IEEE Systems, Man and Cybernetics Magazine - July 2020 - 43

are, however, expanding their usefulness to the peroperative stage. NIRS uses the near-infrared-light bandwidth to
obtain information about the StO 2 within a tissue sample,
based on the absorption coefficients of oxygenated and
deoxygenated hemoglobin. A wearable NIRS sensor, independent of patient demographics, has been developed for
peri- and postoperative, real-time StO 2 monitoring for FTT
[15]. This has shown to increase the FTT salvage rate for
animals and healthy humans, indicating when a vascular
complication has occurred and additional surgery is
required [15].
Raman spectroscopy is an analytical technique that is
insensitive to water and label-free and a promising tool for
in vivo perioperative sensing. A greater signal enhancement can be achieved by SERS [26]. The typical fabrication
of SERS-based sensors necessitates multiple intricate
steps to realize the required geometrical pattern. Recently,
SERS microstructures fabricated by direct laser writing
have demonstrated excellent Raman-signal enhancement
for molecular and bacterial detection, enabling us to de--
velop optical-fiber-based, tethered, in vivo SSI-monitoring -sensors [27], [54].
Rapid metabolic phenotyping through techniques such as
nuclear magnetic resonance spectroscopy and mass spectrometry tissue biopsy and biofluid evaluation are set to
impact the patient-care pathway. They can deliver real-time
diagnostic information during operations, within clinically
actionable time frames that may improve operative decision
making. Rapid evaporative ionization mass spectrometry
has a demonstrated accuracy for differentiating normal tissues from cancer in near real-time and may have a role as a
perioperative margin-assessment system to reduce the reoperative burden for certain tumors, such as breast cancers
with traditionally high rates of positive margins [28].
Instrumentation
Sensor instrumentation is continuously evolving, offering
more precise miniaturized tools that consume less power
for noninvasive patient monitoring and operating room
deployment. Instrumentation development depends on
particular applications and sensor characteristics and
uses commercial off-the-shelf (COTS) electronic components or application-specified integrated circuits (ASICs).
COTS can be readily employed for fast prototyping and
where integration and power requirements are relaxed
[12]. Many microcontrollers now have integrated analog
blocks for basic signal conditioning, while near-field communication (NFC) and Bluetooth chips with very small
footprints are available. Dedicated chips for ECG and
respiration monitoring (e.g., Analog Devices ADAS1000-4
and Texas Instruments ADS1298) and bioimpedance
(Texas Instruments AFE4300) have also emerged. COTS
approaches will fall short as the number of sensors in--
creases, leading to a high power consumption and large
device size. Customized ASIC architectures that are based
on standard CMOS technologies and aim for ultralow
	

power consumption and high integration can be implemented to address the demands of multiparametric biomedical sensing [2]. Early developments focused on the
design of specific blocks or subsystems and single-sensortype interrogation, while recent ones are moving toward
the combination of multiple sensing modalities and complete system integration [29], [30].
The power, size, and performance specifications,
whether a COTS or an ASIC approach is followed, are highly demanding and must not be compromised. Different
sensors come with varying sets of instrumentation re--
quirements that must be addressed to ensure the signal
integrity. For example, ac-current sources for bioimpedance measurements must maintain a high output impedance at high frequencies and minimize common-mode
issues and phase delays [31]. Electrode and circuit offsets
must be minimized to avoid amplifier saturation [29], without compromising input impedance [2] or introducing
phase delays that hamper analog computation [32]. Attoto-nano-range current recordings from miniaturized
amperometric sensors require low front-end (FE) noise [2].
The design of analog-sensor-interfacing FE electronics is a
complicated matter. Hybrid approaches, where sensors are
fabricated on of top or using the top metal layer of CMOS
chips and nanomaterials, lead to greater integration [33].
Power, Data Transfer, and Security
In practice, the application dictates the size of the battery
and charging frequency. Various applications will also
determine whether a battery can be used at all. For example, pacemakers have a battery that, once drained, must
be replaced. On the other hand, implanted cochlear
implants are battery-less and depend on an external
aligned master device. How deep a device is implanted
will determine the transduction mechanism, with deep
implants powered through ultrasounds [34]. The most
common method uses the inductive coupling of two resonant coils [35]. The development of the NFC protocol has
increased the interest in induction-based methods for contactless measurements [36]. The transducer size dictates
the distance across which devices will work, typically a
few centimeters.
Ultrasonic links can deliver up to 100 nW within 4 cm of
tissue, as opposed to 5  mW across 0.5  cm with NFC via a
smartphone. Custom standard-free inductive links, however,
can achieve higher levels (2 10 mW, 2 4 cm). The physiological environment itself can serve as an energy source for
devices including glucose nanowatt biofuel cells [37]; the
endocochlear electrochemical potential gradient (lownanowatt range) [37]; piezoelectric harvesters in body
limbs, joints, and even over the aortic arch and the heart's
pericardium (theoretically providing 1 W) [2]; and triboelectric and hybrid nanogenerators that achieve a microwattto-milliwatt range [38].
When using inductive or ultrasonic powering [39], data
communication may be required, which can be facilitated
Ju ly 2020

IEEE SYSTEMS, MAN, & CYBERNETICS MAGAZINE	

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IEEE Systems, Man and Cybernetics Magazine - July 2020

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