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Energy sources and their


development for application
in medical devices
Expert Rev. Med. Devices 7(5), 693–709 (2010)

Mahdi Rasouli1 and Electronic medical devices have become an indispensable part of modern healthcare. Currently,
Louis Soo Jay Phee†1 a wide variety of electronic medical devices are being used to monitor physiological parameters
of the body, perform therapy and supplement or even entirely replace complex biological
1
Robotics Research Centre, School of
Mechanical and Aerospace functions. Cardiac pacemakers, cardioverter-defibrillators and cochlear implants are a few
Engineering, Nanyang Technological examples of such medical devices. Proper functionality of these devices relies heavily on the
University, Singapore 639798 continuous supply of a sufficient amount of electricity to them. In this sense, a reliable, safe and

Author for correspondence:
Tel.: +65 679 049 59
convenient method for the provision of energy is very crucial. Various approaches have been
Fax: +65 679 118 59 developed to fulfil the divergent and challenging energy requirements of medical devices. In
msjphee@ntu.edu.sg this article, we present a brief overview of the energy requirements of medical devices and
review the existing and emerging energy sources for application in these devices, particularly
wearable and implantable devices.

Keywords : biofuel cell • electrochemical battery • electrochemical capacitor • energy harvesting • energy source
• fuel cell • medical device • nuclear battery • transcutaneous energy transmission • wireless power transmission

The recent advances in integrated circuit tech- continuously and robustly delivering a suf-
nology and wireless communication systems ficient amount of energy to the device. Any
have paved the way for the development of failure or malfunction in the operation of the
medical devices that can continuously and less device may lead to undesired effects, such as
(or non-) invasively monitor and treat various permanent damage to the body or even death
physiological conditions. This has resulted of the patient.
in more effective medical treatments and Safety is another major concern for medical
enhanced quality of life for the patient and the applications. The energy source should not have
disabled. Such medical systems have been inves- any unwanted effect on the body, it should not
tigated intensively over the past two decades poison or damage body tissues and should not
and become the accepted treatment for a broad interfere with vital signals of the body, such as
range of ailments, such as cardiac arrhythmia, heart beat. Dissipated heat due to operation of
hearing loss and diabetes. In recent years, the the device or transmission of energy should not
number of people seeking such treatments has exceed regulatory standards [2] . The increase
increased significantly as a result of longer life in temperature of the surrounding body tissues
expectancy, higher quality-of-life expecta- due to the dissipated heat may result in criti-
tions and greater awareness of new treatment cal damage to body organs. Special consider-
alternatives [1] . ations must be taken into account to optimize
Proper functionality of electronic medical the efficiency of energy delivery and minimize
devices relies heavily on the continuous supply energy dissipations.
of a sufficient amount of energy to them. In this High energy-density and power capacity
sense, an unobtrusive energy source that enables are among other favorable characteristics that
desired portability and energy autonomy for a an energy source must have. Higher energy-
prolonged lifetime is highly desired. density prolongs the lifetime of the device
The energy source of a medical device must and eliminates the burden of replacement or
have several major specifications, most impor- recharging. In addition to the aforementioned
tantly reliability and predictability of opera- specifications, implantable energy sources must
tion. The energy source should be capable of be hermetically sealable.

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Review Rasouli & Phee

The choice of the energy source for medical devices depends Electrochemical batteries
on several factors, such as size, power consumption, lifetime and Electrochemical batteries are energy storage devices that con-
temporal mode of operation (continuous or intermittent) of the vert the chemically stored energy of a material into electricity
device. Table 1 lists some of the existing and emerging medical using oxidation/reduction reactions. Electrochemical batteries
devices and their energy requirements. External medical devices are commonly categorized as primary (single use) or second-
benefit from larger available space, and thus higher energy budget ary (rechargeable). Primary batteries are suitable for low-power
and design flexibility. By contrast, provision of energy to in vivo applications requiring low current drain, intermittent operation
medical devices is very challenging owing to several restrictive or short lifespan; secondary batteries are used in devices with
factors, most importantly limited available space and their inac- high energy consumptions where limited energy of a battery is
cessible location, which renders the replacement or adjustment not sufficient for operation of the device. In these devices, the
of the device impractical. energy is delivered to the system through an external power
Currently, electrochemical batteries (most notably lithium source or harvested from the ambient environment to recharge
batteries) are the dominant source of energy for wearable and the battery.
implantable medical devices. However, the limited energy An electrochemical battery is composed of several electro-
capacity of batteries limits their application in miniature chemical cells that are connected in series and/or in parallel
devices, where it shortens the lifetime and necessitates the to provide the required voltage and capacity, respectively. Each
replacement or recharging of the battery. To overcome this limi- electrochemical cell consists of three main sections: anode, cath-
tation, several alternative energy sources have been investigated, ode and electrolyte (Figure 2) . The electrolyte separates the two
including energy storage supplies with higher energy densities, electrodes and provides the mechanism for the transfer of ions
such as fuel cells, wireless transmission of energy from an active between them. During battery discharge, oxidation at the anode
source and harvesting energy from the ambient environment. results in the generation of electrons and positively charged ions.
In this article, we present a brief overview of the existing and Generated electrons flow through the external circuit toward
emerging energy sources and their development for applica- the cathode, resulting in an electrical current in the external
tion in medical devices, with a special focus on wearable and electric circuit. Positively charged ions move through the electro­
implantable devices. lyte toward the cathode and participate in reduction reactions
occurring at available reaction sites of the cathode. In primary
Energy storage & conversion batteries, these reactions result in inactive reaction sites at the
Local energy storage devices, most notably electrochemical bat- cathode. As discharge proceeds, more and more reaction sites
teries and capacitors, are the most common source of energy for become unavailable until the battery becomes completely dis-
medical devices. This is mainly because of their reliable, safe charged. In secondary batteries, this reaction is reversible and
and robust operation, which is essential for biomedical applica- the battery can be recharged by replacing the electrical load with
tions. Furthermore, the modularity and proper encapsulation and an electrical source.
packaging of these devices make the design of biomedical devices The electrical specifications of a battery mainly depend on its
simpler and more robust. The energy and power densities of some chemistry. Some of common battery chemistries and their speci-
of the existing energy storage devices are plotted in Figure 1. fications are listed in Table 2 . It should be pointed out that each
of these battery technologies has its own
Table 1. Examples of existing and emerging biomedical devices. advantages and disadvantages and may suit
specific applications. For example, zinc–air
Device Power Life-time Energy source Ref. batteries are not hermetically sealable and,
Biomonitoring systems Less than 100 µW NA Primary battery [102] therefore, are not suitable for in vivo medi-
cal applications. These batteries are used
Pacemaker Less than 100 µW 10 years Primary battery [9]
in behind-the-ear hearing aid devices [3] .
Cardioverter-defibrillator Steady state less 10 years Primary battery [9] Currently, lithium batteries are the dom-
than 100 µW inant source of energy for medical devices
Peak: 5–10 W owing to their superior characteristics,
Cochlear processor 200 µW 1 week Rechargeable battery [103] including high energy-density, high open
circuit voltage, reliability, predictability of
Hearing aid 100–2000 µW 1 week Rechargeable battery [104]
operation and hermetic sealing [4] . Several
[105]
battery chemistries based on lithium have
Retinal implant 40–250 mW NA Inductive power
been developed to fulfil the divergent
Neural recorder/ 1–100 mW NA Inductive power [106,107] energy and power requirements of dif-
stimulator ferent applications [4,5] . Lithium–iodine
primary batteries have been widely used
LVAD and TAH 10–100 W NA Inductive power [108]
in cardiac pacemakers since 1972 and
LVAD: Left ventricular assist device; NA: Not available; TAH: Total artificial heart. are still the favorite choice for low-power

694 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

applications where currents in the range 1.0E+07


of a few microamperes are needed  [6] .
Lithium–thionyl chloride (SoCl 2 ) and 1.0E+06
lithium/carbon fluoride (CFx) batteries

Specific power (W/kg)


target medium-rate applications, such as 1.0E+05 Capacitors
neurostimulators and drug delivery sys-
tems that demand for currents in the range 1.0E+04
of a few milliamperes  [7] . Lithium–silver
1.0E+03
vanadium oxide (SVO), lithium–manga- Electrochemical
nese dioxide (MnO2) and lithium–SVO- capacitors
1.0E+02
CFx batteries are suitable for high-rate Batteries
Fuel cells
applications, such as cardioverter-defi-
1.0E+01
brillators [8,9] . Rechargeable lithium-ion
batteries have been utilized in applica- 1.0E+00
tions with high energy demands where the 0.01 0.1 1 10 100 1000
limited energy of primary batteries is not Specific energy (Wh/kg)
sufficient for operation of the device. Left
ventricular assist devices (LVADs) and Figure 1. Ragone plot of various energy storage devices.
total artificial hearts are two examples of Adapted from [98] .
such implantable medical devices [4] .
Thin-film solid-state batteries [10] and flexible batteries [11] are Application of nanomaterials to improve the energy density, rate
two promising emerging technologies for application in medical capacity and cycling performance of electrochemical batteries has
devices. Thin-film solid-state batteries offer excellent cycling per- received considerable attention over the past few years [16] . High
formance, safety, reliability, low self-discharge and compatibility capacity electrodes, such as the Si anode [17,18] and the LiFePO4
with integrated circuit technology [12] . The latter provides the cathode [19], are being developed for high-energy and high-rate appli-
opportunity for integration of batteries with other circuit elements, cations. An exhaustive review of recent developments in battery
resulting in more compact and customized devices. Furthermore, technologies are presented in [20,21] .
this technology opens up the door for fabrication of ultraminia- In addition to developments in general-purpose batteries, appli-
turized microbatteries (with footprints of less than 1 mm2) for cation-specific batteries targeting medical devices have also been
implantable medical devices [13] . To fully benefit from the advan- reported [22,23] . Heller et al. proposed two potentially implantable
tages of thin-film batteries, it is necessary to improve their low-rate miniature batteries that comprise subcutaneously implantable
capacity. 3D battery structures have proved promising to overcome electrodes and utilize the subcutaneous interstitial fluid as their
this limitation [14,15] . electrolyte [23] . The proposed battery structures obviate the need
for a protecting case, and thus provide the
opportunity for significant miniaturization.
The first battery comprised of a Zn anode
and a biocompatible hydrogel-shielded
Ag/AgCl cathode, and could achieve a
projected energy density of 500 Wh/l, a
power density of 50 W/l and a lifetime of
1 month in subcutaneous fluid. The sec-
ond battery, utilizing the same anode and a
bilirubin oxidase O2 cathode, could achieve
projected energy density of 5000 Wh/l, a
power density of 10 W/l and a lifetime of
2 weeks in pH 7.4 saline buffer.

Micro fuel cells/biofuel cells


Fuel cells convert the electrochemical
energy of a fuel into electricity using cata-
lytic oxidation/reduction reactions [24,25] .
As is illustrated in Figure 3, an electrical cur-
rent is generated through oxidation of a fuel
in the anode and reduction of an oxidizing
Figure 2. Operational principle of a typical lithium-ion battery.
material, most commonly oxygen, in the

www.expert-reviews.com 695
Review Rasouli & Phee

Table 2. Common battery chemistries.


Battery technology Anode Cathode Voltage Energy density Specific energy
(V) (Wh/l) (Wh/Kg)
Primary Zn/air Zn O2 1.5 1270–1560 370–490
Zn/Ag2O Zn Ag2O 1.5 207–543 56–137
Li/SO2 Li SO2 3.0 313–498 160–307
Li/SOCl2 Li SOCl2 3.6 715–1100 380–537
Li/MnO2 Li MnO2 3.0 371–789 129–343
Li/I2 Li I2 (P2VP) 2.8 820–1030 220–280
Secondary Zn/Ag2O Zn AgO 1.5 180 105
Zn/MnO2 Zn MnO2 1.5 210–458 50–150
Nickel metal hydride MH NiOOH 1.2 53–360 40–100
Lithium ion C LiCoO2 4.0 200–450 60–200
Lithium polymer C LiFePO4 3.6 160–217 74–180
Adapted from [109].

cathode. A membrane separates the electrodes and facilitates the cells are generally classified as microbial [28] or enzymatic fuel
transfer of ions to complete the electrical circuit. Fuel cells differ cells  [29] . Microbial fuel cells utilize living microorganisms to
from batteries in that the fuel is not an integrated part of the trans- oxidize the fuel substrates, whereas enzymatic fuel cells employ
duction mechanism and is supplied externally. Liquid fuels have isolated enzymes. Microbial fuel cells offer the advantages of long-
higher energy densities compared with battery materials (Figure 4) . term stability and fuel efficiency, but they suffer from low power
Considering the size of the conversion cell, a practical energy density. This is mainly because of the slow process of electron
density four- to five-times higher than that of batteries seems transfer across the cell membrane. The application of isolated
feasible for portable applications. The higher energy density of enzymes eliminates this problem and increases the selectivity and
fuel cells, as well as the possibility of instantaneous replacement specificity of the electrode for biofuels. However, it results in
of the fuel, makes fuel cells an appealing alternative for portable short lifetime and low conversion efficiency due to incomplete
and wearable medical devices. oxidation of the biofuel.
Biofuel cells follow the same mechanism and structure as Although portable medical devices may also benefit from higher
fuel cells, except they replace the precious metal catalysts with energy density and instantaneous recharging capability of tradi-
biocatalysts, such as microorganisms or enzymes [26,27] . Biofuel tional fuel cells, the most appealing medical application of fuel
cells lies in utilization of endogenous substrates and oxygen from
a patient’s body for powering implantable medical devices. The
ubiquitous availability of glucose and oxygen in body fluids (e.g.,
blood and interstitial fluid) allows the continuous production of
e- e- electricity [30] .
The research on implantable glucose fuel cells dates back to the
late 1960s and has focused mostly on enzymatic biofuel cells and
Fuel Oxidant
abiotically catalyzed fuel cells, which are based on nonbiological
(H2) (O2) catalysts, such as noble metals or activated carbon [30] . Microbial
fuel cells did not receive considerable attention for implantable
applications owing to their low power and energy densities and
Cathode

safety concerns [30] .


H+
Anode

In general, enzymatic glucose fuel cells offer the highest output


current and power density compared with other types. Moreover,
they provide the opportunity for extreme miniaturization by
Electrolyte obviating the need for a separating membrane [31] . Heller et al.
(for exchange of ions) reported the development of a miniature membraneless enzy-
Excess Water
fuel/reaction (H2O) matic glucose-O2 biofuel cell [31] . The cell comprised a wired
byproducts glucose oxidase-coated anode and a wired bilirubun oxidase-
coated cathode (each 7 µm in diameter and 2 cm in length),
Figure 3. Operational principle of a solid-oxide fuel cell.
and produced 430 µW/cm 2 at 0.52 V and 37°C. Considering

696 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

the 1-week lifetime of the cell, the power


capacity of the developed biofuel cell is
9000
1000-fold higher than Zn–air batteries,
with similar dimensions and lifetime. 8000
The proposed biofuel cell is an appealing
alternative for disposable applications, 7000

Energy density (Wh/l)


especially for glucose monitoring systems. 6000
Despite their favorable characteristics of
high energy-density and fuel selectivity, 5000
enzymatic biofuel cells suffer from several
4000
major drawbacks that limit their application.
Instability and denaturization of enzymes is 3000
the most important problem of enzymatic
2000
biofuel cells, and impedes their application
in long-life implantable devices [30] . 1000
Abiotically catalyzed fuel cells suggest
a good alternative for long-life implant- 0

NiMH

Li ion

Li ion polymer

NaBH4/H2O (40%)

Methanol

Butane

Iso-octane
able devices. They have the advantages
of long-term stability, sterilizability and
bio­compatibility [30] . Kerzenmacher et al.
reported the development and long-term
characterization of an abiotically catalyzed
glucose fuel cell in physiological glucose
solution. They observed a decrease in Figure 4. Comparison of energy density of fuel cells and batteries.
the maximum power density from 3.3 to Reprinted with permission from [25] .
1.0 µW/cm over a period of 224 days [32] .
2

Recent advancements in micro fuel cells and implantable carbon) [36] . Pseudocapacitors use fast and reversible surface or
fuel cells are reviewed in [24] and [30,33] , respectively. Although near-surface reactions for charge storage, and can achieve higher
implantable fuel cells have proven feasible, several issues remain to charge/discharge rates compared with EDLCs [37] . Hybrid capaci-
be addressed for consideration of applications in medical devices, tors, combining a capacitive or pseudocapacitive electrode with a
most importantly, the long-term in vivo performance of these battery electrode, have also been developed [37] . These capacitors
devices and their safety. benefit from both capacitor and battery properties. These develop-
ments, combined with superior characteristics of nanostructured
Capacitors/supercapacitors electrodes, have brought the energy density of electrochemical
Capacitors are high-power energy storage devices, in which the capacitors closer to that of batteries [38] . A good review of these
energy is stored in the electric field between a pair of oppositely technologies is provided in [39] .
charged electrodes. Compared with batteries and fuel cells,
capacitors offer higher power capacity, higher charge/discharge Nuclear batteries
rates and excellent cycling performance of over 100,000-times. Nuclear batteries are fuel-based energy-storage devices that con-
However, they suffer from low energy-densities as the energy vert the radiative energy of a radioisotope material into electric-
is not stored in the bulk of the material. Capacitors usually ity. Radioisotope materials lose energy through the emission
compliment batteries or fuel cells for high-power applications. of energetic particles, such as a and b particles. The energy
An implantable cardioverter-defibrillator is an example of such carried by these particles can be converted into electricity using
applications, whereas a capacitor is used to gradually accumu- a transduction mechanism, such as thermoelectric generators
late energy from a battery and then discharge it to a load in for the conversion of generated heat [40] or electronic devices
burst [34] . for the collection of electron/hole pairs generated by incident
The supercapacitor (also termed ultracapacitor or electro- particles [41] .
chemical capacitor) is an emerging technology that enhances the Nuclear power sources were introduced into the medical indus-
energy density upon capacitors. Supercapacitors are categorized try in the early 1970s for application in early pacemakers [42] .
as electrochemical double-layer capacitors (EDLCs) or pseudo­ Plutonium 238 was used to generate heat via emission of a particles.
capacitors (also called redox supercapacitors) [35] . EDLCs achieve The heat was then converted into electricity using a thermopile.
high capacitances by storing the charge in the ultrathin electro- Unique characteristics of nuclear batteries, including high
chemical double layer at the electrode–electrolyte interface, and energy density and outstanding reliability, made them an appeal-
increasing the effective surface area of the electrode via applica- ing alternative for implantable applications. However, the tox-
tion of high-surface-area materials (most commonly, activated icity and excessively long half-time of the fuel, necessitating

www.expert-reviews.com 697
Review Rasouli & Phee

tight regulatory controls to avoid loss of any such devices, were gradient  [46] . Mobile charge carriers (electrons or holes) at the
two major concerns that limited their application in medical hot side of the material have higher thermal energy than the car-
devices [42] . riers at the cold side and diffuse to the cold side of the material
as heat flows [43] . The resulting voltage (V) at the open circuit
Energy harvesting condition is proportional to the temperature difference and can
Harvesting energy from the ambient sources is an appealing be expressed as: V = S.DT, where DT is the temperature difference
alternative for powering medical devices. It provides the device between the hot and cold surfaces, and S is the proportionality
with virtually unlimited energy, and thus prolonged lifetime. coefficient, termed Seebeck coefficient.
This is particularly important for implantable medical devices A typical thermoelectric generator, comprising of alternating
where it can extend the lifetime of the device and obviate the n-type and p-type doped semiconductor materials, is depicted
burdensome replacement or recharging of the batteries. However, in Figure 5 [47] . In this configuration, n- and p-type legs are con-
harvesting useful amounts of energy from the ambient environ- nected thermally in parallel and electrically in series to enhance
ment is very challenging. The amount of available energy is the output voltage and conversion efficiency. The negative charge
usually variable, intermittent and unpredictable. As a result, carriers (electrons) from the n-type material produce a current
special voltage-regulating and power-management circuits are from the cold to the hot side, whereas the positive charge carriers
usually needed. (holes) from the p-type electrode generate an electrical current
Table  3 lists some of the possible energy sources for harvest- from the hot to the cold surface. The generated open circuit
ing and their specifications. Among the listed energy sources, voltage is expressed as: V = n.(Sp –Sn).DT, where n is the num-
human-based energy sources (thermoelectric and motion-driven) ber of thermocouples (pairs of n- and p-type legs) connected
are appealing alternatives for medical applications owing to their in series, DT is the temperature difference between the hot and
abundance and the inherent vicinity of the energy source to the cold surfaces, and Sn and Sp are Seebeck coefficients of n- and
device. However, special consideration should be taken to avoid p-type legs, respectively. n- and p-type legs, commonly made of
disturbing the physiological activity of the user or the metabolic doped bismuth telluride semiconductor, have Seebeck coefficients
rate of the body. between 100 and 300 µV/K [43] . To achieve voltage levels of a few
volts, a large number of these thermoelectric devices are usually
Thermoelectric generator connected in series.
Thermoelectric generators are solid-state devices that directly Wearable thermoelectric generators are commercially available
convert the thermal energy of temperature gradients into electri- today. Seiko’s Thermic wristwatch (producing 22 µW of electrical
cal energy [43] . High reliability, durability, compactness and the power and 300 mV open circuit voltage at 1.5 K temperature drop
absence of any moving part make thermoelectric generators an across the device [48]) and Applied Digital Solutions’ Thermo life®
appealing alternative for medical applications. The human body (generating 10 µA at 3 V and 6 V open circuit at 5 K tempera-
is an abundant source of thermal energy, which can be utilized ture difference [49]) are two commercial examples that use body
for the generation of electricity [44,45] . heat to generate electrical energy. The feasibility of thermoelec-
Thermoelectric generators are based on the Seebeck effect, tric harvesting for body-worn medical devices has been recently
discovered by Tomas Seebeck in 1821 [46] . The Seebeck effect demonstrated for a pulse oximeter (62 µW power consumption),
states that an electrical voltage is generated across a metal or a two-channel EEG system (0.8 mW power consumption) and
semi­c onductor material when it is exposed to a temperature an ECG system (0.6 mW power consumption) [50] .

Table 3. Energy harvesting sources and their characteristics.


Energy source Performance Remarks Ref.
Ambient light 100 µW/cm (indoor)
2
Ambient solar energy: [49,110]
100 mW/cm2 (outdoor) 1 mW/cm2 (indoor)
500 mW/cm2 (outdoor)
Ambient radiofrequency Less than 1 µW/cm2 Power density from telecommunication towers and other [74]
radiations sources in urban areas can be as high as 3 µW/cm2, but it is
commonly 2–3 orders of magnitude lower
Thermoelectric 30 µW/cm2 Quoted for Thermo life generator at 5°C [49]
temperature difference
Vibrational 4 µW/cm3 (human motion, Hz) Predicted power density for a vibrational microgenerator [111]
800 µW/cm3 (industrial, KHz) with volume of 1 cm3
Biomechanical energy 4.8 W (knee-brace) Potential available power from heel strike was estimated to [49]
of the body 0.8 W (heel strike) be 7 W
(direct force) Knee-brace harvester extracts energy from negative work [67]
of muscles

698 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

Yang et al. investigated the feasibility of


the application of thermoelectric genera-
Heat absorbed
tors for implantable medical devices [51] .
In their study, theoretical interpretations
and numerical simulations were performed
to evaluate temperature differences estab-
Substrates
lished across a thermoelectric generator
positioned in the body, and proof-of-con-
cept in vitro and in vivo experiments were
carried out. They reported the generation
of output voltages of 5 mV and 25 mV from
Thermoelectric + current
temperature differences of 1.3 K and 5.5 K, Metal
elements External
respectively, across a thermoelectric gen- interconnects
erator implanted in a rabbit in the state of electrical
connection
general anesthesia.
Despite their favorable characteristics, Heat rejected
thermoelectric generators suffer from low
conversion efficiencies, especially at low
temperature differences. The efforts to
improve efficiency of thermoelectric genera-
tors are currently focused on design optimi-
Heat absorption
zations and improving thermal properties
of the materials. It was found that supper-
lattices [52] and nano­materials  [53] could
Heat flow h+ p
greatly enhance the conversion efficiency.
Development of new fabrication techniques e- n
for improved specifications and lower costs
is another major area of research that has
received considerable attention. Of particu-
lar interest is the development of Si-based
Heat rejection
thermoelectric generators that are compat-
ible with integrated circuit technology [54] .
An exhaustive review of thermoelectric
generators and their recent advancement is
presented in [55] . Figure 5. Schematic of a thermoelectric generator.
Reprinted with permission from Macmillan Publishers Ltd: Nature Materials [47] , © 2008.
Motion-driven energy harvesters
The human body is an abundant source of biomechanical energy respect to the coil results in a change of the magnetic flux in the
that can be converted into electrical energy using a conversion coil and, thus, induces an electrical voltage in the coil.
mechanism [56] . These include the energy of respiration, muscle Piezoelectric transduction is based on the ability of piezo­electric
stretching, joint rotations, body weight during walking, the materials to produce an electrical voltage when subjected to a
hydraulic energy of blood flow, heart beats and contractions of mechanical deformation. A typical structure for piezoelectric
blood vessels, to name a few. Considerable caution must be exer- generators is illustrated in Figure 7. In this configuration, defor-
cised so that harvesting energy from the body does not expose mation of the structure due to external forces produces tensile
any extra loads to the body. Extraction of an excessive amount strain on one side and compressive strain in the other, and thus
of energy may exhaust the muscles, increase the metabolic rate results in positive and negative voltages across the beam. Using
of the body and bring about undesired effects. this mechanism, an alternating current (AC) output voltage is
To convert the mechanical energy of motion into electrical generated when the mass oscillates.
energy a transduction mechanism is needed. Electromagnetic [57] , Electrostatic generators are mechanically variable capacitors
piezoelectric [58] and electrostatic [59] are the most commonly with movable electrodes. Relative displacement of the electrodes
applied transduction mechanisms. However, other mechanisms, changes the capacitance of the system and thus also changes the
such as magnetoelectric [60] , have been also developed. stored electrical energy (Figure 8) . The excess energy of the capaci-
Electromagnetic generators are based on the magnetic induc- tor can be extracted to energize an electrical circuit. In contrast to
tion principle and deploy a movable permanent magnet or coil other methods, this mechanism demands a precharged capacitor,
(Figure 6) . Relative displacement of the permanent magnet with and thus a prestored energy source.

www.expert-reviews.com 699
Review Rasouli & Phee

F F
generator that could produce 250  mW
[64,65] . Although the developed devices

Magnetic Eccentric were capable of producing electricity, they


S Magnet magnetic S suffered from several drawbacks, includ-
rotor
N T rotor N
N ing bulky volume, heavy weight, fragile
N
Coils structure and a noticeable effect on the
S S Coils user’s gait (particularly in the case of the
Coils electromagnetic generator).
Donelan et al. developed a novel bio­
Figure 6. Three different types of electromagnetic generators. (A) Rotational mechanical energy harvester for generat-
device driven by continuous rotational power; (B) linear oscillatory device driven in ing electricity from walking by using a
resonance by forced vibration; and (C) hybrid device that converts linear vibrations into
rotational motion.
knee-brace (F igur e  13) [66,67] . The system
Reproduced with permission from [99] , © 1969 IEEE. was based on the concept of regenerative
braking; absorbing energy from muscles
Magnetorestrictive generators rely on the Villari effect for while performing negative work. This mechanism avoids put-
transduction of vibrational motions [61] . The Villari effect states ting extra load on muscles while they are doing positive work,
that an induced strain in a magnetorestrictive material changes and thus does not increase the metabolic rate excessively.
its magnetization. In magnetorestrictive generators, alternating Moreover, it assists the muscles in performing negative work.
tensile and compressive strains in a magnetorestrictive material The developed system generated 4.8 ± 0.8 W of electricity with
results in a varying magnetic field that is converted into electricity a 5 ± 21-W increase in metabolic cost.
by using a pick-up coil (Figure 9) . Lewandowski et al. proposed a stimulated muscle-driven piezo-
Hybrid systems utilizing a combination of the aforementioned electric generator for application in implantable and prosthetic
techniques have also been developed to increase the energy devices (Figure 14) [68] . A piezoelectric generator was connected in
conversion efficiency (Figure 10) . Challa et al. proposed a piezo- series with a muscle-tendon to convert the tensile force of stimu-
electric beam that could resonate in a coil structure to simul- lated muscle contractions into electricity. Software simulations
taneously benefit from both piezoelectric and electromagnetic predicted a possible output power of 690 mW for such a generator,
transductions [62] . with an estimated stimulating power of 46 mW. The feasibility
In general, motion-driven generators fall into two categories: of the proposed concept was demonstrated acutely with rabbit
inertial (vibrational) or force-driven. Vibrational harvesters uti- quadriceps [69] .
lize the inertial energy of a proof mass for the generation of elec- Several other approaches for harvesting human-based energies
trical energy, while force-driven generators are based on the direct for wearable and implantable medical devices have been inves-
application of a mechanical force onto a transducer. tigated. These include, but are not limited to, harvesters for the
Seiko’s Kinetic® wristwatch is a good example of inertial har- utilization of pressure fluctuations of blood vessels [70] , piezo­
vesters (Figure 11) . It consists of an oscillating weight connected electric nanogenerators for harvesting ambient environment vibra-
to a small magnetic generator and can produce an average of tions [71] and flexible nanogenerators for the generation of power
5–10 µW when worn and 1 mW when forcibly shaken [56] . Goto from muscle movements [72] . A review of the recent developments
et al. studied the feasibility of using Seiko wristwatch’s vibrational in energy harvesting technologies is presented in [73,74] .
generator for implantable medical devices [63] . In their study, the The research on motion-driven harvesters, especially vibra-
generator was placed on the right ventricular wall of a dog’s heart tional harvesters, has been largely focused on the development
and produced 80 mJ of energy after recti-
fication and storage in a capacitor over a
30-min period for a heart rate of 200 beats
per minute.
Force-driven generators have also
been investigated for powering medical Mass
devices. In contrast to inertial harvest- Strain
ers, these devices can benefit from slow 3 Strain
and long-range motions of the body.
Paradiso et al. investigated the feasibility Voltage
of harvesting energy from human walking 2
Vertical
using three types of shoe-mounted har- 1 displacement
vesters: a piezoelectric bender placed in
the sole generated 2 mW; a unimorph that
could bend under heel strike and generate Figure 7. Operational principle of a piezoelectric generator.
8 mW (Figure 12) ; and an electromagnetic Reprinted with permission from [100] .

700 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

Wireless power transmission


The limited available space and stringent energy constraints of
some implantable medical devices render the application of on-
board energy supplies or energy harvesters impractical. LVADs
and neural stimulators are examples of such medical devices. The
short lifetime of batteries demands costly and inconvenient surgi-
cal procedures to recharge or replace them. Harvesting energy
Direction from the ambient environment to power the device is not a practi-
of motion cal approach either. Existing energy harvesters are still immature
and can only provide very low power densities in the range of
microwatts. Transfer of energy through the skin is the practical
method for these applications. Percutaneous wires were deployed
to deliver electrical energy from an external wearable battery pack
to LVADs and total artificial hearts [75] . However, application of
percutaneous wires has several major drawbacks. Potential risk of
In-plane overlap varying
infection is among the most important problems of percutaneous
links [76] . Furthermore, a tethered connection affects the mobil-
ity of the patient, decreases their quality of life and brings along
esthetic concerns. A wireless energy delivery mechanism through
the skin, often referred to as trans­cutaneous energy transmis-
sion, is very desirable as it obviates the need for wire leads that
penetrate the skin. Acoustic and nonionizing electromagnetic
waves have been successfully applied to transfer energy through
Direction
of motion the tissue. Here, we briefly review each of these methods and their
development for the provision of power to implantable medical
devices. In this context, we address the optical waves in a separate
section from other electromagnetic waves owing to their different
interaction with body tissue.

Electromagnetic energy
Electromagnetic waves carry energy as they propagate through
In-plane gap closing
space. Various approaches have been investigated to apply this
phenomenon to transfer energy to implantable medical devices
wirelessly (Figure 15) . Some of these mechanisms are discussed in
Direction the following sections. It should be pointed out that all of these
of motion mechanisms may act simultaneously, although one of them is
usually dominant [77] .

Radiative transmission
Out-of-plane gap closing
Figure 15A illustrates the principle of radiative energy transmission.
A transmitting antenna radiates energy into a medium, part of
which will be picked up by a receiving antenna that is located
in the far field of the transmitter. Choice of the transmission
Figure 8. Three different topologies for micromachined
electrostatic converters. (A) In-plane gap closing type: frequency and antenna design is determined mainly by the appli-
capacitance changes by changing gap between fingers; cation. The highest transmission efficiency is usually achieved
(B) in-plane gap varying type: capacitance changes by changing when dimensions of the antenna properly match the wavelength
overlap area of fingers; (C) out-of-plane gap closing type: of the electromagnetic field.
capacitance changes by changing gap between two large plates. Considering the dimensions of typical biomedical implants, an
Adapted from [100] .
efficient antenna for radiative power reception becomes feasible
only in the GHz range. However, the absorption by body tissues,
of new harvesting mechanisms, and less attention has been paid and subsequent attenuation of electromagnetic waves, is very high
to regulation and management of the harvested energy. Variable at these frequencies [2] . For example, the penetration depth of
and usually small output energy levels associated with these muscle tissue is only 3 cm at 1 GHz, while it is approximately 7 cm
mechanisms make the design of power management circuits a at 100 MHz [2] . Transmission of significant amounts of energy at
challenging task that needs to be further investigated. these frequencies is prohibited by health and safety regulations [2] .

www.expert-reviews.com 701
Review Rasouli & Phee

transmitting electrodes and the skin


should also be avoided as it results in poor
Base
Pick-up coil transmission [77] . In case an air gap exists,
most of the voltage will drop over the air
gap owing to its higher impedance com-
MsM laminate pared with body tissue. Passage of gener-
ated currents through the tissue is a serious
safety concern and limits the application
of this mechanism for transcutaneous
power transmission [77] .

Inductive coupling/resonant coupling


Inductive coupling is the most com-
mon method for wireless transmission
of power to medical implants. It offers
a relatively safe and efficient mechanism
Copper layer
for transmission of energy using near-
field electromagnetic waves – which is the
preferred method for implantable appli-
Figure 9. Schematic of a magnetostrictive generator. cations owing to the lower absorption
MsM: Magnetostrictive material. rate by body tissue at lower frequencies.
Reprinted with permission from IOP Publishing Ltd [61] . This method has been successfully used
to power implantable medical devices,
These frequencies are usually used for data communication owing including cochlear implants, LVADs, total artificial hearts and
to their higher bandwidth requirement and lower energy level. neural implants.
Inductive coupling is based on the principle of electromagnetic
Conductive/capacitive coupling induction in conductors. In this method, an alternating current
Electrical power can be transferred wirelessly to a remote load in a transmitting coil generates an alternating magnetic field,
over a conductive or capacitive medium. A conceptual schematic which passes through and couples with a secondary receiving coil
of this mechanism is depicted in Figure 15B. As illustrated, an elec- (Figure 15C) . The generated alternating magnetic field induces an
trical voltage can be induced in the remote load through the electromotive force (EMF) in the receiving coil that can be used
medium. The distance between the transmitting and receiving to power the implanted load, either directly or after rectification
parts is assumed to be short compared with the wavelength of the and regulation.
source. Longer distances of the receiver can be considered under The efficiency of the transmission link depends on geometri-
a far field approximation and radiative transmission. cal factors and material properties of the coupling medium,
In the case of medical implants, receiving electrodes are and is expressed by a coupling factor (k), which ranges from 0
implanted in the body and transmitting electrodes are mounted to 1. A coupling factor of 1 represents perfect coupling where
on the skin. To achieve an acceptable level of power, the receiv- all the generated magnetic flux penetrates the receiver coil,
ing electrodes should have a large surface area and high imped- while a coupling factor of 0 expresses a system in which the
ance compared with the body tissue. Any air gap between the transmitter and receiver coils are independent of each other.
Coupling efficiency can be enhanced by careful design of coils
and the use of magnetic flux guides. Air-core coils are usually
lighter and provide better fitting for implantable or wearable
Piezoelectric cantilever beam applications. However, they have lower efficiencies and are only
+ suitable for applications with low power requirements. Ferrite

cores are usually used in applications with high power require-


Magnet ments, such as artificial hearts and LVADs [78] . Okamoto et al.
proposed a transcutaneous power transmission mechanism for
+
Coil biventricular assist devices based on an air-core external coil
- and a ferrite-core internal coil [79] . The proposed configuration
could provide high transmission efficiency and stable opera-
tion, while eliminating the cosmetic problem of the external
Figure 10. Schematic of a coupled coupling method. The system could achieve a maximum power
piezoelectric–electromagnetic energy harvester. transmission of 60 W and maximum transmission efficiency
Reprinted with permission from IOP Publishing Ltd [62] . of 87.3%.

702 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

with other configurations. The implemented system could provide


Oscillating up to 400 mW of power to a self-propelled and steerable endoscopic
weight
capsule [88] .
Oscillating
weight gear
Magnetoelectric conversion
Transmission gear Magnetoelectric materials can generate an AC output voltage
when they are exposed to a varying magnetic field [89] . This
phenomenon offers an interesting alternative for wireless power
transmission (Figure 15D) . Compared with inductive coupling,
Stator Rotor magneto­electric generators can provide higher output voltages
Coil
without suffering from joule loss. Recently, hybrid structures
of piezoelectric and magnetorestrictive materials have received
Figure 11. The Seiko Kinetic® watch. considerable attention for wireless power transmission. The
Courtesy of Seiko Watch Corporation. alternating magnetic field induces structural changes in the
magnetostrictive material, and subsequently in the piezoelectric
The coupling efficiency is not fixed and may change owing to material, resulting in an AC output voltage over the piezoelectric
body motions. This is especially important for medical devices that material [90] .
are implanted in soft tissues, such as retinal prosthesis and LVADs.
It is estimated that the coupling coefficient may vary between 0.1 Magnetic gearing
and 0.3 for an artificial heart [80] , and between 0.08 and 0.24 for Suzuki et al. proposed the application of magnetic gearing for
a retinal prosthesis [81] . The load may also vary depending on the wireless transfer of power to medical implants [91] . In this method
operation mode of the device. For example, neural stimulators a rotating external magnetic field is used to rotate an in vivo per-
may consume relatively high amounts of power when they are in manent magnet to operate a microgenerator. High ratio gears
stimulation mode, while they need only a negligible amount of were used to increase the rotation speed of the internal magnet
power in their standby state. Coupling and loading variations result and thus the generated voltage. Figures 16A & B depict two imple-
in poor transfer efficiency, and excess or insufficient amounts of mentations of this mechanism with power outputs of 11 mW and
power transmitted. The excess transmitted power results in heat 1.9 W, respectively. This method suffers from several major draw-
generation, while insufficient power may deteriorate or even stop backs. Application of moving mechanical parts and permanent
the operation of the device. This is especially important in battery- magnets can deteriorate the performance of the device over time
free systems. To overcome this problem, closed loop operation con- and reduces the reliability. Moreover, the effect of permanently
trol should be implemented to regulate the transmitted power [82] . implanted magnets and exposure of the body to high magnetic
Adaptive control using back-telemetry from the receiver can be fields need to be investigated further.
used to maintain the optimal operation of the device and increase
the efficiency [83] . Regulating transmitter voltage amplitude [82] or Optical energy
frequency [84,85] has been shown to be effective for this purpose. The application of optical waves to power medical implants has
The optimized power on the load is achieved when the imped- also been proposed. In contrast to electromagnetic waves, opti-
ance of the load and receiving circuit are matched and the circuit cal waves do not interfere with nearby communication systems
operates at its resonance frequency. To increase the efficiency, both
transmitter and receiver can be tuned into the same resonance
frequency to achieve resonant coupling [84,85] . Resonant coupling
can enhance the transmission efficiency, even at low coupling effi-
ciencies and over longer distances [86] . However, implementation
of this mechanism for medical implants is not straightforward
owing to possible variations in load or circuit parameters. An
adaptive control mechanism to adjust the resonant frequency of
Insole
the transmitter can help to overcome this problem [84,85] . PZT PZT unimorph
Inductive powering of freely moving in vivo medical devices, such dimorph PVDF
stave
as ingestible capsules, is very challenging owing to the unpredict- Metal
able orientation and distance of the receiver [87] . Misalignment of midplate PZT unimorph
Sole
transmitting and receiving coils can significantly decrease the trans-
mission efficiency or even result in zero output power. To enhance
the efficiency and avoid zero-crossing in output power, multiple
primary or secondary coils can be used. These configurations have Figure 12. Shoe-mounted piezoelectric energy harvester.
been investigated by Lenaerts and Puers [77] . The authors concluded P2T: Lead zirconate titanate; PVDF: Polyvinylidene fluoride.
that multiple secondary coils offer superior characteristics compared Reprinted with permission from [65] , © 2001 IEEE.

www.expert-reviews.com 703
Review Rasouli & Phee

Expert commentary
Generator Bushings Axis of Significant miniaturization of electronic
rotation Potentiometer devices has paved the way for the develop-
Bearing ment of miniature and light-weight medical
Input shaft
devices that can monitor and treat various
Towards medical conditions continuously. Although
thigh
Roller clutch the processing capability of current elec-
Towards
tronic systems could bring forth more
Chassis advanced and functional medical devices,
shank
Gear train Shaft
connector the full potential of these technologies
remains unattainable owing to the stringent
Angle feedback energy constraints.
Computer
Input One-way control The advancement in battery technol-
shaft clutch ogy is very slow and far behind that of
Rg
RL Output
microelectronic technologies. Thin-film
Potentio- E(t) solid-state battery technology is an emerg-
meter Transmission ing technology that enhances the energy
Generator
density, safety and cycling performance
of electrochemical batteries. Furthermore,
Figure 13. Knee-brace biomechanical energy harvester. it provides the opportunity for miniatur-
Reprinted from [67] with permission from the American Association for the Advancement ization and integration of batteries with
of Science. other microelectronic technologies, and
thus the development of novel microscale

and environmental electromagnetic fields. A transcutaneous


power transmission based on infrared photodiodes was reported
by Goto et al. [92] . The developed system, comprising of an array Bone
of commercial silicon diodes embedded under the skin (area of
ve
2.1 cm 2 ), could successfully charge a lithium battery in 17 min Ner
to power up a pacemaker for 24 h. A modified system to increase
the possible implantation depth is reported in [93] , where an
Muscle

optical fiber is used for transporting light from the region just
under the skin to a desired location of the body without any Stimulator
significant losses.

Ultrasonic energy
Similar to optical waves, ultrasonic waves offer the advantages
Tendon

of lower interference with nearby electromagnetic fields and


communication devices. Ultrasonic waves induce vibration in
the tissue. The kinetic energy of the generated vibration can
attachment

be converted into electrical energy using a proper transducer,


Energy
Tendon

such as piezoelectric transducers [94] . Suzuki et al. reported a storage circuitry


hybrid magnetic/ultrasonic system for transmission of energy to
implanted medical devices [95] . Wang et al. have also proposed
a novel piezoelectric nanogenerator that can convert vibrational
energy into electrical energy [96] . Piezoelectric
Despite their advantages, ultrasonic power transmission suf- generator
fers from several major drawbacks that limit its application for
in vivo medical devices. The ultrasonic power transmission is very
sensitive to the contact between the transmitter and the tissue, Bone attachment
Application load
as well as mutual orientation and distance of the transmitter and Bone
the receiver  [97] . Any misalignment of the transmitter and the
receiver, or impedance mismatch between the transmitter and
the tissue at their contact point, may reduce the transmission Figure 14. Muscle-driven active energy harvester.
efficiency significantly. Reprinted with permission from [68] .

704 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

Equipotential surfaces

Conduction/
displacement
Zremote
current
Zremote

Magnetic field Magnetic field

Zremote Zremote

Figure 15. Principles of electromagnetic wireless power transmission. (A) radiative, (B) conductive/capacitive, (C) inductive and
(D) magnetoelectric.
Adapted from [77] .

medical devices. Application of nanostructured materials is such as a glucose fuel cell, eliminate the need for external refu-
another important approach that has proved promising for eling by tapping into the internal reservoirs of the body, and
improving characteristics of batteries. Although these advance- thus provide the device with a theoretically unlimited amount
ments enhance specifications of batteries, they do not overcome of energy.
the limited power capacity and energy density of electrochemi- Harvesting energy from the ambient environment, especially from
cal batteries. Electrochemical capacitors may compliment or the human body or activities, is another interesting alternative for
replace batteries for high-power applications. However, they powering medical devices. Owing to the intermittent and unpredict-
do not overcome the limited energy capacity of batteries. This able nature of the harvested energy, this technique is most useful
is particularly undesired for in vivo medical applications where in conjunction with secondary batteries. Although proven feasible,
a limited energy budget shortens the lifetime of the device, energy harvesting technologies are still immature and need to be
and demands inconvenient and costly surgical procedures for further investigated. Several major issues, such as output regulation
replacement of batteries. and integration with other system elements, need to be addressed.
Micro fuel cells, providing energy densities four- to five-times Currently, in vivo medical devices with high energy consump-
higher than that of batteries, are very appealing for portable tions or ultrasmall scales are powered through transcutaneous
medical applications. Although fuel cells do not overcome the energy transmission, most commonly inductive coupling. Using
recharging requirement of batteries, they replace it with a less this method, continuous, intermittent and on-demand power-
frequent and faster refueling process. Implantable fuel cells, ing of implantable medical devices is achievable. However, this

www.expert-reviews.com 705
Review Rasouli & Phee

Outside

Outside

N
N
N S
S S

Working
N

circuit
S N
S
S N
Rotor 1 Rotor 2 Rotor 1
SN Inside
Coil
Inside Rotor 3 IMD

Figure 16. Schematics of implantable microgenerators based on magnetic coupling.


Reprinted with permission from [101] , © 2002 IEEE.

method requires an additional infrastructure, which is usually environment. Nanostructured materials are expected to play a key
mounted on the body. This may reduce the mobility and quality role in improving the energy storage capability of electrochemical
of life of the patient. batteries and capacitors. Thin-film batteries are envisaged to be
Considering advantages and disadvantages of each of the exist- applied widely in implantable medical devices in the near future.
ing approaches, hybrid energy supplies, combining two or more They provide the opportunity for development of microscale medi-
energy sources, suggest a practical solution to overcome limita- cal devices with integrated energy storages or hybrid energy supplies
tions of each technology and enhance the performance and life- with the capability of being replenished. Micro fuel cells may soon
time of the system. Electrochemical capacitors can be used to enter the market of portable and wearable medical devices, and
provide instantaneous peak power, while electrochemical batteries replace batteries in some applications. Implantable fuel cells, case-
can handle moderate power and energy requirements. Fuel cells less batteries and energy harvesters, although proven feasible, need
and nuclear batteries may be utilized to supply high energy densi- to be further investigated before application in practical systems.
ties at low average power. Wireless power transmission and energy
harvesting can be deployed to replenish an otherwise exhaustible Financial & competing interests disclosure
reservoir of energy and extend the lifetime of the device. This study was funded by Singapore’s Agency for Science, Technology and
Research (A*STAR) under grant number 082-140-0036 (M47050060).
Five-year view The authors have no other relevant affiliations or financial involvement with
The progress toward unobtrusive energy sources for medical appli- any organization or entity with a financial interest in or financial conflict
cations is focused mainly on miniaturization and enhancement with the subject matter or materials discussed in the manuscript apart from
of electrochemical batteries and fuel cells, as wells as the develop- those disclosed.
ment of new technologies for harvesting energy from the ambient No writing assistance was utilized in the production of this manuscript.

Key issues
• An unobtrusive energy source that enables desired portability and energy autonomy is crucial for medical applications.
• The energy source of a medical device must have several major specifications, most importantly safety, reliability, predictability of
operation and high energy-density.
• Limited energy capacity of electrochemical batteries restricts the operational lifetime of medical devices. This is particularly undesirable
for implanted medical devices where replacement or recharging of batteries demands expensive and inconvenient surgical procedures.
• Energy harvesting is an emerging technology that has the potential to overcome the limited energy capacity of batteries and provide
the device with an extended lifetime.
• The high energy-density of micro fuel cells makes them a promising alternative for external medical devices. Fuel cells replace the
recharging requirement of batteries with a less-frequent and faster refueling process.
• Implantable fuel cells have the potential to extend the lifetime of implantable medical devices by utilizing endogenous substrates and
oxygen from the body for generation of energy.
• Inductive coupling can be used to power implanted devices continuously, intermittently or on demand.
• Hybrid energy supplies have the potential to overcome the limitations of each of the available technologies and to enhance the
performance and lifetime of medical devices.

706 Expert Rev. Med. Devices 7(5), (2010)


Energy sources & their development for application in medical devices Review

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