2017 11th European Conference on Antennas and Propagation (EUCAP)

Overview of Microwave Medical Applications in

Europe Since the Beginning of the COST Action
TD1301 – MiMed
Raquel C. Conceição1, Dario B. Rodrigues2, Bárbara L. Oliveira3, Maria Koutsoupidou4, Giuseppe Ruvio5
1
Instituto de Biofísica e Engenharia Biomédica, Departamento de Física, Faculdade de Ciências, Universidade de Lisboa,
Portugal, [email protected]
2
Sidney Kimmel Cancer Center, Department of Radiation Oncology, Thomas Jefferson University, Philadelphia PA, USA
3
Electrical and Electronic Engineering, College of Engineering & Informatics, National University of Ireland Galway, Ireland
4
Microwave & Fiber Optics Laboratory, National Technical University of Athens, Greece
5
Bioinnovate, National University of Ireland Galway, Ireland

Abstract— In the last twenty years, Microwave Imaging In 2012, a small number of researchers understood that
(MWI) has emerged as one of the most promising novel multiple research groups across Europe were working in
medical imaging modalities. With European researchers being similar, somewhat parallel, lines of research related to the
at the forefront of MWI development of medical applications,
application of microwaves to medical imaging and therapy
the creation in 2013 of the Action network “MiMed”
(MIcrowave MEDical) in the framework of the European techniques. Together we decided to apply for a COST Action
COoperation in Science and Technology (COST) was so that a formal network of researchers could be established.
welcomed with vivid enthusiasm. MiMed has polarised mostly This COST Action is a unique opportunity to advance our
independent research efforts into the design of several MWI fields of research, have a common voice within Europe
devices. Such a reserve of knowledge and numerous initiatives defending MIMed applications and accelerate the
carried by MiMed have constituted a unique opportunity for technological, clinical and commercial translation of
researchers to leverage existing experience and expertise to
streamline the transition from simulation/phantom testing to
microwave medical systems to the benefit of European
full clinical trials and clinical adoption of MWI devices. healthcare, while allowing us to have established
Moreover, collaboration among participants has provided the collaboration with other international groups outside the
support to overcome common challenges and bring MWI from COST geographical area. Our logo is shown in Figure 1.
“research bench to patient bedside”, boosting the European Currently our COST Action (TD1301) network comprises
Research Area and its excellence in a worldwide context. approximately 250 participants from a total of 30 countries
Index Terms—medical microwave imaging, microwave [2]. The geographical distribution of the participants is given
thermotherapy, COST Action, research network. in Figure 2.

I. INTRODUCTION
MWI is one of the most promising emerging modalities
for non-invasive cancer detection. This technique has the
potential to save millions of lives each year through
revolutionary medical imaging which can be used repeatedly
Fig. 1. MiMed COST Action logo.
due to use of non-ionising microwave radiation. Similarly,
within the context of an ageing population, MWI can be used
Our COST Action is organised in four Working Groups
as a method for remote monitoring and incontinence
(WG). WG1 focuses on the optimisation of microwave
management which will allow older people to live longer and
imaging prototypes, with two main sub-divisions: software
independently, thus improving the quality of life for the
and hardware development. WG2 focuses on the
elderly and lessening the burden of care on European states.
establishment of new techniques and emerging applications
Other promising applications of MWI include monitoring
for microwave imaging; and has its actions divided in 3
and detection of brain injuries, imaging of soft and joint
Focus Areas (FA): microwaves to monitor brain diseases and
tissues, and the diagnosis and management of osteoporosis
functionality (FA1), contrast-enhanced microwave imaging
[1]. In addition, other more established microwave
(FA2), and theranostics – microwave diagnostics for therapy
biomedical technologies such as hyperthermia and tissue
(FA3). WG3 focuses on the establishment of the clinical
ablation therapies benefit from positive synergies with
trials of microwave imaging prototypes. WG4 focuses on the
research advancements in MWI. By addressing common
widespread adoption of microwave imaging devices in
challenges in near-field source/sensor characterisation and
clinical practice and framework for their commercialisation.
tissue dispersion modelling, MWI has the potential to
improve treatment planning and theranostic procedures.

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 2017 11th European Conference on Antennas and Propagation (EUCAP)

Fig. 3. GeePs-L2S Breast Phantom, courtesy of Nadine Joachimowicz and

Bernard Duchêne.

Fig. 2. Distribution of MiMed COST Action participants. WG1 also launched the “Centres for Experimental
Microwave Imaging” (CEMI) activity for providing
In the following sections we will describe the COST researchers with access to experimental microwave imaging
Action tools used to achieve our goals of promoting MWI facilities (Prague, 2014): to date, five CEMI locations have
and therapeutics as a standard in healthcare, and the tangible already been established, and their preliminary results have
impact of these tools to date, as well as future directions of been presented.
this non-ionising, non-invasive and potentially low cost In WG3 meetings, clinical trials have been thoroughly
imaging technique. discussed in terms of planning, costs, ethics and safety
issues, since these are a highly important milestone for
II. COST ACTION TOOLS researchers developing medical systems and methodologies.
To this end, clinical researchers and principal investigators of
A. Scientific and Dissemination Meetings clinical trials have shared their experiences, while a training
Since the kick-off meeting in Brussels in November school covering this field has been successfully organised.
2013, five scientific WG meetings have been organised: In parallel, significant effort has been made to bridge
Lisbon, March 2014; Prague, September 2014; Bristol, academic research and industry for the commercialisation of
March 2015; Athens, October 2015; Davos, April 2016; and microwave medical devices in WG4 meetings. During the
Belgrade, June 2016. The next meetings will be held in Split meeting in Bristol, the INESC-TEC (Portugal) organised a
in November 2016 and Naples in January 2017. relevant workshop on “Translating research to product”,
The WG meetings organised by the Action allow our where participants were encouraged to present their research
members to present their work and progress on the field; in work in the form of a commercial product. In the meeting in
addition, the meetings enhance collaborations among Belgrade, we hosted a workshop, organised by the University
different institutions in Europe, but most importantly they of Warwick, about the challenges of adopting new medical
encourage the adoption of standardised practices and the devices and the need to consider Health Technology
launch and promotion of joint activities for solid and Assessment (HTA) during the designing process [5].
tangible outputs. The following text describes the main During the meeting in Lisbon 2014, the need for a more
discussions and outputs accomplished at these meetings. significant involvement of clinicians in the Action activities
WG1 meeting discussions have led to the preliminary was highlighted by all participants. Therefore, in subsequent
definitions of standard physical and numerical phantoms. meetings, we have invited several clinicians in order to
These standards enable a rigorous comparison of emerging address the current gaps and needs in diagnosis/therapy
imaging methods and facilitate the design of future clinical which can benefit from microwave technologies. In
trials. The phantoms were to be manufactured using well particular, clinicians from the Clinical Research and Imaging
documented tissue-mimicking techniques (WG1, Lisbon Centre at the University of Bristol and the Breast Care Unit
2014), and the moulds that replicate realistic at the Southmead Hospital described the clinicians’ point of
anthropomorphic breast tissues were to be manufactured view on the breast cancer detection challenge during the
using accurate 3D printing (WG1, Prague 2014). Towards WG3 meeting in Bristol. At the WG2 meeting in Athens,
this end, an activity was launched in the scientific meeting in doctors from the Department of Neurosurgery and
Athens (2015) entitled “GeePs-L2S Breast Phantom Use Neurology at the University Hospital Bern presented the
Application”. Dr. Nadine Joachimowicz and Dr. Bernard need for novel techniques in diagnosis and therapy of various
Duchêne presented an anthropomorphic 3D-printed MRI- brain diseases.
derived breast phantom (Figure 3) and they encouraged the The idea of identifying and creating FAs within the
participants to borrow it for testing their MWI systems and WG2 was discussed by the round-table during the meeting in
methodologies [3, 4]. Since then, the breast phantom has Lisbon. Three new FAs (defined in section I) were
been used in more than 10 laboratories around the world for introduced in the following meetings: FA1 and FA2 were
microwave measurements. The first results of this activity introduced in Prague 2014, while FA3 was launched during
were presented during the meeting in Belgrade, 2016. the WG2 meeting in Bristol 2015, along with a technical
session that covered two relevant topics: “Theranostics
focusing on nanostructures for tumour microenvironment”

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and “Reconfigurable arrays for microwave theranostics”. Close to 40% of the STSMs approved until July 2016
Also, the first day of the meeting in Athens 2015 was have allowed researchers to work in the development of
dedicated to FA1, as clinicians and engineers discussed image reconstruction algorithms, which include post-
novel methods for microwave brain imaging. FA2 will be processing tools for quality improvement. While the vast
resumed in the meeting in Naples in 2017. majority of the STSMs in this category where specific to
Besides the standard WG meetings, several breast microwave imaging, researchers from institutions in
dissemination meetings have been organised in the Italy, Serbia and Switzerland have also started using
programmes of international conferences, in order to discuss microwaves for brain stroke monitoring.
recent findings and to communicate the progress on Another growing area inside the MiMed community
microwave imaging to the broader scientific community. In concerns the measurement of dielectric properties, which
total fourteen convened/special/focus/regular sessions, a accounts to 18% of the STSMs completed to this date.
scientific workshop, one symposium and two short courses Researchers from Czech Republic, Ireland, Italy, Malta,
comprise the activities of the seven MiMed dissemination Russia and USA have used these STSMs as means to
meetings until today. During the 8th European Conference establishing collaborations, where the goal is the search for
on Antennas and Propagaton, EuCAP (The Hague, 2014), techniques which will allow for a comprehensive
we organised one convened and two regular sessions [6]. characterisation of the dielectric behaviour of human tissues
We organised a special and a regular session at the 2014 in the microwave range.
IEEE International Symposium on Antennas and The design of standard phantoms for standard testing of
Propagation and USNC-URSI Radio Science Meeting, emerging microwave imaging projects is closely aligned
Memphis. We organised a mini symposium at the 2nd with the goals of this COST Action and has also been the
Annual Congress of the European Society for topic of another 12% of the STSMs. The areas of breast
Translational Medicine & Global Network Conference on cancer classification and microwave hyperthermia have seen
Translational Medicine in Vienna, 2014 [7]. During the 9th similar interest amongst the MiMed network. Researchers
EuCAP (Lisbon, 2015 [8]), we organised two convened from England, Germany and Italy have also participated in
sessions, a regular session, a scientific workshop and a short STSMs in the area of contrast-enhanced MWI.
course. In the Progress in Electromagnetics and Research In terms of overall MiMed aims, an overwhelming 73%
Symposium, Prague 2015 [9], we organised a focus session. of the STSMs approved to date are directly aligned with the
In the 10th EuCAP (Davos, 2016 [10]) two convened goals of WG1, with a further 15% contributing to WG2. In
sessions and one short course were organised. In the 11th addition, the topic of 13% of the STSMs is related both to
EuCAP (Paris, 2017 [11]), three new convened sessions WG1 and WG2, highlighting the cooperative nature of this
have been organised. Action. It is hoped that STSMs relating to the development
of clinical trials (WG3) and commercialisation of imaging
B. Short Term Scientific Missions (STSMs) prototypes (WG4) will still be proposed and approved in the
STSMs are one of the most valuable tools provided by lifetime of this COST Action.
the COST Action. Through this mechanism, researchers can In summary, STSMs have been a great vehicle for
travel to another institution within the MiMed network for a researchers to get hands-on experience with microwave
period of a minimum of 5 days up to six months. STSMs are experimental prototypes, otherwise not available at their
key in the establishment of new collaborations in the area of own institutions. With the aid of these scientific missions,
microwave imaging and therapeutics, as researchers with researchers have been able to acquire experimental and
complementary skillsets can develop novel ideas. In the patient data to test their algorithms; such data can increase
application process, researchers must clearly identify the the robustness and reliability of these algorithms and help
areas of collaboration between the home and host bring this research closer to the patient and market, in line
institutions, the aims of the joint project and how they fit the with the goals of the Action.
overall goals of the MiMed COST Action. C. Training Scools (TSs)
The year of 2014 saw the first round of STSMs being
So far, the MiMed COST Action has organised five TSs,
approved, with a total of 7 researchers from institutions in
all with growing participation rates. Topics and contents of
Czech Republic, England, Ireland, Italy, Portugal and
the TSs were designed to satisfy multiple needs of
Switzerland travelling to other research groups in Denmark,
participating members.
Italy, Netherlands, USA, Canada and China. The main
In 2014, two schools were organised: one on
outcomes of this round of STSMs were presented in 2015 at
“Hyperthermia & Thermal Ablation in Cancer Therapy” that
the Bristol meeting, which highlighted the relevance of
took place in Huntsham, UK; and another on “Microwave
STSMs and further encouraged other researchers to embark
Imaging and Diagnostics: Theory, Techniques, and
on joint missions of their own. Since then, another 18
Applications”, in Madonna di Campiglio, Italy. The
STSMs have been completed, and an extra 9 will be
contents of these TSs were designed with the dual purpose
completed by the publication date of this paper. Researchers
of covering fundamental aspects at the basis of our research
who completed their missions during the year of 2015
activity and to network with well-established institutions
presented their findings at the Belgrade WG meeting.
like the the European Society for Hyperthermic Oncology

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(ESHO) and European School of Antennas (ESoA). The gender and inclusiveness balance rates.
Huntsman TS was comprehensive and designed for those
who were new to the fields of hyperthermia and thermal III. IMPACT
ablation, but also for those who felt the need for an update Since the start of the MiMed COST Action in 2013,
in the field. Lectures were centred in oncologic applications multiple milestones have been achieved, which have
and given by well-known experts on biology, physiology, promoted the field of MWI from scattered research groups to
physics and medicine within hyperthermic oncology. This a robust network of clinical- and commercialisation-oriented
multi-disciplinary approach provided participants with a research. The following sub-sections summarise the tangible
better understanding of the field, especially outside the areas outputs achieved to this date.
of their immediate expertise. The school covered several
topics of interest for our Action, such as microwave A. Refinement of MWI hardware for prototype medical
hyperthermia, clinical trial design and reimbursement in devices
Europe. In the Madonna di Campiglio TS, the fundamental Several STSMs were funded to support the refinement of
equations and main challenges of inverse problems in high- existing microwave medical devices for both diagnostic and
frequency electromagnetics were introduced. The following therapeutic applications. WG1 also launched five novel
topics were discussed: classical and recently introduced activities: (1) a standard phantom activity was launched to
solution procedures and algorithms, discussion of provide a common platform for the evaluation of microwave
capabilities, limitations, and perspectives of both imaging systems; (2) the first 3D printing-based phantom
approximate and 'exact' reconstruction methods. Practical was manufactured; (3) the CEMI teaching/training centres
examples, including exercises and lessons regarding specific were created; (4) a sub-group led by Mitos and involving
applications, were given to corroborate the developed Micrima, Medfield, Wispry and Keysight received funding
concepts. under the Eurostar programme to accelerate Small and
Considering the cross-domain nature of MiMed and its Medium-sized Enterprises (SMEs) involved in the Action
focus on commercialisation, another 2 TSs were organised who wish to establish a common hardware platform for
to educate participants on fundamental aspects concerning microwave imaging systems.
the introduction to market of novel medical devices. A TS
on “Clinical Trial Design and Management” in 2015 and B. Sharing expertise in software development
one on “Health Technology Assessment (HTA)” in 2016
were organised. The former took place in Galway, Ireland, Several STSMs were funded to evaluate and optimise
in collaboration with the COST Action BM1309 (European existing algorithms for microwave signal processing and
network for innovative uses of electromagnetic fields in image reconstruction. Dedicated break-out sessions at the
biomedical applications, EMF-MED; and the the latter took WG meetings were very valuable when sharing software
place in Rome, Italy. The TS on “Clinical Trial Design and development experiences. In addition, two TSs were
Management” addressed the core issues involved in running organised within this topic: “Microwave imaging and
a trial of a novel microwave medical device, including study diagnostics: theory, techniques, and applications”.
design, ethical approval, evaluating device safety, data
protection and data analysis. Importantly, many members C. Fostering new applications of microwaves in medicine
are now rapidly moving to clinical trials, or redesigning An active collaboration with the related EMF-MED
their existing trials based on this TS. Most trainers were COST Action has been established. Also, STSMs concerned
affiliated with BioInnovate, which is the medical technology with brain stroke imaging and theranostics were funded. In
incubator of the National University of Ireland Galway and addition, a training school was organised in the topic of
the HRB Clinical Research Facility, Galway. The TS on “Hyperthermia & Thermal Ablation in Cancer Therapy”.
HTA was a valuable opportunity to learn how novel medical Three new main areas being pursued by different
devices are assessed by hospitals and health providers to research groups were established by WG2: (1) application of
respond to their needs. This TS was taught by the HTA Unit microwaves for brain diseases monitoring and diagnostics;
of the Children Hospital “Bambino Gesù” and one speaker (2) exploitation of contrast agents for microwave
from the University of Warwick, England, covering diagnostics; and (3) theranostics – dual uses of microwaves
important topics such as risk analysis and assessment, CE for diagnosis and therapy. Several new medical devices
marking and health economy, through very practical involving microwave imaging/therapeutics have been
experiences and case studies. proposed and submitted for funding: MURiC Medical - a
Finally, due to the success of the second TS in the novel kidney imaging system, and Varx Medical - a
lifetime of the Action, the TS on “Microwave Imaging and microwave ablation system.
Diagnostics: Theory, Techniques, and Applications” was
again organised to take place in Taormina, Italy, 2016, in D. Increasing awareness of medical community regarding
collaboration with ESoA. the potential of MWI devices
Overall, through its 5 TSs, MiMed has supported the MiMed participants chaired and presented their research
participation of more than 100 members with excellent at numerous medical forums and international conferences,

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in an effort to better educate and inform clinicians of the Microwave Imaging for Breast Cancer Detection” [12] has
value and potential of microwave imaging and therapeutic recently been published and another book is under
technologies. These included the first dedicated seminars on preparation entitled “Emerging Electromagnetic
microwave medical technology at the European Society for Technologies for Brain Diseases Diagnostics, Monitoring
Translational Medicine (EUSTM): “The emerging role of and Therapy”. The number of MiMed publications has been
microwave imaging technology”. In addition, one of the increasing: 17 in 2014, 30 in 2015 and so far 30 in 2016;
microwave medical devices (Strokefinder) developed by our demonstrating the scientific impact of this COST Action.
members in Sweden has been added to the exhibition of the
Science Museum in London for medical and general public IV. CONCLUSIONS
awareness. The MiMed COST Action has established a valuable
non-competitive framework that is providing European
E. Setting up the framework for MWI clinical trials researchers with the necessary structure and support to
At each WG meeting, those who have already completed overcome common challenges and bring medical MW
initial clinical trials presented their work, and provided technologies from “research bench to patient bedside” in a
valuable discussion in the non-technical practical challenges much shorter period of time. Overall, the MiMed participants
in running a trial, including ethics, patient recruitment, have begun to share a common "language", in terms of
follow-up, among other topics. To supplement this, we system optimisation and testing, the challenges associated
organised a dedicated week-long training school on “Clinical with pilot patient studies and full clinical trials, as well as the
trial design and management”. subsequent requirements for full commercial exploitation.
Currently, there are at least 50 active clinical trials which This experience has materialised in multiple tangible outputs
are evaluating the safety and efficacy of medical MW that include increased scientific publications, foundation of
devices – listed in the database clinicaltrials.gov and/or training facilities, and ongoing clinical trials to evaluate new
involving members of the COST Action. These trials address medical MWI devices, which is the final step to make non-
diagnostic techniques of MW tomography (4), MW radar ionising and non-invasive microwave technology a reality in
(2), MW reflectometry (1), MW radiometry (4); as well as the medical field.
therapeutic MW diathermy (2), MW hyperthermia (4) and
MW ablation (33). Since the beginning of our COST Action, ACKNOWLEDGMENT
two sites started clinical trials focused on breast cancer
detection using radar at the McGill University and at This paper has been supported by COST Action TD1301,
Micrima, a spin-out of the University of Bristol. In common MiMed.
with many MiMed research groups, they are drawing from
the experience of the TS to redesign their trials to maximise REFERENCES
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