scaglioni B, Norton JC, Subramanian V, Arezzo A, Obstein KL, Valdastri P. Enabling the future of colonoscopy with intelligent and autonomous magnetic manipulation. NAT MACH INTELL 2020; 2:595-606. [PMID: 33089071 PMCID: PMC7571595 DOI: 10.1038/s42256-020-00231-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/01/2020] [Indexed: 12/24/2022]
Abstract
Early diagnosis of colorectal cancer significantly improves survival. However, over half of cases are diagnosed late due to demand exceeding the capacity for colonoscopy - the "gold standard" for screening. Colonoscopy is limited by the outdated design of conventional endoscopes, associated with high complexity of use, cost and pain. Magnetic endoscopes represent a promising alternative, overcoming drawbacks of pain and cost, but struggle to reach the translational stage as magnetic manipulation is complex and unintuitive. In this work, we use machine vision to develop intelligent and autonomous control of a magnetic endoscope, for the first time enabling non-expert users to effectively perform magnetic colonoscopy in-vivo. We combine the use of robotics, computer vision and advanced control to offer an intuitive and effective endoscopic system. Moreover, we define the characteristics required to achieve autonomy in robotic endoscopy. The paradigm described here can be adopted in a variety of applications where navigation in unstructured environments is required, such as catheters, pancreatic endoscopy, bronchoscopy, and gastroscopy. This work brings alternative endoscopic technologies closer to the translational stage, increasing availability of early-stage cancer treatments.
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Affiliation(s)
| | | | | | | | - Alberto Arezzo
- Department of Surgical Science, University of Torino, Corso Dogliotti, Turin, Italy
| | - Keith L. Obstein
- STORM Lab USA, Vanderbilt University, Nashville, USA
- Vanderbilt University Medical Centre, Nashville, TN, USA
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26
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Abstract
PURPOSE OF REVIEW Advanced endoscopy procedures are technically challenging and require extensive training. Recent technological advances made in computer science and robotics have the potential to enhance the performance of complex intraluminal and transluminal interventions and potentially optimize precision and safety. This review covers the different technologies used for robot-assisted interventions in the gastrointestinal tract, organized according to their clinical availability, and focusing on flexible endoscopy-based systems. RECENT FINDINGS In the curvilinear gastrointestinal anatomy, robotic technology can enhance flexible endoscopes to augment effectiveness, safety, and therapeutic capabilities, particularly for complex intraluminal and transluminal interventions. Increased visual angles, increased degrees of freedom of instrumentation, optimized navigation, and locomotion, which may lead to a reduced physician learning curve and workload, are promising achievements with the promise to ultimately replace conventional endoscopy techniques for screening and therapeutic endoscopy. SUMMARY The majority of these devices are not commercially available yet. The best clinical applications are also currently being researched. Nonetheless, robotic assistance may encourage surgeons to use flexible endoscopes to administer surgical therapies and increase interest among gastroenterologists in advanced therapies. Robotics may be a means to overcome the technical obstacles of incisionless natural orifice procedures and favor an increased adoption of complex endoscopic procedures such as third-space therapies.
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da Veiga T, Chandler JH, Lloyd P, Pittiglio G, Wilkinson NJ, Hoshiar AK, Harris RA, Valdastri P. Challenges of continuum robots in clinical context: a review. ACTA ACUST UNITED AC 2020. [DOI: 10.1088/2516-1091/ab9f41] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Li X, Fukuda T. Magnetically Guided Micromanipulation of Magnetic Microrobots for Accurate Creation of Artistic Patterns in Liquid Environment. MICROMACHINES 2020; 11:E697. [PMID: 32708505 PMCID: PMC7408011 DOI: 10.3390/mi11070697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/26/2023]
Abstract
In this paper, a magnetically guided micromanipulation method is proposed to accurately create artistic patterns with magnetic microrobots in a liquid environment for tissue engineering. A magnetically guided device is developed depend on symmetrical combination of square permanent magnets and array layout of soft magnetic wires, which changed the space distribution of magnetic field of conventional permanent magnet and generated powerful magnetic flux density and high magnetic field gradient. Furthermore, the morphological structure of the magnetic microrobot is flexibly adjusted via precise control of the volumetric flow rates inside the microfluidic device and the magnetic nanoparticles are taken along to enable its controllability by rapid magnetic response. And then, the spatial posture of the magnetic microrobot is contactless controlled by the magnetically guided manipulator and it is released under the influence of surface tension and gravity. Subsequently, the artistic fashions of the magnetic microrobots are precisely distributed via the dot-matrix magnetic flux density of the magnetically guided device. Finally, the experimental results herein demonstrate the accuracy and diversity of the pattern structures in the water and the developed method will be providing a new way for personalized functional scaffold construction.
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Affiliation(s)
- Xingfu Li
- Chongqing Key Laboratory of Manufacturing Equipment Mechanism Design and Control, Chongqing Technology and Business University, Chongqing 400067, China
| | - Toshio Fukuda
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, China;
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Lloyd P, Hoshiar AK, da Veiga T, Attanasio A, Marahrens N, Chandler JH, Valdastri P. A Learnt Approach for the Design of Magnetically Actuated Shape Forming Soft Tentacle Robots. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.2983704] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Untethered miniature robots have significant poten-tial and promise in diverse minimally invasive medical applications inside the human body. For drug delivery and physical contra-ception applications inside tubular structures, it is desirable to have a miniature anchoring robot with self-locking mechanism at a target tubular region. Moreover, the behavior of this robot should be tracked and feedback-controlled by a medical imaging-based system. While such a system is unavailable, we report a reversible untethered anchoring robot design based on remote magnetic actuation. The current robot prototype's dimension is 7.5 mm in diameter, 17.8 mm in length, and made of soft polyurethane elastomer, photopolymer, and two tiny permanent magnets. Its relaxation and anchoring states can be maintained in a stable manner without supplying any control and actuation input. To control the robot's locomotion, we implement a two-dimensional (2D) ultrasound imaging-based tracking and control system, which automatically sweeps locally and updates the robot's position. With such a system, we demonstrate that the robot can be controlled to follow a pre-defined 1D path with the maximal position error of 0.53 ± 0.05 mm inside a tubular phantom, where the reversible anchoring could be achieved under the monitoring of ultrasound imaging.
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Affiliation(s)
- Tianlu Wang
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Wenqi Hu
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Ziyu Ren
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
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31
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Ciuti G, Skonieczna-Żydecka K, Marlicz W, Iacovacci V, Liu H, Stoyanov D, Arezzo A, Chiurazzi M, Toth E, Thorlacius H, Dario P, Koulaouzidis A. Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies. J Clin Med 2020; 9:E1648. [PMID: 32486374 PMCID: PMC7356873 DOI: 10.3390/jcm9061648] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
Flexible colonoscopy remains the prime mean of screening for colorectal cancer (CRC) and the gold standard of all population-based screening pathways around the world. Almost 60% of CRC deaths could be prevented with screening. However, colonoscopy attendance rates are affected by discomfort, fear of pain and embarrassment or loss of control during the procedure. Moreover, the emergence and global thread of new communicable diseases might seriously affect the functioning of contemporary centres performing gastrointestinal endoscopy. Innovative solutions are needed: artificial intelligence (AI) and physical robotics will drastically contribute for the future of the healthcare services. The translation of robotic technologies from traditional surgery to minimally invasive endoscopic interventions is an emerging field, mainly challenged by the tough requirements for miniaturization. Pioneering approaches for robotic colonoscopy have been reported in the nineties, with the appearance of inchworm-like devices. Since then, robotic colonoscopes with assistive functionalities have become commercially available. Research prototypes promise enhanced accessibility and flexibility for future therapeutic interventions, even via autonomous or robotic-assisted agents, such as robotic capsules. Furthermore, the pairing of such endoscopic systems with AI-enabled image analysis and recognition methods promises enhanced diagnostic yield. By assembling a multidisciplinary team of engineers and endoscopists, the paper aims to provide a contemporary and highly-pictorial critical review for robotic colonoscopes, hence providing clinicians and researchers with a glimpse of the major changes and challenges that lie ahead.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland;
- Endoklinika sp. z o.o., 70-535 Szczecin, Poland
| | - Veronica Iacovacci
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Hongbin Liu
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 7EH, UK;
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London W1W 7TY, UK;
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy;
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 20502 Malmö, Sweden;
| | - Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery, Lund University, 20502 Malmö, Sweden;
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
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Mandsberg NK, Christfort JF, Kamguyan K, Boisen A, Srivastava SK. Orally ingestible medical devices for gut engineering. Adv Drug Deliv Rev 2020; 165-166:142-154. [PMID: 32416112 PMCID: PMC7255201 DOI: 10.1016/j.addr.2020.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
Abstract
Orally ingestible medical devices provide significant advancement for diagnosis and treatment of gastrointestinal (GI) tract-related conditions. From micro- to macroscale devices, with designs ranging from very simple to complex, these medical devices can be used for site-directed drug delivery in the GI tract, real-time imaging and sensing of gut biomarkers. Equipped with uni-direction release, or self-propulsion, or origami design, these microdevices are breaking the barriers associated with drug delivery, including biologics, across the GI tract. Further, on-board microelectronics allow imaging and sensing of gut tissue and biomarkers, providing a more comprehensive understanding of underlying pathophysiological conditions. We provide an overview of recent advances in orally ingestible medical devices towards drug delivery, imaging and sensing. Challenges associated with gut microenvironment, together with various activation/actuation modalities of medical devices for micromanipulation of the gut are discussed. We have critically examined the relationship between materials–device design–pharmacological responses with respect to existing regulatory guidelines and provided a clear roadmap for the future.
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Abstract
Needle steering is a technology for guiding needles around sensitive internal obstacles in minimally invasive surgery. Traditional techniques apply rotation at the base of a needle with an asymmetric tip, enabling steering through the redirection of radial forces. Magnetic steering of catheters and continuum manipulators is another technology that allows steering of a shaft in the body. Both of these techniques rely on mechanical or manual shaft advancement methods. Needle steering has not achieved widespread clinical use due to several limitations: 1- buckling and compression effects in the shaft and needle rotation cause excessive tissue damage; 2- torsion effects on the shaft and needle deflection at tissue boundaries lead to difficulty in control; and 3- restricted radius of curvature results in limited workspace. Magnetically steered catheters and continuum manipulators also suffer from limited curvature and the possibility of buckling. This paper proposes a novel needle steering method empowered by electromagnetic actuation that overcomes all of the aforementioned limitations, making it a promising option for further study toward healthcare applications.
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Affiliation(s)
- Jihong Min
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Yiran Yang
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Zhiguang Wu
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
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