2024-06-06 ReviewPaper InductiveUltrasound Szabo

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Challenges and Opportunities in Combining

Ultrasound and Inductive Coupling for Energy
Supply and Bidirectional Data Exchange in
Bioelectronics Medicine Implant Networks
B. Szabo, J. Helmerich, Student Member, IEEE, T. Schaechtle, A.B. Amado-Rey,
S.J. Rupitsch, Member, IEEE, T. Stieglitz, Fellow, IEEE
 using implants (“electroceuticals”) instead of pharmaceutical

Abstract— Personalized medicine meets microimplants. Many approaches has been envisioned about one decade ago [1]. New
not yet treatable diseases could be alleviated through the use of generations of neural interfaces intervening with the central, pe-
miniaturized, distributed implants. In order to supply these im- ripheral, and autonomic nervous systems promise new treat-
plants efficiently with energy and to transfer as much power as ment options but also pose open questions and challenges, like
possible, inductive links as established and ultrasonic transducers
as prospective energy transmission methods were investigated.
the evaluation of effectiveness and side effects [2, 3]. In an age-
Comparing the fundamentals behind the technologies, two use ing society with bioelectronics medicine as a valid treatment
cases are defined: inductive links are suitable for energy transmis- option, networks of implants seem to become realistic as multi-
sion over short distances, but require a relatively large amount of ple diseases like hypertension, rheumatic arthritis and diabetes
space. Ultrasound is more suitable for longer distances in an aque- are treated with simultaneous drug intake, which could also be
ous environment, as the losses are lower, and ultrasonic transduc- treated by distributed implants.
ers can be miniaturized without losses in energy density. There-
fore, a system is proposed with transcutaneous energy transmis-
As an example, a patient with too slow or fast heart rate, and
sion through an inductive link and intracorporeal through ultra- auditive problems, might require two gold-standard devices: a
sound transducers. To ensure high and simultaneous data and en- cardiac pacemaker and a cochlear implant. Each implant func-
ergy transmission, planar butterfly coils and membrane-based pi- tions as a standalone device. It might be beneficial for treatment
ezoelectric micromachined ultrasonic transducer (PMUT) arrays and intervention to interlink implants on a physiological level
were chosen, with non-hermetic encapsulation with medical grade to minimize potential side effects and maximize effectivity and
silicone adhesive being ideal for both.
efficiency, but it has not been realized, so far. This contribution
Index Terms—Implantable Medical Devices, Medical implant primarily discusses the idea of networks of neural implants,
networks, Ultrasound, Inductive Link, Power Transfer, Data which are distributed inside the body, wirelessly powered, and
Transfer, Non-hermetic encapsulation. attached directly to nerves to derive or stimulate nerve signals
and their inter-implant communication. Applications of bioe-
lectronic medicine would benefit from this technology since it
I. INTRODUCTION can be used for a wide range of implants that need to be placed
deep inside the body close to the target organ and need to be
T HE emerging capabilities of diagnosing diseases and im-
pairments of an aging society promote new medical ap-
proaches. This includes both the prevention of developing
supplied with energy wirelessly.
Intervention with multiple deep-seated nerves, whether to re-
health problems, in the first place, and the application of thera- duce pain to stimulate nerve pathways to support the healing
peutic treatments in cases of already ongoing medical care. In process or to modulate the autonomic nervous system, for ex-
severe cases, such therapies involve invasive medical proce- ample, involves major challenges in powering implants as well
dures carried out by physicians or the use of a new generation as their intracorporeal, and extracorporeal communication with
of implants. Bioelectronics medicine as a new treatment option, devices placed outside the body. So far, an electrode is placed
B. Szabo, J. Helmerich, A.B. Amado-Rey, J.S. Rupitsch and Thomas Stieg- This work was supported in part by the German Federal Ministry of Educa-
litz are with the BrainLinks-BrainTools//IMBIT, 79110 Freiburg, and also with tion and Research (16MEE0078) and the European Union under the ECSEL JU
the Department of Microsystems Engineering (IMTEK), University of and H2020 Framework Programme under Grants H2020-ECSEL-2019-IA-
Freiburg, Germany (e-mail: [email protected], 876190.
[email protected], [email protected] Part of the work was within BrainLinks-BrainTools which is funded by the
[email protected], [email protected] Federal Ministry of Economics, Science and Arts of Baden-Württemberg
burg.de) within the sustainability programm for projects of the excellence initiative II.
T. Schachtle is with the Department of Microsystems Engineering (IMTEK),
University of Freiburg, Germany (e-mail: [email protected]
burg.de)
close to the target structure and is connected via an implanted energy transmission by inductivity, energy transmission inside
cable with an implantable pulse generator (IPG) or recorder, the body through ultrasound, a communication channel with the
which is seated in a subcutaneous pocket to minimize transcuta- combination of both technologies and their limitations on size
neous distances for data transmission. and energy demands to power devices continously, as well as
A novel approach to treat diseases or pain is the interconnec- safety limits to do so. In Section 2 the fundamentals of power-
tion of multiple implants. If the traditional way of treating pain ing implants and fundamentals of communication are de-
with analgesics cannot adjust to the patient’s demand for sooth- scribed. Section 3 lists existing transducers to be used for
ing pain [4] or if analgesics have strong side effects on patients, power supply and communication for implant networks, fol-
implants can be used as an alternative. If the propagation of pain lowed by an ideal combination of previously discussed trans-
stimuli could be detected, another implant can be activated to ducers in section 4.
reduce or intervene in the transmission of feeling pain [5–7].
For instance, phantom limb pain might be reduced by matched II. FUNDAMENTALS OF POWERING AN IMPLANT AND
implants both near the amputation [8] and the targeted reduction COMMUNICATION
of pain in the central nervous system [9]. Another treatment op- Ever since active implantable medical devices have existed,
tion is the sensing of pain in a certain area and the targeted re- the question of how to supply them with energy has arisen. Per-
lease of analgesics on-site [10]. A further field of application manent energy supply with percutaneous cables is only feasible
would be the treatment of motility disorders, which affect many to short term implants, but needs to be avoided for long-term
people worldwide [11] and lead to a reduced quality of life [12, implants, as it is an acute threat to cause skin infections. There-
13]. Motility disorders can originate from diseases of extrinsic fore, implants and their energy supply need to be fully im-
neural control or muscular diseases [14, 15]. With the help of planted into the body. One of the mostly used and simplest
interconnected network implants, a lack of bowel movement method of power supply is the integration of a non-rechargeable
could be detected by one implant and, simmultaneoulsy, the en- battery (primary cell) into the medical device. This is the typical
teric nervous system could be stimulated by other, inde- case in, for example, cardiac pacemakers. With the help of a
pendently acting implants, so that the bowel is stimulated to battery, implants can be seated deeply inside the body with no
contract[16–18]. contact to outer tissue layers. The disadvantages of such an en-
We hypothesize that the communication of these implants ergy supply are the need for surgical replacement of batteries at
with each other and their energy supply poses major challenges their end of life (between five to ten years for a pacemaker),
to be solved best by a combination of electromagnetic induction along with the disproportionality of energy density with the bat-
and ultrasound, exploiting the properties of each energy- and tery size. Both prevents long-term applications for a lifetime
data-transmitting technology. An inductively powered implant [19]. To solve this problem, a variety of solutions were quickly
may be placed underneath the skin to serve as a platform for sought: either to permanently power implants wirelessly (Fig-
communication and powering other implants in the body with ure 1) or to charge a small battery at short intervals. The possi-
the help of ultrasound. In this case, induction transfers energy bilities and limitations of supplying an implant with different
efficiently over short distances inside and within the body, and energy transmission techniques are manifold and strongly de-
ultrasound is used for energy transfer in aqueous environment pend on the location and targeted nerves of the implant.
over long distances inside the body (Figure 1). As seen in Table 1, various approaches to power implants
have been investigated in the literature: inductive links [20, 21]
or capacitors [22, 23] for short-distance power transmission, ra-
diofrequency links (RF-link) [24, 25] or ultrasound [26, 27] for
transmission over longer distances, employing the body’s glu-
cose [28, 29] for energy harvesting or conventional batteries
[22–24, 28–44]. Should the implant be continuously powered,
it is apparent that only inductive links and ultrasonic transduc-
ers can be used up to now regarding the combination of trans-
mittable energy densities over sufficient distances, lifetime in-
side living tissue and frequencies used for communication. Ca-
pacitors have too low frequencies to be used for communication
Fig. 1. Human body with a schematic arrangement of various implants to parallel to power transfer, body glucose based implants do not
transmit energy and data: at short distance through the superficial layer of the harvest sufficient power, RF-links are suitable for communica-
skin with an inductive link, inside the body and for larger penetration depths
by ultrasound. In the electromagnetic field, electrical fields E are coupled with
tion but do not transmit high energy densities and batteries have
magnetic fields H, resulting in the field S, for ultrasound the incoming wave i limited lifetimes.
is split into the reflective part r and the transmitted part t. In these cases, the power transmission via an inductive link
In this seminal review, we collect all relevant fundamentals is the most known and used, especially with the success of the
of electromagnetic and piezoelectric transmission principles commercially available cochlear implant, which consists of two
and present state-of-the-art transducers. We highlight ways in parts: (i) the extracorporeal part with the microphone and trans-
which deep-seated implants can be linked and energized, and mitting inductive link and (ii) the intracorporal or implanted
how upcoming challenges might be addressed: transcutaneous
TABLE I
COMPARISON OF IMPLANTABLE ENERGY HARVESTING SYSTEMS
Energy Type Frequency Active Range Lifetime Energy Biological Risk References
†
Inductive Link 1 – 5800 MHz 1 – 50 mm > 30 years < 5 mW / mm 2
Low after implantation H
[30, 31, 32, 43,
191, 193]
†
Ultrasonic 0.088 – 5.85 MHz 2 – 176 mm - < 1.1 mW / mm2 Low after implantation H [33, 34, 35, 174]
†
Capacitors < 125 Hz 1 – 100 mm - < 0.72 mW / mm2 Low after implantation H [22, 23, 36, 37]
†
RF-Link 2.4 – 3.7 GHz <1m - < 2.2 µW / mm2 Maturity no given yet for MIDs [24, 38, 39, 40]
⁕
Body Glucose - Freely placable < 16 weeks < 40 µW Low after implantationA [28, 29]
‡
Batteries - Freely placable < 10 years < 440 mWh /g Low after implantation, high [41, 42, 43]
when explantation needed H
† ⁕ ‡
Shows only received energy densities, Harvested power over the implant lifetime and stored energy density in batteries. Hare implanted in humans and Aare
implanted in animals.
part with the receiving inductive link and the stimulation elec-
B. Inductive Link
tronics and sites. Using an inductive link is efficient for subcu-
taneous implants, but becomes increasingly inefficient for Powering implants transcutaneously by recharging a battery
deeper-lying implants. Ultrasound as an energy transmission or by continuous power transfer, requires different forms of
method is the subject of current research with promising results wireless power transfer through human tissue. Inductive links
regarding the transmission of large energy densities over long are based on the principle of using two coupled coils, one inside
distances, combined with the possibility of miniaturization and and another outside of the human body, and by conventionally
efficient transmission through aqueous tissues of the body. driving a pulsed current in the transmitter coil [56, 57], a volt-
Transmission through the skin is difficult due to acoustic im- age at the receiver coil is induced [19]. The inductive links’ op-
pedance mismatch. timal power transfer is strongly dependent on the coils’ reso-
As some of the energy transmission or conversion methods nance frequency [58, 59] and their alignment [60, 61]. The mu-
do not harvest enough energy to power AIMDs, they are not tual inductance decreases with increasing conductivity of the
further addressed. Only established or promising power supply medium between the coils [62], while the skin and tissue con-
methods as batteries, inductive links and ultrasonic transducers ductivity increases with rising frequencies of electric fields
are discussed with regard to their limitations and alternative [63], leading to higher power dissipation, and thus higher spe-
possibilities are shown, especially concerning their miniaturi- cific absorption ratio of electromagnetic waves inside the tissue
zation. [59]. In short: electromagnetic waves are strongly attenuated by
conductive tissue (also depicted in Figure 3).
A. Energy Storage The miniaturization of coil designs is limited and, according
Cardiac pacemakers have been the first commercially im- to Equation (2.1) depends on primary (L1) and secondary (L2)
planted devices (first implantation in 1958), powered by pri- coil’s self-induction and the mutual inductance (M) in between
mary batteries [42]. Based on the previous commercial release which determines the coupling coefficient k [64]
of lithium/ionide-polyvinylpyridine batteries, the technology 𝑀
was adapted for use in implants in the late 1960s and early 𝑘= . (2.1)
1970s. These batteries can reliably store energy for months or √𝐿1 𝐿2
even years due to their featuring of high power density and low Describing formula (2.1) in terms of potential miniaturiza-
self-discharge [45, 46]. Up to this day, these batteries remain tion, it is necessary to divide it into the mutual inductance M
the state-of-the-art for non-rechargeable battery systems in car- and the respective inductions L1 and L2 of the coils. In general,
diac pacemakers [47]. Even though the pacemakers consume mutual inductance can be described by the Neumann formula
low electric current in the µA-range at a few volts [48, 49], the (2.2) [65]
energy density of batteries is limited, which makes it impossible
to miniaturize batteries while maintaining the same lifetime 𝑁1 𝑁2 𝜇0 d𝑙1 ∙ d𝑙2
𝑀= ∮ ∮ , (2.2)
[41]. The development of stable, rechargeable batteries has, 4𝜋 𝑙1 𝑙2 𝑅𝐶𝐹
therefore, come into focus in recent years [50], and has yielded
remarkable results in the increase of energy density [51]. How- in which N1 and N2 are the number of turns of the primary
ever, batteries are not suitable for every implant. A battery in a and secondary coil, respectively, μ0 the magnetic permeability
pacemaker usually has an electric charge of 0.5 Ah – 1.6 Ah of vacuum, l1 and l2 the line elements to determine the distance
[47, 52, 53], while a cochlear implant consumes between between the two coils, and RCF a correction factor for the dis-
1.20 mA and 1.75 mA per hour [54, 55]. If the same battery of tance and angular displacement between the coils. The mutual
a pacemaker would be used for the cochlear implant, it would inductance increases with well aligned coils, with the self-in-
result in a lifetime of a cochlear implant of only 55 days in the ductance of the coils and the number of turns [66, 67]. The self-
best-case scenario. Consequently, for longer lifespans, there is inductance of the coils is described in Equation (2.3), in which
a demand for some implants to be permanently supplied with μ0 is the permittivity of free space, d is the coil diameter, n is
energy, e.g., by an inductive link. the number of turns, κ is the Nagaoka’s coefficient and l the
distance between two coil planes of a solenoid coil [68, 69]
Thus, there are non-focused transducers and focused transduc-

𝑑 2
𝜇0 𝜋 ( ) 𝑛 2 𝜅 (2.3) ers mostly based on parabolic geometries, for material analysis,
𝐿= 2 . or based on phased arrays, mostly used in biomedical engineer-
𝑙
ing. Phased arrays create a focused beam with the help of a
Equation (2.3) shows that the coupling coefficient is directly phase-shifted wavefronts driving separate transducers without
proportional to the square of the coil diameter d. The self-in- physically moving them [81].
ductance decreases therefore exponentially, when the diameter
is reduced. 1) Fundamentals of Wave Propagation
One way to indicate the efficiency of energy transfer between Acoustic waves can be considered as an adiabatic transmis-
two coils is the quality factor Q (Equation 2.4); high values of sion of collisions, as rapidly vibrating particles, where pres-
the Q factor indicate good energy transmission. sure differences propagate through a medium. For a propa-
2𝜋𝑓𝐿 𝜔𝐿 gation of acoustic waves in fluids, particles oscillate longi-
𝑄= = (2.4) tudinally, releasing their energy to an adjacent particle. This
𝑅 𝑅 relationship results in the Newton-Laplace equation
This factor describes the ratio of the coils inductive reactance
ωL to its DC resistance R at a certain frequency f [70]. Accord- 𝐾𝑠
𝑣= √ , (2.5)
ingly, higher frequencies should lead to a higher transmission 𝜌
of the energy. This property is limited by the skin-effect, which
increases the resistance at higher frequencies [68, 71]. The skin in which the speed of sound v is dependent on the adiabatic
effect and other losses cause the Q factor to decrease at high bulk modulus Ks and the medium density ρ [82].
frequencies [72]. High Q factors come with a steep decrease Following the equation (2.5), the speed of sound is faster
apart from the resonance frequency. Slight deviations in this in materials with a high bulk modulus, which are mostly
frequency due to changes in insulation materials of coils, for solid materials, but also liquids, despite having also a higher
example, or frequency modulation lead to working points in density. Derived from Equation (2.5), complex acoustic im-
which the efficiency of the links is significantly decreased. pedance Z
Even though resonance frequency tracking circuits exist, lower 𝜌𝑣
Q factors are often preferred due to their larger bandwidth [73]. 𝑍= 𝛼𝑣 (2.6)
1+𝑗
A comparison of the energy transmission modes and their lim- 2𝜔
itations regarding distance and miniaturization is presented in states the resistance of a material that opposes to the prop-
Section D. agation a sound wave.
C. Ultrasound In addition to the acoustic density ρ and speed v, ω denotes
the angular frequency, α the attenuation coefficient, and j
Several limitations of inductive links, in particular their chal-
the imaginary number. If an acoustic wave is transmitted
lenges of miniaturization, safety limits, and the limitation of
between two different materials, its transmission coefficient
transmission depth through aqueous (and conductive) tissue t and its reflection coefficient r can be described by the
(see section D), can be solved with the ultrasound-based energy acoustic impedances of the two materials, Z1 and Z2, respec-
transfer. Therefore, acoustic energy transfer constitutes an al- tively, according to Equations (2.7) and (2.8). These equa-
ternative to power implants wirelessly. Acoustic energy transfer tions assume that sounds propagates perpendicular to the
is based mostly on ultrasound; with sound waves operating in material interface[83].
the frequency region of 20 kHz - 4.5 MHz [74]. The sound
propagates with low loss through human tissue by pressure dif- 2𝑍2
𝑡= (2.7)
ferences [75]. These pressure differences can be used to convert 𝑍1 + 𝑍2
vibrations into electrical energy by various electromechanical
transducers. Commonly, piezoelectric and capacitive principles 𝑍2 − 𝑍1
𝑟= . (2.8)
are utilized to convert ultrasound to electrical energy and vice 𝑍2 + 𝑍1
versa. This contribution concentrates on piezoelectric materials
and their implementation as lead zirconium titanate (PZT) These formulas state that the energy of the transmitted
acoustic waves will decrease due to reflections if the waves
transducers [76, 77] or piezoelectric micromachined ultrasonic
propagate across boundaries of materials with different
transducers (PMUTs) [78, 79], as well as capacitive transducers
acoustic impedances. Moreover, sound waves get attenu-
and their implementation as capacitive micromachined ultra- ated or absorbed by the material. In addition, inhomogenei-
sonic transducers (CMUTs) [34, 80]. Compared to an energy ties of small size lead to scattering of the wave during prop-
conversion via inductive link, these ultrasonic transducers can agation [84].
be miniaturized without significant loss in received energy den-
sity due to their piezoelectric and capacitive nature of energy 2) Piezoelectric Effect
conversion. Creating ultrasonic waves can be achieved with ultrasonic
Another advantage compared to inductive energy transmis- transducers that are based on piezoelectricity. Piezoelectric-
sion is the possibility to focus and steering the ultrasound beam. ity is the generation of an electrical field by the mechanical
deformation of a solid material, such as certain crystals or a surplus polarization in comparison to the non-bent state
ceramics, under the effect of mechanical stress [85]. For a [93–95].
material to have piezoelectric properties, the center of 3) Capacitive Basics
charge neutrality must have an slightly offset with respect Another possibility to generate ultrasonic waves is to use
to the geometric center of the unit cell [86, 87]. When de- miniaturized capacitors that excite membranes to vibrate.
formed under mechanical force, atoms and thus charges will Capacitors are an electrical component, which separate and
shift within the unit cell and polarize the material (Figure 2). store electric charges on their electrodes, creating an electric
These small dipoles add up to an accumulated dipole, which field[96]. A parallel plate capacitor is used to explain the
energy conversion from the displacement of the plates to
electrical energy. The capacitance C for a parallel plate ca-
pacitor with capacitor plates of equal size is given by the
vacuum permittivity ε0, the dielectric constant εr, the plate
area A and the distance between plates d [97]
𝐴
𝐶 = 𝜀0 𝜀𝑟 . (2.11)
𝑑
In capacitors, charges are present or applied to the con-
ducting capacitor plates. These charges induce an electric
field, which changes either due to the presence of additional
charges or to the change of the distance d between the ca-
Fig. 2. Piezoelectric effect within 1) an AlN-crystal, which has uniformly
pacitor plates. If this occurs periodically, this capacitor can
distributed ions without any force applied and 2) with a longitudinal force F, be used to convert energy, as an alternating voltage is in-
which leads to a displacement of positive and negative charges and therefore duced. For example, if an ultrasonic wave causes a mem-
a change surplus, resulting in an electrical dipole and an electrical potential at brane, which also acts as a plate capacitor, to vibrate, there
the electrodes.
will be a change in the distance d and, thus, also in the ca-
can be measured as electrical potential at the electrodes [88]. pacitance. This oscillating change can then be exploited to
This applied, unilateral force can be caused by a sound wave harvest electrical energy.
that deforms the crystal, resulting in a charge difference. On
the other hand, the piezoelectric crystal can exert force by D. Comparison of Energy Transfer Methods
applying such a charge difference and generate a sound In order to efficiently transfer energy from extracorporeal to
wave [89]. The fundamental equation to describe the dis- intracorporeal devices, one must first understand energy propa-
placement of a piezoelectric crystal is the so-called strain- gation through body tissues and the physical limits of coils and
charge-form or d-form ultrasonic transducers. Signal attenuation in tissues and the fun-
𝜎
damental possibility to miniaturize energy transmission devices
𝐷m = 𝜀m,n ∙ 𝐸n + 𝑑kl ∙ 𝜎kl (2.9) are discussed in the following paragraphs.
with m, n, k ∈ N = {1,2,3} and k, l ∈ N = {1, 2, 3, 4, 5, 6}. 1) Attenuation of Waves and Dissipation of Energy
In Equation (2.9), D is the electric displacement, ε the elec- Different tissues of the human body attenuate electromag-
tric permittivity, E the electric field, d the piezoelectric cou- netic fields and acoustic waves differently. To display this
pling coefficient, and σ the mechanical stress [75, 90, 91]. correlation, data was extracted from different publications
The efficiency of energy harvesting depends on the piezo- and is presented in the upcoming graphs. Even if constants
electric coupling coefficient d. In cases of a d33 optimized (the dielectric constant and the dielectric loss factor) are
system, the induced voltage reads used for the decrease in electric fields and a real-value quan-
tity for acoustic attenuation, both are used in an exponential
𝑑33 ⋅ 𝑙 equation and are both dependent on the distance. As for the
𝑈12 = − 𝜎 𝜎3 (2.10) electromagnetic fields, tissue with higher conductivity at-
𝜀33
tenuate electromagnetic fields more strongly than tissue
where l denotes the distance between the two electrodes with low conductivity. Electromagnetic fields are strongly
attached on the piezoelectric material. Thus, increasing the attenuated by blood (Figure 3), but much less by bone [63,
thickness of the piezoelectric layer results in both a change 98, 99]. This behavior can be described in simplified form
in the resonance frequency and the induced voltage. Con- with the electric permittivity ε (consisting of the relative
sidering PZT as the material of choice, the induced voltage permittivity εr multiplied by the vacuum permittivity ε0) and
increases and the resonance frequency decreases in such a its effect on the electric field E and the electric displacement
system, the thicker the piezoelectric layer is. This decreas- D [100–103]
ing resonance frequency also benefits implanted devices
due to a less tissue associated attenuation of the signal [92]. 𝐷= 𝜀𝐸. (2.12)
In addition to the piezoelectric effect, the flexoelectric ef-
fect needs to be considered, when miniaturizing piezoelec-
tric structures. It occurs if a thin material is bent and the
charges displace due to inhomogeneous strains, resulting in
acoustic attenuation; ultrasound is viable to transmit ener-

gies through every soft tissue, therefore ideal in the bowel
region, for example.
2) Miniaturisation of Coils and Ultrasonic Transducers
Since small, distributed implants throughout the body are
to be supplied with as much energy as possible and needed,
the highest possible energy density received is required. Ac-
cordingly, it is not only about the absolute energy trans-
ferred, but also about the potential degree of miniaturization
of the presented types of receiving transducers, which com-
promises the received power density. A two coil system, a
round plate capacitor and a piezoelectric element are intro-
duced as potential transducers that follow different working
principles (Figure 5).
For absolute energy transmission through coils, no global
maximum can be formulated. However, a clear trend can be
seen in miniaturization: if the diameter of the coils is re-
duced, the coupling coefficient will be reduced (Eq. 2.1
and 2.3). Increasing the number of turns to increase the mu-
tual inductance (Eq. 2.2) and thus the coupling coefficient,
a higher conductor resistance due to an increased length of
the conductor is created, which is only amplified by the skin
effect at high frequencies. This in turn would have a coun-
terproductive effect, as the quality factor Q (Eq. 2.4) would
again decrease. A highly miniaturized receiving coil would,
Fig. 3. Attenuation of electrical field strength E as a function of the original therefore, receive a significant lower energy density. For ex-
electrical field E0, dielectric constant ε’, the dielectric loss factor ε’’, the dis- isting inductive links, the coupling coefficient decreases ex-
tance z and the wavelength z0. Bone (cancellous and cortical) and fat show ponentially with rising distance [60]. If the implanted sys-
low attenuation while aqueous tissue (blood, kidney, wet skin, muscle) show
high attenuation [63, 98, 99].
tem should be supplied with the same amount of energy
even though the distance has increased, the energy and thus
With ultrasound, it is exactly the opposite: the attenuation
the induced electric field Erms will need to be increased ex-
is high for bone, but low for blood (Figure 4) [104–108].
ponentially as well. This limits the system’s depth of im-
This can be explained with power losses due to thermal dis-
plantation, as only a limited amount of energy is allowed in
sipation and heat dissipation, which are dependent on the
the human body (see section E. Regulations). As rule of
density and viscousity of the material and therefore lower
for liquids and higher for solid materials.
Fig. 4. Attenuation of acoustic sound waves with the resulting intensity I, the
original intensity I0, which is attenuated by the attenuation constant α and the Fig. 5. Schematic illustration of the basics of three power transmission meth-
distance x. Blood, kidney, muscle and fat show low attenuation, while bone ods and their corresponding equations to describe their properties. Left: two-
(cancellous and cortical) and wet skin show high attenuation [105-108]. coil inductive link with the equations for the inductance (Eq. 2.3), the cou-
pling coefficient k (Eq. 2.1), the quality factor Q (Eq. 2.4) and the mutual
inductance M (Eq. 2.2). Right: schematic depiction of an ultrasonic transducer
Thus, inductive links are ideal for short distance energy with a single CMUT element as capacitor and the voltage u(t), which is de-
transmission through the skin and hard tissue and ultrasound pendent on the capacitance C (Eq. 2.11) and the current i(t). Furthermore a
inside the body to yield the highest transmittable energies single PMUT element as a piezoelectric crystal between two electrodes and
and reach larger penetration depths. It can be seen that tissue the electric displacement D (Eq. 2.9) and the generated voltage U12 (Eq. 2.10).
with high water content as organs and muscles have a low
thumb, transmission distances up to the coil diameter can be lines, the IEEE standard from the IEEE standards associa-
envisioned. tion and the International Commission on Non-Ionizing Ra-
For the various systems of ultrasonic receivers addressed diation Protection (ICNIRP), recommend similar SAR-
here, similar limitations apply with respect to miniaturiza- limits. Whereas the IEEE standards organization suggests
tion. Bulk PZTs will not change their energy density if only an SAR-limit of 1.6 W/kg between 3 kHz and 300 GHz
the surface, but not their thickness, is changed. This also ap- [114] , the ICNIRP standard recommends a limit of 2 W/kg
plies for transducer arrays built from membranes (PMUTs, between 100 kHz and 6 GHz [115].
CMUTs), since the array can be made smaller as desired by Temperature Increase
integrating fewer membranes; the energy density does not A well-tolerated temperature increase that the body can
change here either. The reduced transmission of energy due still endure, regulate and in which no physical or mental im-
to different acoustic impedances (Eq. 2.6) must not be ne- pairment occurs is generally considered to be 1 K [116–
glected here, but can be at least partially solved by acoustic 118]. To prevent the rise in temperature above 1 K over av-
matching layers. In addition to the potential for miniaturiza- erage body temperature, the ICNIRP proposes a conserva-
tion, it should be noted that the particular tissue that lies in tive whole-body average SAR of 0.4 W/kg (100 kHz to 6
between the transducers has a major influence on the trans- GHz) for 30 mins, within safety margins and a reduction of
mitted energy, as described in 1). the factor 10 for scientific uncertainty [115]. A short-term,
local increase in tissue temperature or when the energy is
Regulations transmitted only periodically with long pauses between
Regulations are in place to limit strength of the electromag- transmissions, allowing the body to dissipate excessive heat,
netic fields and energy level of sound pressure to protect pa- allows an increase in SAR to 10 W/kg (100 kHz to 6 GHz)
tients from potential risks and hazards. A comparison between for a 6 min interval. The European Union follows the
the different limits helps to identify boundary conditions under ICNIRP guidelines in its recommendation for electromag-
which the use of a transmission method is beneficial over the netic fields safety [119]. The US Food and Drug Admin-
other. However, the following example illustrates why a com- istration (FDA) limits only localized temperature increases
parison is difficult: The energy density with which ultrasound for medical implants. During MRI examinations, local tem-
is allowed to be sent into the body is set to 720 mW/cm2 [109, perature increases of 2 K are allowed, but for sensitive areas
110], the energy transmission over a long period of time by in- of the body, such as brain, these 2 K are limited to 15
ductive coupling is set to 1.6 W/kg [111]. The limits refer to minutes [120]. However, it is strongly recommended that
even a local increase in tissue temperature does not exceed
different references, namely the area of tissue where the waves
39 °C [121].
propagate through for ultrasound and body weight for electro-
4) Ultrasound Regulations
magnetic fields. Therefore, different safety limits are presented For ultrasound, different limits and methods apply to en-
in the following sections without a direct comparison, only their sure patient safety. Here, too, is a limit that prevents in-
effects on the human body are highlighted. crease in the body temperature. Additionally, there is a limit
One important parameter for all active implantable medical intended to prevent the entry of local, mechanical forces that
devices is the temperature increase in the body (temperature in- might lead to cavitation in fluids, for example.
crease and thermal index) that is legally limited to 1 K inde- Thermal Index
pendent of the physical origin of the dissipation energy as de- Originating from medical diagnostic ultrasound is the
scribed in detail below. Thermal Index TI, a relative indicator for determining the
3) Electromagnetic Regulations heat input into the human body
Power introduced to the human body by electric fields
𝑊𝑝
heats the human tissue in the given area. Since proteins and 𝑇𝐼 = . (2.14)
cells in the body can only tolerate a certain temperature rise, 𝑊𝑑𝑒𝑔
the heat introduced must not exceed certain limits. The lim-
its presented here consider both the highest induced electric Here, the attenuated acoustic power Wp at the depth of in-
field as well as the maximum allowed temperature increase terested is divided by Wdeg, the estimated power to raise the
on the human body. temperature of equilibrium tissue by 1 K, depending on the
Specific Absorption Rate (SAR) chosen specific tissue model [122]. The TI is an empirical
The SAR describes the energy absorption of living tissue. estimation, from which in the field of medical ultrasound
The energy is hereby converted into heat, which intake is can be concluded that hard tissue, such as bone, is more
limited in living human tissue. The SAR for electric fields prone to be heated than soft tissue [123, 124] and that a
can be calculated via higher power input always leads to a higher temperature rise
[125, 126].
𝜎 |𝐸𝑟𝑚𝑠 |2 Mechanical Index
𝑆𝐴𝑅 = , (2.13) Another metric to evaluate the safe use of ultrasound is the
𝜌
so-called mechanical index MI. It describes the direct me-
in which σ is the tissue conductivity, Erms2 is the induced chanical entry of the ultrasound into the tissue and indicates
electric field and ρ is the density of the tissue under electro-
magnetic exposure [112, 113]. Both most significant guide-
the possibility of bioeffects, such as cavitation and acoustic Off Keying. If a continuous energy supply is needed, two
streaming and is defined as different voltage levels are preferable.
ASK features relatively moderate demands on both soft-
𝑃𝑟 ∙ 10−0.015 ∙ 𝑓𝑎𝑣𝑔∙𝑧 ware and hardware implementation compared to FSK. Par-
𝑀𝐼 = (2.15)
√𝑓𝑎𝑣𝑔 ∙ 𝐶𝑀𝐼 ticularly, its straightforward concept has been applied as one
standard communication modulation in cochlear implants
in which Pr is the negative pressure amplitude in MPa, [129]. Still, its requirement on the interpretation of the am-
favg is the acoustic-applied frequency in MHz, z is the dis- plitude level is prone to noise and reflections and, therefore,
tance from the transducers in cm and CMI = 1 MPa ∙ MHz-1/2 incorrect retrieval of information. This fact is mainly con-
is a correction factor [126]. The MI indicates the risk for
micromechanical damages through cavitation [127]. From
the formula, it can be concluded that a higher pressure, a
higher frequency and a greater depth in the human body lead
to a lower MI. The mechanical index effectively means the
violent collapse of bubbles in tissue. Within the lungs, the
limit of MI < 0.7 [126] is recommended by the FDA,
whereas the legal limit for medical diagnostic applications
from the FDA is significantly higher with MI < 1.9 [109,
128]. At this index, cavitation effects already occur; in real
applications, the MI should therefore be significantly lower.
Time evaluations for permanent use are also not considered
by the MI, so standards for permanent and safe operation
are currently lacking.
E. Basics in Communication
An essential concept of implantable devices intends a pa-
tient’s improved treatment based on the device’s collected data.
These data may include the body’s temperature, blood pressure,
or inflammatory markers but also bioelectrical signals from
muscles and nerves, providing the physicians with more de-
tailed information to address the disease most efficiently. In Fig. 6. Signal modulation techniques Amplitude Shift Keying (ASK), Fre-
other cases, the implant aids in restoring human senses, such as quency Shift Keying (FSK) and Differential Phase Shift Keying (DPSK) with
examples of their waveforms and their advantages and disadvantages.
the cochlear implant does. Yet, in both contexts, data needs to
be exchanged between the implanted device and extracorporeal nected with the attenuation of human tissue or bones, appli-
body-mounted device or in the future also between the im- cable to both electromagnetic and ultrasonic waves in their
planted devices themselves. individual terms, respectively. It is for this reason that ASK
1) Basic Modulation Techniques demands constantly sufficient differences in the bit associ-
Both ultrasonic and inductive-based communication tech- ated amplitude levels, despite the distance-related reduction
niques often follow the same fundamental principles to ex- of signal strength between two devices.
change the required data. These principles include Ampli- A frequency, in comparison, is less susceptible to fluctua-
tude Shift Keying (ASK), Frequency Shift Keying (FSK), tions in amplitude, thus, FSK-based modulations are con-
and Differential Phase Shift Keying (DPSK). For basic dig- sidered to be more robust to environmental disturbances. In
ital techniques, only a binary modulation is considered in the case of binary FSK (BFSK), the information is coded
this contribution. Beyond the modulation of data on the car- via two discrete frequencies. In this context, a higher fre-
rier frequency of energy supply, encoding of data is done in quency represents a logical ‘1’, and the lower frequency a
most cases to de-couple the amount of energy supply from logical ‘0’ (see Figure 6). The interpretation of data requires
the information transmitted (e.g., by the Manchester code) the accurate determination of the frequency, with a separate
and to provide error correction possibilities by means of ad- narrowband filtering of the transmission frequencies or of-
vanced encoding. Encryption is not a topic of this work but ten by means of a Fast Fourier Transform (FFT) [130].
should be considered to ensure not only safety and security Eventually, this fact results in more complex designs on ei-
but also privacy of subjects’ health data. ther the software or hardware side for modulation and de-
In cases of ASK, the data modulates the carrier by varying modulation. The Q factor of the system must be chosen such
the amplitude according to the data’s bit‑sequence. For in- that frequency shifts are still in a reasonably high transmis-
stance, the highest amplitude level may represent the bit ‘1’, sion efficiency to prevent data loss.
the lower amplitude the bit ‘0’ (see Figure 6). If only one bit DPSK, in turn, allows for energy-efficient communication
is coded per symbol and the lower amplitude level is set at moderate hardware requirements [131]. The interpreta-
to 0 V, the modulation technique will be referred to as On- tion of the message depends only on the shift of the phase
and not the absolute phase of the signal itself, e.g., a logical
‘0’ is indicated by no shift, a logical ‘1’ by 180 ° (see Fig- should be considered in relation to the benefits for each ap-
ure 6). In this concept, amplitude levels remain constant, plication.
and, the signal energy is independent of the sent message.
Advances in Modulation Techniques

ASK, FSK and DPSK enable the use of more than two dis-
crete values, i.e., several amplitude levels, frequencies, or
Fig. 7. Connection between Bit-Coding and Modulation.
phase shifts. This introduction of different values leads to
the interpretation of symbols (waveform that represents one
of more bits) rather than bits and may increase the overall In cases of implantable devices used for energy and data
data rate. Taking four discrete values such as 4-FSK, 4-PSK transfer, it is often desired to keep the energy independent
or 4-ASK, two bits are transferred per symbol. For instance, of the conveyed information itself. The transmission of in-
in case of 4-FSK with 1 MHz, 1.25 MHz, 1.5 MHz and 1.75 formation, however, also relates to a certain amount of re-
MHz as carrier frequencies, 1 MHz represents the bit-se- ceived energy on the recipient’s side. For this demand, the
quence ‘00’, 1.25 MHz the bit-sequence ‘01’, 1.5 MHz the received signal’s energy E is evaluated by
bit-sequence ‘10’ and 1.75 MHz the bit-sequence ’11’. A +∞
combination of ASK, FSK, and PSK is also applicable. Fur- 𝐸= ∫ |𝑠(𝑡)|2 d𝑡, (2.17)
ther studies suggest the combination of the transmitted data −∞
simultaneous to the harvesting of energy [132, 133].
Validation of Data where s denotes the course of the signal in the time do-
Despite the exchange of information via these communi- main.
cation techniques, the validation of the data’s correctness The desire for a constant received energy E may be ad-
remains essentially crucial for implanted devices. The sys- dressed by either bit-coding or modulation. In fact, the mod-
tem’s ability to both detect and correct false information ulation technique dictates how the energy’s decoupling
dictates the overall performance of the implant’s potential from the information is realized. This circumstance is
to serve as a guide for medical diagnoses or treatment. mainly associated with the modulation technique’s being a
The Bit-Error-Rate (BER) compares the overall number of function of the sent data.
sent bits with the number of incorrectly received or inter- Regarding ASK, the implementation of the Manchester
preted bits, yielding bit-coding satisfies the demand for a constant energy per bit.
The BER is an elementary parameter to evaluate the com-
munication channel and, yet, does not address the challenge Number of incorrect bits
of noticing errors in the information payload. Instead, the 𝐵𝐸𝑅 = . (2.16)
Total number of sent bits
communication protocol needs to account for the bit error
detection, such as by means of an even parity bit. This bit, This fact ascribes to the Manchester Code’s DC level being
added at the end of a bit-sequence, reads either ‘1’ or ‘0’. zero and its enforced flipping as rising or falling edge to
This parity bit is determined by the bit sequence’s number represent either a binary ‘1’ or ‘0’, resulting in a reduced
of ‘1’ being either odd or even. However, adding just one data rate.
parity bit is limited to one bit error per bit-sequence only. The modulation technique DPSK is based on a similar
An advanced technique referred to as Cycle Redundancy principle as the Manchester bit coding, provided its bit-de-
Check (CRC) is based on polynomials and enables the dependent changing of the phase during zero crossings. Due
tection of more than one flipping of a bit. In comparison to this concept, the amplitude levels remain constant and,
with error detection codes only, more advanced methods thus, the signal’s energy is always independent of the sent
such as Hamming or Solomon-Reed even allow for both the message. Additionally, bit-coding and de-coding may be fa-
detection and correction of errors, however, lowering the ef- cilitated since the modulation technique itself incorporates
fective BER at the cost of a reduced effective bit rate the desired energy guideline.
Energy Considerations in Terms of Bit-Coding and Modu- Communication links based on FSK may also integrate the
lation Techniques energy restriction on the modulation’s side but demand ad-
Modulation techniques such as ASK, FSK, or DPSK de- ditional aspects to be considered. These aspects deal with
termine how a message impacts the carrier. Coding, in turn, the medium’s frequency independent attenuation, along
describes how the intended message is created before mod- with the selected frequencies’ periods being a multiple of
ulating the carrier by means of ASK, FSK, and DPSK (Fig- each other. These frequencies’ periods require their adjust-
ure 7). The coding itself provides additional features such ing in such that each symbol takes the same time to be mod-
as synchronization, e.g., with barker codes or error detec- ulated. Considering BFSK as an example, based on 1 MHz
tion. These features always represent a redundancy of infor- and 2 MHz being representatives of the binaries ‘0’ and ‘1’,
mation with the inherent reduction of the data rate, which respectively, the sinusoidal signal of the binary ‘1’ needs to
take twice as many periods as the sinusoidal representative part. One occurring problem is the immediate decrease of the
of ‘0’. coupling coefficient k and therefore the transmitted energy if
Frequency Selection and Data Communication Bands in the the coils are misaligned [142]. This problem can be solved by
Medical Sector the dimensioning of a large transmitter coil and a small receiver
Different frequency bands are allocated to medical appli- coil. This guarantees that energy is still transmitted regardless
cations such as Active Implantable Medical Devices of an inaccurate positioning of the transmitter coil; however, the
(AIMDs). These bands mainly apply to RF or inductive efficiency and the quality factor also drop significantly [143–
based communication and include but are not limited to the 145]. For multi-coil systems, different resonator configurations
lower kHz (9 kHz – 315 kHz), mid-MHz (30 - 37.5 MHz) can be implemented, which also reduce losses through misa-
and higher-MHz region (401 MHz – 457 MHz, 902 - 928 lignment [146]. Another challenge to transmit as much energy
MHz) [134]. The first band to be specifically allocated to as possible is to match the load resistance on the receiving site
medical equipment was the industrial, scientific, medical and source resistance on the transmitting side [147, 148].
band (ISM), followed by the extension to more bands such
as the Medical Device Radiocommunication Service Compared to two coil systems, three- and four coil systems
(MedRadio) or the Medical Implant Communication Ser- have higher power transmit efficiencies. With multi-coil sys-
vice (MICS) [135]. For instance, MICS reserves several tems, the output power can be tuned better to the load with the
bands in the 400 MHz region (402 MHz - 405 MHz) for additional coils, which leads to higher possible energy trans-
medical purposes only. Particularly, cardiac pacemakers mission [149]. Also for increasing load resistances, three- [150,
and neuromuscular stimulators may use this band, all of 151] and four-coil systems [152, 153] have a better impedance
them being based on electromagnetic communication exclu- matching and act more robust in specific cases [154]. The prob-
sively [136]. lem with multiple coil systems is not only the lack of miniatur-
In comparison, ultrasonic-based systems are not subject to ization of the implant, but also an increased risk of inflamma-
be restricted to specific bands, but will rather occupy a fre- tion as the implant size increases [155].
quency range from the low kHz up to low MHz. This fact A way to solve both the size and efficiency problem, is to use
mostly relates to the tissue associated attenuation with an a system of four planar coils with two large extracorporeal and
increasing frequency. For instance, an ultrasonic signal with two small implanted coils developed by Stoecklin et. al [133,
a frequency of 400 MHz is already attenuated by several 148, 156]. In this setup, the two coil systems are independent of
tens of dB per cm in muscle tissue [137–141]. each other, since the energy and signal transmission are decou-
pled from each other, using one of the large and small coils
III. EXISTING TRANSDUCERS – POWER AND COMMUNICATION each. This allows energy transmission at relatively high fre-
Based on the fundamentals of the previous section, combina- quencies (40.68 MHz) and robust communication; the whole
tions of energy transmission technologies are discussed and the system is additionally resilient against mismatch. Experiments
best possible combinations are presented. Different coils and have shown that round coils transfer more energy than square
their arrangement (two-coil systems, four coil systems and 2D coils; therefore the use of round, rather than square, coils is rec-
coil systems) as well as different types of ultrasonic transducers ommended [157]. In the before mentioned configuration of
(CMUTs, PMUTs and piezoelectric crystal transducers) are in- Stoecklin, the power transmission of 30 mW and the data trans-
troduced. mission of 6.78 Mbit/s over a distance of 20 mm are not the
highest of all coils compared, but the combination of miniatur-
A. Inductive Link ization, power and data transmission is nevertheless optimal for
Two-, three- and four-coil systems are used for energy trans- the implant proposed in this article.
mission (Figure 8). Two-coil systems are long known and sim-
ple to design, consisting of an extracorporeal and an implanted B. Ultrasonic Transducers
Commercially available ultrasonic transducers, often also re-
ferred to as bulk transducers, are mostly in use for diagnostic
applications such as sonography. Their working principle is
based on the exploitation of the piezoelectric ceramic’s d33
mode, resulting in the transmission of longitudinal waves inside
the body (Figure 9). For the sake of best energy transmission,
most bulk PZT transducers come with a thickness of λ/2 and
feature an additional λ/4 layer to ensure acoustic impedance
matching [75].
Fig. 9. Schematic representation of different types of ultrasonic transducers

Fig. 8. Schematic representation of different coil systems and their magnetic (bulk transducer, CMUT and PMUT), their movement behavior and their
fields (B-fields), with each coil system consisting of an extracorporeal and an method of energy conversion..
implanted part, separated by skin.
Still, future applications based on these traditional bulk- the membrane’s materials, in combination with the PMUT’s
transducer’s design will be restricted to a substate thickness in mechanical clamping and shape, define its resonance fre-
the mm range. This fact mainly relates to the material’s reso- quency. PMUTs with their membranes and substrate thick-
nance frequency constant Nt (Nt = 2000 Hz/m for PZT), along nesses in the µm range can, therefore, feature resonance fre-
with the increasing acoustic damping of the human tissue with quencies between 100 kHz up to the lower MHz range. This is
an increasing frequency. For instance, a ceramic’s thickness of ideal for intra-body communication as the frequencies allow for
100 µm results in a resonance frequency of 20 MHz and, there- sufficient focusing capabilities and they guarantee adequate sig-
fore, to a damping of 20 dB/cm. Future designs, including nal strength at the same time. Each application itself might re-
CMUTs (capacitive micromachined ultrasonic transducers) quire specific frequencies.
[26, 34, 80, 158] and PMUTs (piezoelectric micromachined ul- For intra-body communication with implants placed closely
trasonic transducers) [75, 78, 159–161], are supposed to over- to one another, higher frequencies or bandwidth can increase
come this challenge. the data rate and avert multipath effects. Communication be-
Instead of relying on the thickness mode, both PMUTs’ and tween implants placed further away may rely on rather low fre-
CMUTs’ membranes are excited in such a way that energy is quency-based communication. PMUTs and CMUTs both have
transmitted via a flexural bending mode. It is essential to notice data transmission rates of up to 600 kBit/s and transmission dis-
that only the (0, 1) mode (first order resonance mode) is of in- tances of up to 10 cm [167, 168], while other transducers have
terest due to its most efficient transfer of energy to another me- data rates of up to 15 MBit/s and a transmission distance of
dium [162]. In addition, the flexural mode allows to adjust the 5 cm [169, 170].
acoustic impedance and, therefore, potentially the sparing of an
C. Power Densities
acoustic matching layer [78].
CMUTs comprise a top electrode, membrane, insulation, One metric to compare different energy transfer methods is
cavity and bottom electrode (Figure 9). However, their opera- the comparison of the received power density. A comparison
tion requires a DC bias voltage for both transmitting and emit- between different energy transmission methods and even within
ting. In receiving mode, CMUTs take advantage of a change in technologies is difficult, as most are usually designed for dif-
current i, relating to ferent distances and, tailored to the desired application, differ-
ent amounts of transmitted electrical energy. Nevertheless, in
d d order to find a suitable comparison for different depths, re-
𝑖(𝑡) = 𝐶(𝑡) ⋅ 𝑉AC + 𝑉DC ⋅ 𝐶(𝑡) (3.1)
d𝑡 d𝑡 ceived energy densities are used.
The comparison between power densities for ultrasonic
where VDC denotes the bias voltage, VAC the signal voltage, and transducers and inductive links shows a broad spectrum of
C(t) the time-varying capacitance, respectively [163]. This power densities transmitted over distances between 1 – 180 mm
equation implies that the higher the bias voltage is, the higher (Figure 10 and Table 2). Most inductively powered systems
the detected current and the better the sensitivity of receiving have been optimized for short distances up to 50 mm, while ul-
ultrasound. Yet, it does not address an additional issue of trasonic transducers show a broad range of energy densities and
CMUTs’ initial capacitance being in the lower pF range. This energy transmitting distances with more than 50 mm.
low capacitance value matches parasitic capacitances of electri-
cal layouts, complicating the reading out of the change in ca-
pacitance and its resulting current. It is for this reason that bias
voltages between 30 V and 200 V are necessary to operate
CMUTs efficiently [164]. However, these voltages are not only
complex to provide on a miniaturized PCB but also pose chal-
lenges of electrical insolation to prevent potential health risks
to the patient. Despite this, CMUTs have the big advantage to
be operated in snap-in mode, which can increase their output
pressure by up to three times [165, 166]. Therefore, future de-
sign of CMUTs might require lower bias voltages and remain a
promising alternative for implantable devices with high power
transfer.
PMUTs, in comparison, do not demand a bias voltage to op-
erate effectively but are rather easily driven with voltages be-
tween VPP = 2 V and VPP = 30 V. This also allows the layer ac-
tuation by a highly integrated circuitry without the need for fur-
ther hardware. Their design is similar to those of CMUTs, with
the main difference of not constituting a capacitance but rather
having both electrodes directly attached to the bending mem-
brane (Figure 9). The membrane itself comprises not only the Fig. 10. Comparison of planar, helical and cubic coils (blue markers) and
piezoelectric material and electrodes but also often an SiO 2 piezocrystal ultrasonic transducers, PMUTs and CMUTs (red markers) with
layer [78]. In addition, using AIN (Aluminum Nitride) as a pi- regard to their transmitted power density over a distance inside the body or
fluids [31-35, 133, 150, 160, 171-193]. On the bottom, different transducer
ezoelectric material, PMUTs feature good biocompatibility. technologies are displayed with a) an helical coil [178], b) a planar coil [133],
The properties such as the Young’s modulus and thickness of c) a piezoelectric crystal [173] and d) a PMUT [160].
TABLE 2 represent a Faraday cage through which electromagnetic

OVERVIEW OF THE COMPARED INDUCTIVE LINKS AND ULTRASONIC TRANSDUCERS
fields cannot or only hardly penetrate, and since thick metal
Transmis- Energy den- Active Range Frequency
sion type sity in mW in mm in MHz
Reference encapsulations have high acoustic attenuations and reflection
coefficients, we concentrate on non-hermetic encapsulation
Inductive 0.008 10 13.56 [175]
link 0.032 6 10 [184] methods, such as the ones provided by polymers.
0.066 10 50 [177] Non-hermetic encapsulation is an essential packaging con-
0.095 50 13.56 [193] cept for both inductive links and ultrasonic transducers. In-
0.107 30 13.56 [183] ductive links require encapsulations, which have low dielec-
0.179 10 1 [32]
0.362 1 5800 [31] tric losses; materials such as ceramics and polymers fulfill
0.480 10 950 [187] this demand [195, 196]. The permeability of water through
0.745 20 13.56 [193] polymers does not pose a problem for silicones (PDMS),
1.150 16 60 [150] since it acts as an ion barrier. The presence of pure water va-
1.154 5 13.56 [179]
1.154 5 60 [179] por should not harm the electrical components, and in this
1.260 12 39.86 [188] case, particularly the coils [197, 198]. To protect electrical
1.528 20 40.68 [133] circuits from any humidity, hermetic chip size packaging can
2.215 5 403 [185] be attached around the electronic circuits [199, 200] with
4.400 10 13.56 [190]
4.587 10 160 [191] feedthroughs [201] to the rest of the non-hermetic encapsu-
Ultrasonic 0.0003 2 3.3 [35] lated implant.
transducer 0.0004 150 0.250 – [182] Encapsulation concepts for ultrasonic transducers have to
0.268 endure cyclic stresses while vibrating, but still maintain good
0.007 25 3 [160]
0.082 40 0.7 [176] adhesion to the surface of the transducers. Thin metal layers
0.124 176 5.85 [34] would pose as such an encapsulation, although with high
0.175 20 0.088 [33] acoustic attenuation and high acoustic reflections. In general,
0.216 22 0.0669 [186] acoustic attenuation of polymers makes them bad encapsul-
0.280 30 0.94 [181]
0.420 105 0.84 [171] ants of transducers. Applied thinly enough, the sound waves
0.500 70 0.97 [189] would be transmitted well, while the thin membranes of
0.616 19 3 [192] PMUTs and CMUTs would not be affected in their stiffness.
0.622 21.5 1.85 [180] As possible polymers, Polyimide and Parlylene-C can both
0.710 40 2 [172]
0.826 60 1.19 [173] be deposited in the lower µm range [202, 203]. Both also
0.826 60 1.27 [173] show good adhesion properties to silicon compounds, of
0.826 60 1.58 [173] which the passivation layer of CMUTs and PMUTs mem-
0.909 50 1.6 [178] branes are mostly made of (Parylene C after adding a chemi-
1.103 105 1.314 [174]
cal adhesion promoter, such as Silane A-174) [203]. How-
ever, it is not possible to encapsulate whole implants with the
For most biomedical devices presented here, it should be
respective materials and the adhesion is low to other non-her-
noted, that despite relatively high transmitted energy densities
metic encapsulants and components of the implant. Addition-
of ultrasonic transducers, inductive coupling outperforms ultra-
ally, polyimide is a relatively stiff polymer, which greatly af-
sonic energy transmission in terms of the absolute received en-
fects the vibration of thin membranes, such as for CMUTs and
ergy. However, different designs of the inductive links and the
PMUTs. It also needs to be cured at high temperatures (350 -
ultrasonic transducers define their applications: helical coils
450 °C) [202], which is not compatible with the fabrication pro-
tend to have a higher energy density, but are only feasible for
cesses of currently manufactured PMUTs.
energy transmission over short distances. Planar coils on the
Therefore, we propose medical grade PDMS as an encapsul-
other hand, are suitable for energy transmissions until 50 mm
ant for both the coil and the ultrasonic transducers. However,
with lower energy densities in all evaluated implementations.
the manufacturing process and cross-linking mechanisms re-
This difference is even more pronounced with ultrasonic trans-
quire their respective consideration in the encapsulation pro-
ducers: bulk piezo crystal transducers are the only types, which
cess. One-component silicone, as example, is self-crosslinking
can provide both sufficient energy densities and transmission
with evaporating by-products. Shrinkage and as a consequence
distances. Current CMUTs and PMUTs feature either a high
inner stresses are the result. These inner stresses could affect
transmission distance or an acceptable power density [31–35,
the movement of the transducer, especially when the transduc-
133, 150, 160, 171–193].
ers consist of membranes as it is the case for PMUTs and
D. Encapsulation CMUTs. Two-component silicones show no shrinking, but are
Active medical implants consist of various components, most mostly sensitive to nitrile as crosslinking poison. This results in
of which require encapsulation. An implant is obsolete without a special workplace hygiene, which has to be nitrile free.
the correctly selected encapsulation to protect both the body and CMUTs and PMUTs have already been successfully coated
the implant from each other. Here, we focus on the encapsula- with silicones, but it is not specified which type of silicone was
tion of the energy converters and the challenges that need to be used [204–206]. For both types of silicone coatings, special
taken into account here. To achieve hermeticity, implants are workplace hygiene is essential: not only is a particle free clean-
often encapsulated in metal cases; thus neither gases nor liquids room environment necessary to prevent failures of the silicone
can penetrate or escape [194]. Since a metallic enclosure would adhesion (Figure 11), but for the two-component silicones also
free of nitrile and other crosslinking poisons [207–210].
According to the previously shown requirements and ad-

vantages, we propose a combination of planar coils and
PMUTs. As planar coils, we propose a combination of two pla-
nar coils for energy transmission and two planar coils for data
transmission. Here, one pair of coils is placed outside the body
for transmission, while the second pair of coils receives energy
and data inside the body. Such a combination of planar coils
was developed by Stöcklin [133, 148, 156]: two sets of butterfly
shaped coils for optimal energy and data transmission. The ad-
vantage of this coil shape is that the induced voltages are can-
celled out at the ‘wings’ of the butterfly shape. This enables a
relatively high energy and data transmission at different carrier
frequencies, while they are placed close together and, therefore,
do not take up much space.
The limit on data transmission would come from the plat-
form, as it receives and forwards the data to and from the ultra-
sonic based implants. Implants at nerve interfaces can be de-
signed in such way that the recorded signals are processed im-
mediately, allowing high data rates at proportionally low fre-
quencies [217]. With this method, 8 distributed implants each
with 12 channels [8, 218], a resolution of 11 bit per channel and
a sampling rate of 20 kHz could be implanted in the peripheral
nervous system and be transmitted to and from the platform,
Fig. 11. Schematic of an US-transducer with PDMS coating and the failure which is capable of 6.78 Mbit/s (2 PSK modulation).
mechanisms. Water condenses inside air bubbles or through ionic contamina- Both the inductive link and the ultrasonic transducers should
tion. When the membrane vibrates with distance d, the incompressible water
be coated and packaged with medical grade silicone adhesive.
leads to 1a) further delamination, 1b) rupture in the PDMS or 2a) additional
pressure P on the SiN and small cracks. Silicone is a non-hermetic encapsulation and permeable to elec-
tromagnetic fields, it is already used as a packing material for
cochlear implants and is therefore well researched [129]. It is
IV. TRANSDUCER COMBINATION FOR RELAY NETWORKS also a practical option for encapsulating implants that are dis-
Based on the power consumption of existing implantable sys- tributed in the body and supplied with energy via ultrasound.
tems, we propose a transducer combination consisting of a Ultrasonic waves are transmitted through silicone coatings,
short-range inductive link for the transmission through the skin while silicone adhesives show promising results to adhere for
and a subsequent acoustic power transmission to smaller im- the lifetime of such an implant.
plants distributed in the body. In this system, a platform inserted We propose PMUTs as ultrasonic transducers, since they can
below the skin is supplied with energy and data by inductive deliver sufficient amounts of energy and be scaled down to de-
coupling efficiently. This platform serves as a hub, energy and sired sizes relatively easily. PMUT arrays consist of membranes
data are allocated to the distributed implants and transmitted via connected in series or parallel, which makes them easy to scale
ultrasound to the respective implants in the body. In the distrib- them up or down. Through their individually addressable mem-
uted implants, the ultrasonic waves are converted back into branes, PMUTs are in general capable of beam steering as a
electrical energy by the ultrasonic transducers and can now sup- phase shift array; their ultrasonic waves can be oriented. Using
ply the miniaturized implants with energy. When the implants this ability, one transducer array could power distributed im-
should record and return data, the same ultrasound transducers plants with energy. In this specific case, we propose an AlN-
and coils can be utilized for bidirectional communication. based PMUT array, which may deliver up to 0.71 mW per mm2
Implantable systems have mostly power consumptions be- [172]. If the PMUT is provided with the right charging elec-
tween 5 µW to 40 mW [211]. Assuming that the relay network tronics and an appropriate size is chosen, low-power implants
inside the body will consist of small, distributed implants, the can be supplied continously with a sufficient amount of energy.
power consumption for these miniaturized implants is usually Even if the implant is not continuously supplied with ultrasound
in the µW region [212, 213]. and, thus, energy, a small rechargable battery could be imple-
Since the small implants are not stationary due to the move- mented and charged in cycles. These arrays would include com-
ments of the body, beam steering allows to compensate such plex control electronics in the form of application specific inte-
movements. Acoustic beam steering is well-known with linear grated circuits (ASICs). Hermetic chip-size packaging with
ultrasonic transducer arrays for medical sonography. Two di- atomic layer deposition (ALD) could protect these CMOS
mensional planar transducer arrays may even increase the steer- based ASICs well [219] and might be part of a multimaterial
ing capabilities, often based on a CMUT and PMUT design matching layer (ALD and PDMS) in composition with the non-
[214–216]. This ultrasonic focusing capability allows for high hermetic packaging material.
energy densities at the respective receiver, thereby reducing the
total energy input and the overall power to be transmitted from
one implant to another and minimizing energy dissipation in
tissue areas in which no transducers reside.
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Challenges and Opportunities in Combining

 using implants (“electroceuticals”) instead of pharmaceutical

Thus, there are non-focused transducers and focused transduc-

acoustic attenuation; ultrasound is viable to transmit ener-

Advances in Modulation Techniques

Fig. 9. Schematic representation of different types of ultrasonic transducers

TABLE 2 represent a Faraday cage through which electromagnetic

According to the previously shown requirements and ad-

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