522 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO.

3, JUNE 2021

Textile Electromagnetic Brace for Knee Imaging

Kamel S. Sultan , Student Member, IEEE, Ahmed Mahmoud , and Amin M. Abbosh , Senior Member, IEEE

Abstract—A wearable textile brace is introduced as an elec-

tromagnetic imaging system that breaks hospital boundaries to
real-time onsite scanning for knee injuries. The proposed brace
consists of a 12-element textile slot loop antenna array, which is
designed to match the human knee for enhanced electromagnetic
wave penetration. Wool felt and conductive fabric are used to
fabricate the antenna array thanks to their flexibility and proper
dielectric properties. Each antenna element has a compact footprint
of 42 × 24 × 3.22 mm3 and achieves unidirectional radiation,
high front-to-back ratio of 14 dB, wide bandwidth of 81% at
0.7–1.7 GHz, and safe SAR levels. A modified double-stage delay,
multiply, and sum (DS-DMAS) algorithm is used to process the
collected signals from the antenna array based on differential
left/right knee imaging. The reconstructed images numerically and
experimentally on realistic phantoms demonstrate the potential
of the brace system for onsite detection of different types of lig-
aments/tendon tears.
Fig. 1. 3-D structures of the knee joint [1]; (a) Tendon view and (b) ACL/view.
Index Terms—Knee injuries, on-body matched antenna, textile
antenna, electromagnetic imaging, double-stage delay multiply and
sum algorithm. knee ligaments without obstructing natural activity reduces the
severity of the injury and its transformation into a complete tear,
I. INTRODUCTION which can only be treated by the use of interventional surgery
[3], [6]. Besides, the treatment period is shortened from nearly
HE knee is prone to injuries more often than other joints
T in the body due to its complexity and weight-bearing role.
These injuries are not only inherent to sport fields but also can oc-
one year in the case of full tears (Grade III) to several weeks
in the case of mild or moderate tears (Grade I and Grade II).
Moreover, early detection decreases the risk of other injuries
cur during activities of daily living. The tissue at the level of the that are associated with full ligament tears, such as meniscal
knee joint includes skin, subcutaneous fat, fascia, extraarticular and tendon tears, posttraumatic osteoarthritis, and dislocation
and intraarticular ligaments (see Fig. 1). The main extraarticular [4], [7].
ligaments include the medial collateral ligament (MCL), lateral Current modalities to detect and image the connective tissue
collateral ligament (LCL), and medial patellofemoral ligament. tearing include magnetic resonance imaging (MRI) as a golden
The interarticular ligaments include the posterior cruciate liga- standard tool. As much as MRI has the capability to detect liga-
ment (PCL) and anterior cruciate ligament (ACL). The tendons ment injury with an average accuracy of 85%, its high cost and
of the hamstrings, quadriceps, and gastrocnemius act across the bulky size make it unsuitable for onsite early detection [8]–[10].
knee joint [1]–[4]. Ligament tears are the common knee injury The other modalities like computed tomography (CT) and X-ray
with more than 6 million lacerations per year and considered don’t have the capability to detect connective tissue tears. Also,
the most violent because of the need for long-term treatment ultrasound has limitations in detecting all knee tissues, and it is
(9-12 months) [5], [6]. Early detection of a partial tear for limited to detect outer tissues [11].
Electromagnetic imaging (EMI) has undergone rapid devel-
Manuscript received March 14, 2021; revised April 26, 2021 and May 25, opment and become one of the promising biomedical imaging
2021; accepted May 26, 2021. Date of publication June 2, 2021; date of current
version August 17, 2021. This work was supported by an Australian Government modalities over the past two decades because of its unique
Research Training Program Scholarship. (Corresponding author: Kamel S. features, such as low cost, simple structure, portability, and
Sultan.) non-ionization. Thus, EMI has been investigated for the early
Kamel S. Sultan and Amin M. Abbosh are with the School of Information
Technology and Electrical Engineering, University of Queensland, Brisbane detection/monitoring of strokes, skin cancer, heart failure, breast
QLD 4072, Australia (e-mail: k.sultan@uq.ed.au; a.abbosh@uq.edu.au). cancer, bone fracture, and pulmonary edema [12]–[22]. EMI
Ahmed Mahmoud is with the School of Medicine, Griffith University (A.M.), modality is based on the significant changes in dielectric char-
Gold Coast, QLD 4222, Australia, Brisbane Orthopaedic and Sports Medicine
Centre, The Brisbane Private Hospital (J.Y., P.M.), Brisbane, QLD 4000, Aus- acteristics of tissues due to abnormality or injuries. For knee in-
tralia, and Active Rehabilitation Physiotherapy (J.B-S.), South Brisbane, QLD juries, when the ligament/tendon tear happens, the synovial fluid
4000, Australia (e-mail: a.mahmoud@uq.edu.au). increases inside the knee joint. Specifically, it is a haematoma-
Color versions of one or more figures in this article are available at https:
//doi.org/10.1109/TBCAS.2021.3085351. a mixture of blood and synovial fluid, leading to knee effusion
Digital Object Identifier 10.1109/TBCAS.2021.3085351 and changes in its dielectric properties [23, 24]. Therefore, EMI
1932-4545 © 2021 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission.
See https://www.ieee.org/publications/rights/index.html for more information.

Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING
is investigated here as a tool that may overcome the limitations
of current modalities. Although few initial works are introduced
in the literature to investigate the use of EMI to detect tear or
defect of some knee tissues, such as tendon [25], meniscus [26],
[27], and artificial meniscus [28], those studies didn’t introduce
an applicable study in real life as those are limited in scope
to extracted individual tissue outside the knee joint without
considering of surrounding tissues.
The key elements of EMI systems are imaging algorithms and
antenna array. Specifically, EMI algorithms can be divided into
radar-based and tomography-based algorithms. The radar-based
algorithms require wide bandwidth antennas [12], [29] while the
tomography-based algorithms require a single frequency [30] or
multiple frequencies [31], [32]. Thus, a wide bandwidth antenna
with unidirectional characteristics is the main candidate to fulfill
the different types of the aforementioned algorithms. Several
types of antennas were introduced to meet those requirements,
such as Vivaldi antennas [33], cavity-backed antennas [34], 3D
structure antenna [35], log-periodic [36], monopole integrated
with reflector [37], [38]. Most of these antennas have large
profiles and heavy structures that limit the number of antenna
array elements around the imaged object. Additionally, they
suffer from a low front-to-back ratio that reduces the penetration
of EM signals inside tissues under test.
An alternative approach for EMI antennas is on-body matched
antennas which reduce skin interface reflections [39]–[45].
The reported antennas have restrictions in terms of large size,
back radiation, complicated structure, and conformality with
the body. For instance, the antennas reported in [40], [41] are
partial/slotted ground antennas, which means the EM signals
don’t effectively penetrate inside the tissues under test, whereas
the antennas in [39]–[42] have a relatively large size. On the
other hand, the reported antenna in [43] is fabricated on a home-
made thick substrate and high dielectric constant which leads to
reduced radiation efficiency and changing characteristics over
time. Therefore, a new antenna that can fit with the dielectric
characteristic of the knee joint and conformal shape is required.
Otherwise, a lower microwave frequency around 1 GHz with
wide bandwidth is recommended for EMI systems to increase
penetration with low specific absorption rate (SAR) values and
improve the reconstruction images.
This paper presents a non-invasive wearable textile brace for
electromagnetic imaging of knee injuries. Since the proposed
system is a wearable brace, it is designed to be in direct contact
with the knee. The proposed brace consists of a 12-element
slot-loop antenna array that is fabricated on flexible wool felt
substrate. In addition to the wide bandwidth of the antenna
(0.7–1.7 GHz), it exhibits unidirectional characteristics in the
near field and safe SAR values. Besides the brace, the proposed
system consists of a multiport vector network analyzer (VNA)
and host PC. The operating frequency of the proposed system
provides a reasonable compromise between the penetration of
microwave signals into the knee and spatial resolution of recon-
structed images. The system is verified experimentally using
durable knee and liquid knee phantoms with different types
of connective tissue tearing. A modified algorithm based on
the combination of double stage delay multiply, add and sum
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
523
Fig. 2. Overview of the proposed textile wearable system for knee injuries.
(DMAS), coherence factor (CF), and differentiate between the
left and right human knees are used to reconstruct the images.
The reconstructed images prove the ability of the proposed brace
system to detect different types of knee injuries.
The remaining parts of this paper are organized as follows.
Section II presents an overview of the proposed electromagnetic
brace system in addition to more details about knee structure and
its dielectric characteristics. In section III, the antenna design
procedure, textile material characteristics, fabrication process,
evaluation of antenna performance in presence of knee phan-
tom and human knee are introduced. The modified microwave
algorithm and the reconstructed images of different scenarios of
knee injuries in the simulation and experimental environment
are evaluated and discussed in section IV. Finally, section V
presents the concluded remarks.
II. OVERVIEW OF BRACE EMI SYSTEM AND KNEE STRUCTURE
A schematic diagram of the proposed brace system is shown in
Fig. 2. It is fabricated from a textile material that is worn around
the knee and includes a 12-element antenna array. Thanks to
its flexibility, the proposed wearable brace can fit with different
knee sizes. The antennas are connected to multiport VNA. The
backscattered signals that describe the characteristic of knee
tissues are gathered and stored using a laptop. A modified double
stage confocal algorithm is used to differentiate between the left
and right knee joints (normal and abnormal joints) to reconstruct
the knee image. This differential method is used here thanks
to the fact of anatomical similarity between the left and right
knees with more than 98% correlation [46], [47]. To achieve
the balance tradeoff between the spatial imaging resolution
and electromagnetic penetration inside the knee tissues, the
operating frequency is selected to be around 1 GHz with wide
bandwidth.
A. Structure and Dielectric Properties of Knee Joint
Since changes in the dielectric properties of tissues are the
main factor in EMI, an extensive study of the knee structure and
its tissue characteristics is vital before starting in system design.
Thus, 150 transverse slices with a total height of 15 cm from the
MRI Duke voxel knee model that has 1 mm × 1 mm × 1 mm
resolution [48] were imported into MATLAB© and mapped with
the relative dielectric properties for each tissue from [48], [49].
A dielectric profile of the three different knee planes (Sagittal,
Coronal, and Axial) are depicted in Fig. 3 to present the variation
of relative permittivity and conductivity at 1.2 GHz (the center
 524 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021
Fig. 3. Dielectric profile for human knee joint (relative permittivity and
conductivity) at the center of the used band (f = 1.2 GHz) in different planes:
(a) Sagittal plane of a normal knee, (b) Coronal plane of a normal knee, (c) Axial
plane of a normal knee, and (d) Axial plane of an injured knee. Left and right
images present relative permittivity and conductivity of the knee joint before
tear, respectively. While the read shapes (circles\ellips) refer to the location of
ligaments. The first colour bar is for the normal kne, whereas the second colour
bar for the injured knee.
of the interested band of operation). Once the ligament tear
happens, synovial fluid with blood (Haematoma fluid) starts
to accumulate at the location of the tear, inside the dotted red
regions (see Fig. 3) then starts to fill the whole knee joint and
causes knee effusion [2], [50]. This fluid leads to a change in the
dielectric properties of the knee joint due to its high dielectric
properties (εr = 84 and σ = 2.3 s/m) [48] compared to low
dielectric of other knee tissues. Fig. 3(d) shows the dielectric
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
Fig. 4. Setup configuration of the proposed antenna in presence of knee model
(a) One-layer knee model and the average dielectric properties of the knee, (b)
Multilayer knee model, (c) Realistic knee model.
properties of injured knee with torn ACL/PCL ligaments and
tendon, and thus have accumulated synovial fluid (water). It is
clear to note that the injured areas have high dielectric contrast
compared to surrounding tissues and healthy knee.
The knee has heterogeneous tissues with irregular distribution
around its center. Also, the thickness of knee tissues differs
between individuals. Thus, the antenna is designed and opti-
mized in three different models simultaneously; (I) Model 1: a
one-layer model that emulates the average dielectric properties
of knee tissues (Fig. 4(a)), (II) Model 2, a multilayer model
that emulates all knee tissues in the axial plane, considering the
thickness of each tissue and its dielectric properties (Fig. 4(b)),
and (III) Model 3, 3-D realistic voxel model (Fig. 4(c)). For the
first model, the average dielectric properties for the knee tissues
is calculated from (1):
L   T εi (w)−jεi (w)

k=1 i=1 di D
εav (ω) = k
(1)
L
where εav refers to the average complex permittivity, k and i
denote the index number of knee layers and tissues, respectively,
whereas L is the total number of axial slices (70 slices), T is the
number of different tissues in each slice, d is the tissue thickness,
and D is the total thickness of all tissues in the slice. The average
dielectric properties of the knee are shown in (Fig. 4(a)). For the
second and third models, the maximum and minimum values of
dielectric properties for main knee tissues across the investigated
frequency band are listed in Table I.
III. KNEE MATCHED SLOT LOOP ANTENNA
This section describes the criteria to design a wideband, uni-
directional, and wearable antenna for knee imaging. Firstly, the
dielectric properties of the used substrate are measured followed
by antenna design and studying its performance in different
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING
TABLE I
DIELECTRIC PROPERTIES OF THE KNEE TISSUES OVER THE INTERESTING
FREQUENCY RANGE (0.7–1.8 GHZ)
Fig. 5. Measured dielectric properties of Wool Felt substrate using DAK (a)
measurement setup and (b) relative permittivity and loss tangent of the Wool
Felt substrate.
scenarios. Secondly, the fabrication process and measurements
of the antenna in presence of knee models are presented.
A. Material Properties
For the proposed antenna, a conductive fabric sheet (Silver
Nylon Ripstop Fabric) with a thickness of 110 μm and surface
resistivity less than 0.03 Ω/square is used to serve as the
radiating patch and ground plane. This fabric conductive sheet
is robust enough to stay undeformed for several uses and thus
ensures durability of the antenna [51]. Textile wool felt sheet
with a thickness of 3 mm serves as the dielectric substrate for
the antenna and offers high flexibility and robustness as proven in
several applications [40], [41], [51], [52]. A conductive thread is
used to serve the shorting pins between the patch and the ground
by sewing. An initial step to measure the dielectric properties
of the wool felt substrate is performed using SPEAG dielectric
assessment kit (DAK), (see Fig. 5(a)). As shown in Fig. 5(b),
the measured average relative permittivity and tangential loss
are 1.65 and 0.001, respectively. The textile material is selected
here because of its flexibility, conformability, and soft-touch
properties.
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
525
Fig. 6. Front configuration of the proposed slot loop antenna with full ground
plane.
TABLE II
DIMENSIONS OF ANTENNA PARAMETERS (MM)
B. Antenna Configuration and Operation Principle
To achieve wide operating bandwidth and directional radi-
ation patterns, a full grounded slot loop antenna is introduced.
The proposed antenna is designed on 3 mm thick wool felt textile
material with a low-profile structure (42 × 24 × 3.22 mm3 ) to
operate around 1 GHz. Fig. 6 and Table II show the configu-
ration of the antenna and its related dimensions, respectively.
Fig. 4(a-c) depicts the simulation setup when the antenna is in
contact with knee models. All simulations were carried out using
CST Microwave Studio. The fabric conductive surfaces of the
antenna are modeled as a resistive sheet, while the measured
dielectric characteristics of wool felt are imported and assigned
for the substrate.
To understand the implicit performance of the antenna, the
design criteria are presented step by step as shown in Fig. 7(a).
In specific, the design started with a simple two slot-loops full
ground backed structure, which typically leads to the wide band-
width and unidirectional radiation. The feed point is selected at
the center of the antenna to achieve symmetry between antenna
parts and keep them in a parallel connection using a 50 Ω coaxial
connector. To reduce the radiating element length, two shorting
pins (vias) at the edge of the loop slot (marked as V in Fig. 6)
are used. With the shorting pins, the slot loop antenna operates
in a magnetic current loop mode. The circumference and the
edge length of the slot loop are the two main parameters to
control the resonance modes of the antenna. They are calculated
as ci = [L1 + 2(L2 + L3 ) + Wd ] = 0.5λg and L1 = 0.25λg ,
respectively, λg is the guided wavelength calculated as in (2):
c
λg ≈  (2)
εrs (f)+εav (f)
f∗ 2
where εrs and εav are the dielectric constant of Wool Felt
substrate and knee model, respectively, f is frequency, and c
 526 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021
Fig. 7. Simulated results (a) reflection coefficients of the proposed antenna
step by step, (b) and (c) real and imaginary part of input impedance. The antenna
is loaded by the first knee model.
is the speed of light. Fig. 7(a) shows that Ant. A operates around
1.25 GHz with a wide bandwidth from 1.1 GHz to 1.6 GHz. It can
be observed that the antenna generates two close modes that give
a wide bandwidth. To increase the bandwidth and maintain the
same size, a tuning stub is added to the antenna structure (Ant. B
and Ant. C) to tune its input impedance, along with improving the
matching of the second mode. Although the antenna has a wide
bandwidth, its input impedance has a high inductance part due
to using 3.22 mm long wires of feed probe and vias as depicted
in Fig. 7(b and c). To reduce the inductance, a rectangular gap is
etched around the feed probe to introduce a series capacitance
with the input impedance [53] (see Ant. D in Fig. 7(a)). The
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
Fig. 8. Simulated reflection coefficient of the proposed antenna with different
knee models.
Fig. 9. Reflection coefficient and bent view of the proposed antenna with a
different bent radius.
gap width is optimized to achieve real impedance close to 50
Ω and reduce the imaginary part (see Fig. 7(b and c)) which
leads to improved impedance bandwidth of 81% (from 0.736 to
1.738 GHz).
Performance of the antenna in the presence of knee is depicted
in Fig. 8. The aforementioned three knee models are used. The
reflection coefficients indicate that knee model 1 has better
matching than the other two models especially at the second
operating mode (1.55 GHz). Although the proposed antenna is
designed using different equivalent three models, the three cases
have the same bandwidth at −10 dB reference. As the proposed
antenna is designed on a flexible brace, and it is expected to be
worn by humans, it is supposed to be conformed and bent to
the knee surface. Thus, it is essential to study the performance
of the antenna during bending. Therefore, the antenna is bent
to R (mm) radius of a cylinder model that emulates the average
dielectric properties of knee tissues. Fig. 9 indicates the influence
of bending on the performance using CST. Changing the bending
radius from 40 mm to 70 mm did not change the antenna’s
performance significantly.
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING
Fig. 10. Fabrication process (a) laser cutting machine engraver speedy 500,
fabric conductive sheet is fixed on the platform, (b) prototype of conductive parts
and (c) fabricated prototype attached with SMA connector using conductive
epoxy.
Fig. 11. Measurement setup for a single element textile antenna in the vicinity
of a 3-D realistic phantom of the left knee (healthy).
C. Fabrication Process and Measured Results
A laser cutter (Laser Engraver speedy 500) is used to trim
the fabric conductive sheet and pattern the required structure
(see Fig. 10(a)). A sticky tape of 0.05 mm is used to protect and
support the conductive fabric sheet during the trimming process
then used to attach the fabricated pattern to the textile substrate to
avoid shape distortion. Thanks to the high-resolution laser trim
mechanism and interwoven thread bundles fabric conductive
sheet, any restriction to fabricate the critical dimensions of
the proposed antenna that faced previous textile antennas [42],
[54] are avoided, resulting in an accurate prototype as shown
in Fig. 10(b). After the adhesion of the conductor layers with
the textile substrate, the conductive epoxy CW-2400 is used to
bond the SMA to the antenna, thanks to its excellent electrical
conductivity and strong mechanical bonds. Finally, two holes
were drilled in the substrate to build the shorting pins. There are
two main approaches introduced in the literature [51] to make
the shorting pins; the first approach uses metallic wire, while
the second uses a conductive thread to form the vias. To assess
these approaches, two prototypes of the antenna are fabricated
using the aforementioned approaches. Fig. 12(a) demonstrates
that there are no significant changes in the reflection coefficients
between the two approaches. Therefore, the second approach by
using conductive thread is selected to complete the fabrication of
the antenna array to maintain the flexibility of the textile brace.
To validate the performance of the antenna, it is tested in
the vicinity of a 3-D realistic knee phantom that was presented
recently [55]. The antenna is attached to the front of the knee
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
527
Fig. 12. Reflection coefficient of the fabricated antenna (a) different cases
to fabricate shorting pins (VIAs), (b) the fabricated antenna attached to the
phantom.
(kneecap) as adopted in Fig. 11. Then, the antenna is connected
to VNA and the reflection coefficients are measured as shown
in Fig. 12 and compared with the simulated results. A good
agreement between them is noted with a slight mismatch due
to the slight difference between the dielectric properties of the
simulated knee model and fabricated phantom. Nevertheless,
the simulated and measured results show approximately the
same operational bandwidth using −10 dB as the reference.
After validating the antenna design, the optimum number
of antenna array elements that fit an average knee curvature,
have below −20 dB coupling and cover the same operational
bandwidth is selected to be 12. Thus, a 12-element antenna
array is fabricated and assembled as illustrated in Fig. 13. As
seen in Fig. 13(e and f), the antenna array is flexible even after
inserting the SMA connectors. The proposed antenna achieves
the required balance between compact size, wide operational
bandwidth and directional pattern in addition to flexibility and
conformity to the knee joint compared to other wearable anten-
nas in the literature [16], [34], [39], [41], [52], [56].
D. Evaluation of Antenna Performance
The real part of the Poynting vector Pav (time average power
density) is used to estimate the signal propagates inside the knee
joint. It refers to the power flow per unit area at a distance from
the antenna position and it decays inversely with the distance.
The real part of the Poynting vector is calculated as [39]:
1
P av (x, y, z) = Re (E × H ∗ ) W/m2 (3)
2
 528 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021
Fig. 13. Prototype of the antenna array (12 elements), (a-d) before and after
the assembly with SMA connectors and VIAs, and (e-f) the bent views.
Fig. 14. Calculated Poynting vector at 0.9 and 1.7 GHz for the sagittal plane
(YZ) and axial plane (XY) (where the antenna is placed in XZ plane as shown
in Fig. 4(c)).
where E and H are the complex vectors of electric and magnetic
instantaneous fields at a point (x, y, z) , respectively. The real
part of the Poynting vector is calculated as shown in Fig. 14, for
the different planes of the knee joint. To evaluate the power
penetration inside human tissues, the average power density
normalized to 10 W/m2 (10 dB W/m2 ) [39], [43]. It can be
noticed that the average power density is more than 6 W/m2 at
the center of the knee (65 mm inside the knee), which indicates
sufficient penetration depth. On the other hand, the specific
absorption rate (SAR) is calculated to check the safety of using
the antenna with the standard regulation by IEEE C95.1-1999
(<2 W/kg), [57]. The maximum SAR is 0.065 W/kg (10 g)
when the input power to the antenna was 10 dBm which is well
within the safe level as per the standard [57] and means the input
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
power can be increased without significantly affect on human
safety to achieve more penetration inside the knee joint.
Since the antenna for knee imaging operates in both the near
and far fields, the near field radiation patterns are investigated
numerically and experimentally in presence of the knee model.
Numerically, the antenna is attached to the kneecap and E-field
probes are arranged along a circle with a radius r = 50 mm
that intersects the axial plane of the knee as illustrated in
Fig. 15(a). Experimentally, the MRI voxel knee model, which
was used in the numerical analysis, was converted to a CAD
model and fabricated using a 3-D printer. The fabricated model
is an anthropomorphically knee-shaped shell that is filled with
a broadband 0.29/0.71 water/glycerin homogeneous liquid to
emulate the average dielectric properties of knee tissues. The
dielectric properties of the homogeneous liquid were measured
using Keysight slim probe as shown in Fig. 15(b) and compared
to the calculated values from (1) as shown in Fig. 15(c). The
average difference between the dielectric properties of mimick-
ing liquid and calculated values from (1) is 3% and 4.5% for the
relative permittivity and conductivity, respectively.
The fabricated antenna array is attached to the knee model
to demonstrate the experimental setup which presents the real
situation for the proposed brace. One antenna and an E-field
probe are connected to the multiport VNA. The E-probe was
carried using a dynamic movable multi-section holder. More-
over, PLA holders and Acrylic base were designed and fab-
ricated to fix the proposed brace system to avoid movement
errors during the measurements as shown in Fig. 15(d). Fig. 16
illustrates the normalized simulated and measured near field at
0.9 GHz and 1.5 GHz in the XY plane. The near field radiation
patterns are symmetric, unidirectional in the Y-axis, and have
a front-to-back ratio of 14 dB. The simulated and measured
results ensure that the electromagnetic signals can penetrate
effectively into the knee tissues. The antenna achieves more
than 86% penetration efficiency (ηp ) over the whole band as
calculated using ηp = Pbody /(Pbody + Pair ), where Pbody and
Pair are the penetration power into the human body and radiated
power in free space, respectively.
IV. BRACE VALIDATION FOR KNEE INJURIES
To demonstrate the proposed brace capabilities in the real en-
vironment, different cases of ligament tears are imaged. Numer-
ical and experimental scenarios are utilized based on a numerical
knee model, and homogenous liquid and durable phantoms. This
section starts with an explanation of the utilized modified imag-
ing algorithm followed by studying different testing scenarios.
A. Electromagnetic Imaging Algorithm
The other main key in EMI is the processing algorithm, which
analyzes the received scattered signals to reconstruct the image.
The utilized algorithm is described in detail in Fig. 17. Since
left/right knees have anatomical symmetry with more than 0.98
correlation [46], [47], [58], [59], along with the fact that bilateral
ligament tears that happen simultaneously are extremely rare
[60], the differential algorithm [56, 61] between normal and
injured knee is a realistic approach to remove clutter from
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING 529

Fig. 16. Simulated and measured near-field radiation patterns of the antenna
in presence of knee models (XY plane).

where V (t) refers to the backscattered signal received at the

antenna, subscripts U and H denote to unhealthy (abnormal)
and healthy (normal), respectively, and ( ) refers to the mirror of
the matrix, while subscript m refers to the order of backscattered
signal in the scattered matrix.
A modified double-stage delay-multiply-and-sum (DS-
DMAS) algorithm is used to reconstruct knee images. Starting
from the concept of multi-static radar-based algorithms, DMAS
can be expressed as, [62], [63]:

M −1 
M
YDM AS (t) = Si (t) Sj (t) (5)
i=1 j=i+1


M −1 
M
YDM AS (t) = Si (ti (r)) Sj (tj (r))
i=1 j=i+1

= S1 (t) [S2 (t) + S3 (t) + · · · + SM (t) ]

Fig. 15. Near-field radiation pattern setup, (a) simulation setup, (b) measure-
ment system setup of homogenous knee model (liquid: Glycerin and water), (c)
dielectric properties of the liquid phantom, and (d) experimental setup of the
near-field radiation pattern.
the data and enhance detection accuracy. To do so, the left
and right knees are scanned by a 12-element antenna array,
and data are recorded in two matrices. To emulate the natural
mirror-orientation of left/right knees, one of the two matrices is
mirrored before being subtracted from the other matrix:
Sm (τ ) = VU (t) − V H (t) (4)
+ S2 (t) [S3 (t) + S4 (t) + · · · + SM (t) ]
+ ···
+ SM −1 (t) [SM (t)] (6)
where Y is the output signal after applying DMAS, M is the
total number of scattered signals, while i, and j refers to the
order of multiplied signals (To simplify the writing of equations,
each τ (r) is replaced t). After applying the multiplication, the
dimensionality of the obtained signal is squared. Therefore, the
signed square root for each signal is calculated [63] to keep the
sign of signals and the square root is used to correct the signal
dimensionality like the input signals Si or Sj . The signals after
signed term are expressed as:

YDM AS (t) = X1 (t) + X2 (t) + · · · + XM (t) (7)
where Y  is the output of DMAS after applying signed process,
X1 (t), X2 (t), . . . . XM (t) refer to terms number 1, 2, and
M, respectively in (6). A double stage concept of DMAS, it
is adapted from ultrasound imaging [64], [65] to solve the
problems of low resolution and sensitivity of DAS and DMAS
algorithms in addition to its capability to detect small and deep
targets with high contrast compared to single-stage DMAS
[64], [65], it can be expressed as follows:

M −2 M
 −1
E(t) = Xi (t)Xj (t)
i=1 j=i+1

Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
 530 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021

Fig. 17. Block diagram of the proposed imaging algorithm that combines double multiply stage and coherence factor to improve the reconstructing images.

= X1 (t)[X2 (t) + X3 (t) + · · · + XM −1 (t)]

+ X2 (t)[X3 (t) + X4 (t) + · · · + XM −1 (t)]
+ ···
+ XM −2 (t)[XM −1 (t)]

M −2
× Dk (t) (8)
k=1
Fig. 18. (a) Configuration of the proposed system in the simulation environ-
ment (a)3-D structure, (b) transverse view, and (c) transverse slice of the knee
where Dk (t) and E(t) refer to the term number k in (5) and the joint.
output signal of DS-DMAS, respectively. On the other hand,
the coherence performance of the scattered signals is taken into
consideration to improve the coherence quality of the received B. Numerical Verification of Brace System
signal [29]. The calculated coherence factor is applied to the Since the contrast between the dielectric properties of the fluid
final output signal that can be calculated as: that accumulate after tear and surrounding tissues (muscle and
bones) is high (see Fig. 3), the differential scan is helpful to
 M 2 detect ligament tear. Fig. 18 shows the numerical setup of the
M −1
i=1 j=i+1 Si (t) Sj (t) proposed brace system in presence of a realistic knee model in
CF (t) = M −1 M (9)
i=1 j=i+1 |Si (t) Sj (t)|2 the CST microwave studio. For the injured knee, different targets
of volumes (2.25 to 8 mL) representing the accumulated fluid are
ECF (t) = CF (t) E (t) (10) inserted inside the knee model to emulate different knee injuries
as listed in Table III. Fig. 19 presents the reconstructed images
where CF is the coherence factor and E refers to the output signal; using the delay and sum (DAS) and proposed algorithms. The
that represents the intensity of the signal at each focal point. higher intensity (red color) indicates the detected position of

Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING 531

TABLE III
COMPARISON BETWEEN DAS, DMAS AND DS-DMAS FOR DIFFERENT SCENARIOS

dc refers to delocalization between centers in cm.

Fig. 19. Reconstructed images from different simulated scenarios of knee

injuries. Cases (1-2) represent LCL tear, (3-4) MCL tear, (5-6) tendon tear, and
(7-8) ACL/PCL tear.

the targets, whereas the circles and squares indicate the exact
location of cylindrical and cubic targets, respectively. In con-
trast, the dark blue indicates high similarity between left/right
knee tissue, indicating healthy tissues. The reconstructed images
demonstrate that the tear location and its approximate size are
successfully detected using the proposed method compared with
significant errors or false targets when using other methods.
To investigate the impact of displacement (uncertainty in
positioning) of the brace, vertical and angular displacements are
studied as Δz and ΔΦ, respectively (see Fig. 18 for the directions
of those displacements), on cases #(1, 3, 5, 7). The created
images (Fig. 20 ) show that the system is robust to displacements
of ∼10 mm and angular rotation of 10o thanks to the fact that
Fig. 20. DS-DMAS reconstructed images for healthy (H-H) and unhealthy
knees for left/right knee asymmetry and left/right brace misalignment.
different healthy knee tissues have close values of dielectric
properties, Fig. 3(a)–(c), compared to the high contrast caused
by knee injuries. On the other hand, to study the impact of any
slight difference between the anatomical structure of the left and
right knee, the cases #3 and #7 are repeated with relatively large
+5% differences in the dielectric properties of all tissues in the
healthy knee compared to their counterpart tissues in the injured
knee. The reconstructed images in Fig. 20 confirm robustness of
the system to those differences.

Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
 532 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021

TABLE IV
ROBUSTNESS OF DS-DMAS WITH LEFT/RIGHT ASYMMETRY AND MISALIGNMENT

Fig. 22. A sample of measured S-parameters when antenna array attached on

the homogeneous knee phantom. (a) reflection coefficients and (b) transmission
coefficient between neighboring antennas.

Fig. 21. Setup of brace system; it consists of 12-element antenna array attached
to homogeneous knee phantom that connected to multiport VNA via RF cables
and PC to analyze the recorded data.

To assess quality of the generated images using the proposed

method compared to DAS and DMAS, three quantitative factors
are used [29], [56]: the first factor is the contrast ratio index CR
which refers to the mean intensity of the target region compared
to the surrounding background clutter in the reset of the knee
domain. The second factor dc is the displacement between the
center of the detected target (Cd ) region and the actual target
region in the simulated or measured environment (Ca ). The third Fig. 23. Photos of the targets that used during the measurements to emulate
knee injuries; Tm1 : a cubic of 3 × 1.5 × 5 cm3 , Tm2 : a cubic of 3 × 2.5 ×
factor is the maximum intensity ratio M IR, which refers to 5 cm3 , and Tm3 : a cylinder of 0.75 cm radius and 6 cm length.
the maximum intensity of the target (It ) region compared to
the corresponding same region of healthy-to-healthy differential
image (Ih ). MIR is used to differentiate between the healthy
cases and unhealthy cases [56]. dc = |Cd − Ca | (12)
max (It )
CR =
μt M IR = (13)
μb
(11) max (Ih )

Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING
TABLE V
COMPARISON BETWEEN DIFFERENT SCENARIOS OF KNEE INJURIES BASED ON
EMBEDDED TARGET INSIDE KNEE PHANTOM
∗ CR1 and CR2 are contrast ratios after the first and second stage, respectively. A refers
to the order of antenna.
Fig. 24. Reconstructed images of different targets with different sizes and at
different positions to emulate different cases of ligament/tendon tears.
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
533
Fig. 25. Photos for some steps for unhealthy knee phantom (right knee) (a)
The integration between tibia bone and connective tissues, (b) The integration
between femur bone, muscle, target, and tibia with connective tissue, (c) The
whole 3-D unhealthy phantom after fat and skin layers, and (d) Configuration
of proposed brace system with durable knee phantom.
Those quantitive factors are calculated for the reconstructed
images in Fig. 19 and listed in Table III, which confirms superi-
ority of the proposed DS-DMAS in detecting different targets.
Also, the reconstructed images in Fig. 20 are evaluated with
the aforementioned three quantitively factors and the results are
listed in Table IV. The values of CR and dc along with the high
values of MRI prove that the impact of those slight left/right
displacements and asymmetry are negligible compared to the
high contrast between the dielectric properties of accumulated
fluid after ligament tear and surrounding tissues.
C. Brace Verification on Homogeneous Knee Phantom
The brace is used to image a knee phantom, which is filled with
homogeneous liquid (see Section III-C). The liquid phantom was
utilized to study different sizes/locations of ligament tears that
cannot be done with rigid realistic phantoms. The embedded
antenna elements in the brace are connected to a multiport
VNA (Keysight M9037A). The system is calibrated using the
electronic calibration tool (Keysight-859xC) over the frequency
band from 0.5-2.5 GHz. Firstly, the measurements of the healthy
phantom are done and the backscattered signals are captured (see
Fig. 22). Secondly, several measurements are performed when
a target is embedded inside the homogeneous knee phantom to
emulate ligament tear at different positions. Fig. 23 illustrates
photos of different sizes and shapes of the used targets. Table
V shows the different scenarios that are carried out during the
measurements. To simplify the positioning of the target inside
the liquid, for LCL, MCL, and tendon cases, the targets are
 534 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021
Fig. 26. Results of the brace system in presence of durable phantom. (a-b)
Measured S-parameters of the antenna array in presence of durable phantom.
(c) The reconstructed image in case of ACL/PCL tear in durable phantom.
fixed close to the edge of the phantom, while the multi-section
holder (see Fig. 15(d)) is used to fix the targets in case of ACL/
PCL. The presented algorithm is then used to produce knee
images as presented in Fig. 24. It is clear that the targets are
detected and localized with significant contrast compared to the
surrounding knee medium. The calculated metrics confirm the
ability of the modified algorithm to detect all targets with high
contrast compared to a single-stage DMAS as listed in Table V.
The system not only has the ability to detect shallow tears, but
it has also the ability to detect deeper targets like cases 7 and 8
(see Table V).
D. Brace Verification on Durable Knee Phantoms
Two 3-D durable realistic knee phantoms based on epoxy
resin, graphite, aluminum oxide powder, and isopropanol ma-
terials were fabricated and sued to verify the capability of the
system. The fabricated phantoms consist of four main groups
are bones, connective tissues, muscle, and skin. One of those
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
phantoms, which represents a healthy knee, is the same one
that was presented recently by the authors in [55] whilst the
other one represents an unhealthy knee with ACL/PCL tear that
was fabricated with the same procedure in [55] as shown in
Fig. 25(a-c). To emulate the Haematoma fluid deposition after
a ligament tear, distilled water was used because accumulating
fluid after ligament injury is mainly water [2], [50]. A polylactic
acid (PLA) target container was manufactured as a hollow sphere
of 0.25 mm wall thickness and 10 mm radius and filled with
approximately 4 mL of distilled water. The target is embedded
inside the phantom during the fabrication process in the position
of ACL/PCL tear, which is a common and serious knee injury
(see Fig. 25(c)).
A photograph of the experimental setup is shown in Fig. 25(d).
The healthy and unhealthy phantoms were scanned sequentially,
4 times to ensure the reliability of measurements. The measured
S-parameters of the proposed antenna array in presence of the
unhealthy durable knee phantom are shown in Fig. 26(a) and
(b). The reconstructed image in the case of the durable phantom
(see Fig. 26(c)) has a high contrast at the target location with a
contrast ratio of 11.79 compared to the healthy tissues. On the
other hand, the detected target has a slight shift of dc = 0.45 cm
from the actual position of the target.
V. CONCLUSION
A wearable electromagnetic brace imaging system for the
early detection of knee connective tissues’ tear onsite has been
introduced. The brace is comprised of a twelve-element antenna
array that is knee matched to achieve compact size and improved
penetration. The unidirectional antenna utilizes a dual-slot loop
and matched stubs and is fabricated on textile wool felt ma-
terial to achieve wide operational bandwidth and conformity
with knee curvature. The brace is evaluated numerically and
experimentally on realistic phantoms with different types and
stages of ligaments/tendon tear. A modified double stage DMAS
combined with coherence factor and differential left/right knee
imaging is used to reconstruct knee images in different sce-
narios of ligament and tendon tears. The reconstructed images
demonstrate brace capability of detecting shallow and deep knee
injuries at early stages as it can detect accumulated fluid of
1.3 mL at the location of ACL/PCL and 1.1 mL at the loca-
tion of MCL/LCL/Tendon which are less than the accumulated
fluid in the first grade of ligaments tear. The proposed portable
electromagnetic brace can be used at home, sports fields, and
clinics, making it easy to detect and manage early injuries and
avoid serious consequences. Since it is wearable, it can be used
for knee monitoring.
REFERENCES
[1] Mayo clinic knee injuries. Oct. 2020. [Online]. Available: https:
//www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-
causes/syc-20350738
[2] F. R. Noyes, Knee Disorders : Surgery, Rehabilitation, Clinical Outcomes.
St. Louis, MO, USA: Elsevier, 2016.
[3] A. B. Yanke and B. J. Cole, Joint Preservation of the Knee : A Clinical
Casebook. Cham, Switzerland: Springer, 2019.
 SULTAN et al.: TEXTILE ELECTROMAGNETIC BRACE FOR KNEE IMAGING
[4] P. Volpi, Football Traumatology: New Trends, 2nd ed., Springer Int. Pub-
lishing: Imprint: Springer, Springer Cham Heidelberg New York Dordrecht
London, 2015.
[5] R. T. M. D. M. P. H. Forsch, S. H. M. D. P. Little, and C. M. D. Williams,
“Laceration repair: A practical approach,” Amer. Fam. Physician, vol. 95,
no. 10, pp. 628–636A, 2017.
[6] D. Zbrojkiewicz, C. Vertullo, and J. E. Grayson, “Increasing rates of an-
terior cruciate ligament reconstruction in young australians, 2000–2015,”
Med. J. Aust., vol. 208, no. 8, pp. 354–358, Jan.-May 2018.
[7] A. Pennock, M. Murphy, and M. Wu, “Anterior cruciate ligament recon-
struction in skeletally immature patients,” Curr. Rev. Musculoskelet. Med.,
vol. 9, no. 4, pp. 445–453, 2016.
[8] M. Grle, I. Grle, G. Vrgoc, and G. Sporis, “Diagnosis of acute knee injury
comparison of the results of clinical examination, MRI and arthroscopy
save clinical tests from extinction,” Arastirma Makalesi, vol. 8, no. 2,
pp. 96–102, 2019.
[9] N. Phelan, P. Rowland, R. Galvin, and J. O’Byrne, “A systematic review
and meta-analysis of the diagnostic accuracy of MRI for suspected ACL
and meniscal tears of the knee,” Knee Surg., Sports Traumatol., Arthrosc.,
vol. 24, no. 5, pp. 1525–1539, 2016.
[10] C. Smith et al., “Diagnostic efficacy of 3-T MRI for knee injuries
using arthroscopy as a reference standard: A meta-analysis,” Amer. J.
Roentgenol., vol. 207, no. 2, pp. 369–377, 2016.
[11] N. Orlando Júnior, M. G. d. S. Leão, and N. H. C. d. Oliveira, “Diagnosis
of knee injuries: Comparison of the physical examination and magnetic
resonance imaging with the findings from arthroscopy,” Revista Brasileira
de Ortopedia, vol. 50, no. 6, pp. 712–719, 2015.
[12] A. Naghibi and A. R. Attari, “Near-field radar-based microwave imaging
for breast cancer detection: A study on resolution and image quality,” IEEE
Trans. Antennas Propag., vol. 69, no. 3, pp. 1670–1680, Mar. 2021.
[13] D. O. Rodriguez-Duarte, J. A. T. Vasquez, R. Scapaticci, L. Crocco, and
F. Vipiana, “Assessing a microwave imaging system for brain stroke mon-
itoring via high fidelity numerical modelling,” IEEE J. Electromagn., RF
Microw. Med. Biol., to be published, doi: 10.1109/JERM.2020.3049071.
[14] H. L. Zhang et al., “A low-profile compact dual-band L-shape monopole
antenna for microwave thorax monitoring,” IEEE Antennas Wireless
Propag. Lett., vol. 19, no. 3, pp. 448–452, Mar. 2020.
[15] M. Klemm, J. A. Leendertz, D. Gibbins, I. J. Craddock, A. Preece, and
R. Benjamin, “Microwave radar-based breast cancer detection: Imaging in
inhomogeneous breast phantoms,” IEEE Antennas Wireless Propag. Lett.,
vol. 8, pp. 1349–1352, Nov. 2009.
[16] A. S. M. Alqadami, K. S. Bialkowski, A. T. Mobashsher, and A. M.
Abbosh, “Wearable electromagnetic head imaging system using flexible
wideband antenna array based on polymer technology for brain stroke
diagnosis,” IEEE Trans. Biomed. Circuits Syst., vol. 13, no. 1, pp. 124–134,
Feb. 2019.
[17] A. S. M. Alqadami, A. Trakic, A. E. Stancombe, B. Mohammed,
K. Bialkowski, and A. Abbosh, “Flexible electromagnetic cap for
head imaging,” IEEE Trans. Biomed. Circuits Syst., vol. 14, no. 5,
pp. 1097–1107, Oct. 2020.
[18] A. E. Omer et al., “Non-Invasive real-time monitoring of glucose level
using novel microwave biosensor based on triple-pole CSRR,” IEEE Trans.
Biomed. Circuits Syst., vol. 14, no. 6, pp. 1407–1420, Dec. 2020.
[19] E. Porter, E. Kirshin, A. Santorelli, M. Coates, and M. Popovic, “Time-
domain multistatic radar system for microwave breast screening,” IEEE
Antennas Wireless Propag. Lett., vol. 12, pp. 229–232, Feb. 2013.
[20] L. Kranold, M. Taherzadeh, F. Nabki, M. Coates, and M. Popovic, “Mi-
crowave breast screening prototype: System miniaturization with IC pulse
radio,” IEEE J. Electromagn., RF Microw. Med. Biol., vol. 5, no. 2,
pp. 168–178, Jun. 2021.
[21] P. M. Meaney, D. Goodwin, A. Golnabi, M. Pallone, S. Geimer, and K. D.
Paulsen, “3D microwave bone imaging,” in Proc. 6th Eur. Conf. Antennas
Propag., Prague, Czech Republic, Mar. 2012, pp. 1770–1771.
[22] B. Amin, A. Shahzad, M. O’Halloran, and M. A. Elahi, “Microwave bone
imaging: A preliminary investigation on numerical bone phantoms for
bone health monitoring,” Sensors, vol. 20, no. 21, pp. 1–20, 2020.
[23] M. Johnson, “Acute knee effusions: A systematic approach to diagnosis,”
Amer. Fam. Physician, vol. 61, no. 8, pp. 2391–2400, 2000.
[24] A. M. Kiapour, J. T. Sieker, B. L. Proffen, T. T. Lam, B. C. Fleming, and
M. M. Murray, “Synovial fluid proteome changes in ACL injury-induced
posttraumatic osteoarthritis: Proteomics analysis of porcine knee synovial
fluid,” PLoS ONE, vol. 14, no. 3, 2019, Art. no. e0212662.
[25] S. M. Salvador, E. C. Fear, M. Okoniewski, and J. R. Matyas, “Microwave
imaging of the knee: Application to ligaments and tendons,” in Proc. IEEE
MTT-S Int. Microw. Symp. Dig., Jun. 2009, pp. 1437–1440.
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
535
[26] S. M. Salvador, E. C. Fear, M. Okoniewski, and J. R. Matyas, “Exploring
joint tissues with microwave imaging,” IEEE Trans. Microw. Theory
Techn., vol. 58, no. 8, pp. 2307–2313, Aug. 2010.
[27] S. M. Salvador, E. C. Fear, M. Okoniewski, and J. R. Matyas, “Microwave
imaging of the knee: On sensitivity, resolution and multiple tears detec-
tion,” in Proc. 13th Int. Symp. Antenna Technol. Appl. Electromagn. Can.
Radio Sci. Meeting, Feb. 2009, pp. 1–4.
[28] K. Root, I. Ullmann, F. Seehaus, and M. Vossiek, “A feasibility study on
the use of microwave imaging for in-vivo screening of knee prostheses,”
in Proc. IEEE/MTT-S Int. Microw. Symp., Aug. 2020, pp. 655–658.
[29] M. A. Elahi et al., “Evaluation of image reconstruction algorithms for con-
focal microwave imaging: Application to patient data,” Sensors, vol. 18,
no. 6, pp. 1–21, May 23, 2018.
[30] M. Hopfer, R. Planas, A. Hamidipour, T. Henriksson, and S. Semenov,
“Electromagnetic tomography for detection, differentiation, and monitor-
ing of brain stroke: A virtual data and human head phantom study,” IEEE
Antennas Propag. Mag., vol. 59, no. 5, pp. 86–97, Oct. 2017.
[31] M. Ambrosanio, P. Kosmas, and V. Pascazio, “A multithreshold iterative
DBIM-based algorithm for the imaging of heterogeneous breast tissues,”
IEEE Trans. Biomed. Eng., vol. 66, no. 2, pp. 509–520, Feb. 2019.
[32] Z. Miao and P. Kosmas, “Multiple-frequency DBIM-TwIST algorithm for
microwave breast imaging,” IEEE Trans. Antennas Propag., vol. 65, no. 5,
pp. 2507–2516, May 2017.
[33] M. Moosazadeh, S. Kharkovsky, J. T. Case, and B. Samali, “Improved radi-
ation characteristics of small antipodal vivaldi antenna for microwave and
millimeter-wave imaging applications,” IEEE Antennas Wireless Propag.
Lett., vol. 16, pp. 1961–1964, Apr. 2017.
[34] M. Rokunuzzaman, A. Ahmed, T. C. Baum, and W. S. T. Rowe, “Compact
3-D antenna for medical diagnosis of the human head,” IEEE Trans.
Antennas Propag., vol. 67, no. 8, pp. 5093–5103, Aug. 2019.
[35] A. T. Mobashsher and A. M. Abbosh, “Compact 3-D slot-loaded folded
dipole antenna with unidirectional radiation and low impulse distortion
for head imaging applications,” IEEE Trans. Antennas Propag., vol. 64,
no. 7, pp. 3245–3250, Jul. 2016.
[36] A. E. Stancombe, K. S. Bialkowski, and A. M. Abbosh, “Portable mi-
crowave head imaging system using software-defined radio and switching
network,” IEEE J. Electromagn., RF Microw. Med. Biol., vol. 3, no. 4,
pp. 284–291, Dec. 2019.
[37] M. Z. Mahmud, M. T. Islam, N. Misran, S. Kibria, and M. Samsuz-
zaman, “Microwave imaging for breast tumor detection using unipla-
nar AMC based CPW-fed microstrip antenna,” IEEE Access, vol. 6,
pp. 44763–44775, Aug. 2018.
[38] K. S. Sultan and B. Mohammed, “Compressed higher order modes slot
loaded trapezoidal antenna for electromagnetic imaging,” in Proc. 4th Aust.
Microw. Symp., Feb. 2020, pp. 1–2.
[39] H. Bahramiabarghouei, E. Porter, A. Santorelli, B. Gosselin, M. Popović,
and L. A. Rusch, “Flexible 16 antenna array for microwave breast cancer
detection,” IEEE Trans. Biomed. Eng., vol. 62, no. 10, pp. 2516–2525,
Oct. 2015.
[40] I. M. Saied and T. Arslan, “Noninvasive wearable RF device towards
monitoring brain atrophy and lateral ventricle enlargement,” IEEE J.
Electromagn., RF Microw. Med. Biol., vol. 4, no. 1, pp. 61–68, Mar. 2020.
[41] I. Saied, T. Arslan, S. Chandran, C. Smith, T. Spires-Jones, and S. Pal,
“Non-invasive RF technique for detecting different stages of Alzheimer’s
disease and imaging beta-amyloid plaques and tau tangles in the brain,”
IEEE Trans. Med. Imag., vol. 39, no. 12, pp. 4060–4070, Dec. 2020.
[42] E. F. N. M. Hussin, P. J. Soh, M. F. Jamlos, H. Lago, and A. A. Al-
Hadi, “Wideband microstrip-based wearable antenna backed with full
ground plane,” Int. J. RF Microw. Comput.-Aided Eng., vol. 29, no. 7,
pp. 21739–21750, 2019.
[43] A. S. M. Alqadami, N. Nguyen-Trong, B. Mohammed, A. E. Stancombe,
M. T. Heitzmann, and A. Abbosh, “Compact unidirectional conformal
antenna based on flexible high-permittivity custom-made substrate for
wearable wideband electromagnetic head imaging system,” IEEE Trans.
Antennas Propag., vol. 68, no. 1, pp. 183–194, Jan. 2020.
[44] I. M. Saied, S. Chandran, and T. Arslan, “Integrated flexible hybrid
silicone-textile dual-resonant sensors and switching circuit for wearable
neurodegeneration monitoring systems,” IEEE Trans. Biomed. Circuits
Syst., vol. 13, no. 6, pp. 1304–1312, Dec. 2019.
[45] E. Porter, H. Bahrami, A. Santorelli, B. Gosselin, L. A. Rusch, and
M. Popovic, “A wearable microwave antenna array for time-domain breast
tumor screening,” IEEE Trans. Med. Imag., vol. 35, no. 6, pp. 1501–1509,
Jun. 2016.
[46] K.-M. Jang et al., “Three-dimensional evaluation of similarity of right and
left knee joints,” Knee Surg. Related Res., vol. 29, no. 4, pp. 307–315,
2017.
 536 IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS, VOL. 15, NO. 3, JUNE 2021
[47] E. Y. Young, J. Gebhart, D. Cooperman, and N. U. Ahn, “Are the left
and right proximal femurs symmetric?” Clin Orthopaedics Related Res.,
vol. 471, no. 5, pp. 1593–1601, 2013.
[48] IT’IS. Human models. [Online]. Available: itis.swiss/virtual-population/
virtual-population/overview/
[49] S. Gabriel, “The dielectric properties of biological tissues: II. measure-
ments in the frequency range 10 hz to 20 ghz,” Phys. Med. Biol., vol. 41,
no. 11, pp. 2251–2269, 1996.
[50] J.-H. Zhang, “Artificial synovial fluid,” in Encyclopedia of Tribology,
Q. J. Wang and Y.-W. Chung Eds. Boston, MA, USA: Springer, 2013,
pp. 110–113.
[51] S. J. Chen, “Flexible, wearable and reconfigurable antennas based on
novel conductive materials: Graphene, polymers and textiles,” Res. Thesis,
School Elect. Electron. Eng., PhD thesis, Australia, Univ. Adelaide, 2017.
[52] X. Y. Lin, Y. F. Chen, Z. Gong, B. C. Seet, L. Huang, and Y. L. Lu, “Ul-
trawideband textile antenna for wearable microwave medical imaging ap-
plications,” IEEE Trans. Antennas Propag., vol. 68, no. 6, pp. 4238–4249,
Jun. 2020.
[53] M. J. Alexander, “Capacitive matching of microstrip patch antennas,” IEE
Proc. H - Microw., Antennas Propag., vol. 136, no. 2, pp. 172–174, 1989.
[54] K. N. Paracha, S. K. A. Rahim, P. J. Soh, and M. Khalily, “Wear-
able antennas: A review of materials, structures, and innovative fea-
tures for autonomous communication and sensing,” IEEE Access, vol. 7,
pp. 56694–56712, Apr. 2019.
[55] K. S. Sultan, B. Mohammed, P. Mills, and A. Abbosh, “Anthropomor-
phic durable realistic knee phantom for testing electromagnetic imaging
systems,” IEEE J. Electromagn., RF Microw. Med. Biol., vol. 5, no. 2,
pp. 132–138, Jun. 2021.
[56] L. Kranold and M. Popovic, “RF radar breast health monitoring: System
evaluation with post-biopsy marker,” IEEE J. Electromagn., RF Microw.
Med. Biol., vol. 5, no. 2, pp. 148–154, Jun. 2021.
[57] IEEE Standard for Safety Levels With Respect to Human Exposure to Radio
Frequency Electromagnetic Fields, 3 kHz to 300 GHz, IEEE Standard
C95.1, Apr. 1999.
[58] B. Wissussek, J. Feiser, S. Gick, D. Pennig, J. Koebke, and J. Dargel,
“Side differences in human knee joints-An anatomical study,” Orthopaedic
Proc., vol. 93-B, no. SUPP_II, pp. 117–117, 2011.
[59] J. Dargel, J. Feiser, M. Gotter, D. Pennig, and J. Koebke, “Side differences
in the anatomy of human knee joints,” Knee Surg., Sports Traumatol.,
Arthroscopy, vol. 17, no. 11, pp. 1368–1376, 2009.
[60] E. Saadat, E. J. Curry, X. Li, and E. G. Matzkin, “Bilateral simultaneous
anterior cruciate ligament injury: A case report and national survey of
orthopedic surgeon management preference,” Orthopedic Rev., vol. 6,
no. 4, pp. 5551–5551, 2014.
[61] A. M. Abbosh, B. Mohammed, and K. S. Bialkowski, “Differential mi-
crowave imaging of the breast pair,” IEEE Antennas Wireless Propag. Lett.,
vol. 15, pp. 1434–1437, Dec. 2015.
[62] H. B. Lim, N. T. T. Nhung, E. Li, and N. D. Thang, “Confocal mi-
crowave imaging for breast cancer detection: Delay-multiply-and-sum
image reconstruction algorithm,” IEEE Trans. Biomed. Eng., vol. 55, no. 6,
pp. 1697–1704, Jun. 2008.
[63] G. Matrone, A. S. Savoia, G. Caliano, and G. Magenes, “The delay multiply
and sum beamforming algorithm in ultrasound B-mode medical imaging,”
IEEE Trans. Med. Imag., vol. 34, no. 4, pp. 940–949, Apr. 2015.
[64] M. Mozaffarzadeh, A. Mahloojifar, M. Orooji, S. Adabi, and M. Nasiri-
avanaki, “Double-stage delay multiply and sum beamforming algorithm:
Application to linear-array photoacoustic imaging,” IEEE Trans. Biomed.
Eng., vol. 65, no. 1, pp. 31–42, Jan. 2018.
[65] M. Mozaffarzadeh, M. Sadeghi, A. Mahloojifar, and M. Orooji, “Double-
stage delay multiply and sum beamforming algorithm applied to ultrasound
medical imaging,” Ultrasound Med. Biol., vol. 44, no. 3, pp. 677–686,
2018.
Authorized licensed use limited to: INDIAN INSTITUTE OF TECHNOLOGY ROORKEE. Downloaded on September 12,2021 at 10:24:39 UTC from IEEE Xplore. Restrictions apply.
Kamel S. Sultan (Student Member, IEEE) received
the B.Sc. degree in electronics and electrical commu-
nication engineering from the University of Menofia,
Shibin Al Kawm, Egypt, in 2009, and the M.Sc.
degree from Cairo University, Giza, Egypt, in 2014.
He is currently working toward the Ph.D. degree with
the EMAGIN Group, School of Information Tech-
nology and Electrical Engineering, The University of
Queensland, Brisbane, QLD, Australia. From 2010 to
2015, he was a Research Assistant with Electronics
Research Institute, Cairo, Egypt, and from 2015 to
2018, with the Zewail City for Science and Technology, Giza, Egypt. From 2011
to 2018, he was a Member of four projects funded by different funding agencies
more than 8 years. His main research interests include biomedical applications,
microwave imaging, design and implementation of antennas, antenna arrays,
dielectric resonator antennas, automotive radar antennas, microwave devices,
and feeding networks.
Ahmed Mahmoud received the Bachelor of Physio-
therapy degree from The University of Queensland,
Brisbane, QLD, Australia, the Doctor of Medicine
degree from Griffith University, Nathan, QLD, Aus-
tralia, and the Master of Surgery degree from The
University of Sydney, Sydney, NSW, Australia. He is
currently a Trainee of orthopaedic surgery. He has a
special interest in knee surgery and has multiple pub-
lications on the topics of meniscus transplantation,
anterior cruciate reconstruction and electromagnetic
imaging. He is a Reviewer for Arthroscopy, The Jour-
nal of Arthroscopic and Related Surgery.
Amin M. Abbosh (Senior Member, IEEE) received
the higher Doctorate (Doctor of Engineering) degree
from The University of Queensland, Brisbane, QLD,
Australia, in 2013, as recognition of the international
research standing. He is currently leading the Electro-
magnetic Innovations Group and the Head of School
at ITEE School, The University of Queensland. He
has authored more than 400 papers on electromag-
netic imaging systems, wideband passive microwave
devices, and planar antennas. He won IEEE APS King
Prize Paper Award twice.