Shape-shifting Capsule Robot for Endoscopy based on Eversion Navigation

Comprehensive screening of the lower gastrointestinal (GI) tract is essential to detect and treat the early stages of deadly diseases, such as cancer. Ingestible endoscopic capsules have shown promising results in the past two decades, offering a less invasive and painful alternative to colonoscopic screening. To date capsule endoscopy is the only available option for the screening of the small bowel. Nonetheless, limited control over capsules' motion, which relies solely on peristalsis, prevents this technology from achieving equivalent performance to conventional endoscopes, which are still regarded as the golden standard for screening of the lower GI tract.

This project proposes a novel design for a Shape-shifting Capsule Robot for Endoscopy based on Eversion Navigation: a capsule-sized system that propels itself through the GI tract by means of a series of continuously everting elastic tracks distributed all around its body. Constant contact between the tracks and the GI tract is enabled by a series of inflatable toroidal chambers used to deform their elastic structure to match the lumen of the navigated section. This controlled deformation causes them to adhere to the walls of the GI tract, thus ensuring the needed traction to navigate it, regardless of the local lumen size. The proposed project will investigate both (soft) tethered and untethered designs of the proposed capsule system for the screening of the lower-/upper- GI tract.

According to the International Agency for Research on Cancer (IARC), colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second most common cause of cancer-related deaths worldwide (2018, estimated) [1]. Despite being one of the deadliest pathologies with more than 880,000 deaths worldwide (2018, estimated), the survival rate of CRC patients can be as high as 90% when diagnosed at an early stage [2]. However, discomfort as well as fear of pain caused by colonoscopy discourages patients from undertaking regular screening. Endoscopic capsules, if made as clinically reliable as endoscopes (or even more), will remove both these obstacles on the pathway to an effective screening programme.

The long-term goal of this research is to develop the system in a completely untethered version for the navigation of the GI tract from the mouth to the anus with a capsule-size system capable of autonomous navigation, thus enabling reliable screening of hard-to-reach portions of the GI tract e.g. the small intestine, which is not accessible with traditional endoscopes. The potential impact of such system on healthcare worldwide can be significant and it can pave the way for a comprehensive screening program transversally affecting the lives of all the world population.

The aim of the project is to develop the proposed system, a shape-shifting endoscopic capsule up to TRL 6. The specific scientific objectives for research and engineering of the full system are:

1) Design and fabricate the proposed system in a soft tethered 2:1 scale, embedding all final system components, to undergo navigation tests in lower-GI tract phantoms.

2) Develop a tethered 1:1 scale capsule for GI phantom and in vivo animal testing.

3) Design and implement a control interface for the clinician and to understand how to optimize the UX by directly involving end-users in the development process.

The main novelty of the proposed system is the use of a set of inflatable toroidal chambers to enable the adjustment of the outer diameter of the system together with the use of elastic tracks, to ensure their constant contact with the walls of the GI tract.

The proposed project well aligns with the EPSRC grand challenge of the Frontiers of Physical Intervention by proposing a novel approach to GI tract navigation for screening and surgical interventions.

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.