Fluidic soft robot for needle guidance and motion compensation for intratympanic steroid injections

1. The World Health organization estimates that hearing loss affects 500 million people worldwide. Delivery of drugs to the inner ear via the surgical approach offers the optimum delivery of drugs to the cochlea. However, it poses risks, such as further reduction in hearing due to the highly invasiveness. Therefore, in most cases administration of drugs through diffusion to the inner ear from the middle ear is the preferred option, which is done in the intratympanic injection of steroids, where flushing of steroids to the middle ear through the ear drum is done, with uncertainty of the treatment's efficiency. This is currently performed by trained ear, nose, and throat (ENT) surgeons as the procedure could induce pain to the patient and pose the risk of inducing permanent hearing loss, vertigo, or tinnitus, if the inner or middle ear is damaged. In recent years, the emergence of technologies for diagnosis and treatment through natural orifices has been exponentially growing. However, the morphology of the ear orifice presents a major challenge for its adoption in this field due to its small dimension, fragility, and highly non-uniform shape. To provide a first steppingstone towards inner ear drug delivery, a fluidic soft robot for needle guidance and motion compensation has been introduced for intratympanic steroid injections. The design constitutes of a camera and six integrated fluidic actuators that is capable in stabilising, translating and rotating of a given needle within a lumen. This system indeed could provide needle guidance towards desired target while reducing needle motion. However, whilst it shows the capability to aid in drug delivery into the middle ear cavity, the current design inherits several limitations which prevent it from targeted delivery directly to the cochlea.

2. Further research needs to be undertaken to better understand state-of-the-art drug delivery mechanisms, develop means for efficient monitoring of the delivery and integrate this with bespoke soft robotic system.

3. As part of this project, I will develop new, realistic and sensorized phantoms which can provide quantitative assessment of today's manual delivery and determine the efficacy of local drug delivery to the inner ear. As current state-of-the-art endoscope systems are incapable of visualizing the middle ear cavity through the ear drum, which is crucial in determining the efficacy of drug delivery to the inner ear, I will research new means of imaging the ear anatomy, for example by using endoscopic vision paired with near-infrared or narrow-band imaging. The gained understanding of the procedure and the derived imaging methodologies will be incorporated in a soft robotic platform inspired by to aid in delivery and monitoring the efficacy of the delivery whilst ensuring patient safety and comfort and greatly de-risking the procedure.

4. This interdisciplinary research track combines aspects from biomedical engineering, medical imaging and image computing and soft robotics, which could pave the way for democratizing drug delivery to the inner ear. Furthering the understanding of current clinical practices could aid in developing new delivery protocols and provide training for ENT surgeons or other clinical staff which could lead to the more widespread adoption of treatment for inner ear pathologies. Novel imaging capabilities for visualizing the middle ear cavity to assess drug delivery to the inner ear are of paramount importance in drug discovery and assessment for treating inner ear pathologies. Finally, the integration with a soft robotic system could greatly de-risk and de-skill such drug delivery protocols with the potential to enable other ENT procedures. These are all alligned with EPSRC' strategy and research area on transforming health and healthcare, improving quality of life through innovative technological solutions.

5. WEISS and UCL EAR institute.

The critical mass of scientists and engineers that i4health will produce will ensure the UK's continued standing as a world-leader in medical imaging and healthcare technology research. In addition to continued academic excellence, they will further support a future culture of industry and entrepreneurship in healthcare technologies driven by highly trained engineers with deep understanding of the key factors involved in delivering effective translatable and marketable technology. They will achieve this through high quality engineering and imaging science, a broad view of other relevant technological areas, the ability to pinpoint clinical gaps and needs, consideration of clinical user requirements, and patient considerations. Our graduates will provide the drive, determination and enthusiasm to build future UK industry in this vital area via start-ups and spin-outs adding to the burgeoning community of healthcare-related SMEs in London and the rest of the UK. The training in entrepreneurship, coupled with the vibrant environment we are developing for this topic via unique linkage of Engineering and Medicine at UCL, is specifically designed to foster such outcomes. These same innovative leaders will bolster the UK's presence in medical multinationals - pharmaceutical companies, scanner manufacturers, etc. - and ensure the UK's competitiveness as a location for future R&D and medical engineering. They will also provide an invaluable source of expertise for the future NHS and other healthcare-delivery services enabling rapid translation and uptake of the latest imaging and healthcare technologies at the clinical front line. The ultimate impact will be on people and patients, both in the UK and internationally, who will benefit from the increased knowledge of health and disease, as well as better treatment and healthcare management provided by the future technologies our trainees will produce.

In addition to impact in healthcare research, development, and capability, the CDT will have major impact on the students we will attract and train. We will provide our talented cohorts of students with the skills required to lead academic research in this area, to lead industrial development and to make a significant impact as advocates of the science and engineering of their discipline. The i4health CDT's combination of the highest academic standards of research with excellent in-depth training in core skills will mean that our cohorts of students will be in great demand placing them in a powerful position to sculpt their own careers, have major impact within our discipline, while influencing the international mindset and direction. Strong evidence demonstrates this in our existing cohorts of students through high levels of conference podium talks in the most prestigious venues in our field, conference prizes, high impact publications in both engineering, clinical, and general science journals, as well as post-PhD fellowships and career progression. The content and training innovations we propose in i4health will ensure this continues and expands over the next decade.