Review Article

https://doi.org/10.1038/s41928-021-00589-7

Metasurfaces for bioelectronics and healthcare

Zhipeng Li 1
, Xi Tian , Cheng-Wei Qiu
1 1 ✉ and John S. Ho 1,2,3 ✉

Bioelectronic systems typically rely on radiofrequency wireless components to interface with the human body, but such compo-
nents are bulky and energy-demanding, which limits the performance of the systems. Metasurfaces—artificial two-dimensional
materials with subwavelength structure—can be engineered to control electromagnetic fields around the human body and could
be used to overcome the current limitations of bioelectronic interfaces. Here we review the development of metasurfaces for
bioelectronics, and explore their potential for application in current and emerging healthcare technologies. We examine the use
of metasurfaces to control electromagnetic fields in the vicinity of the human body, and discuss their application in microwave
imaging, magnetic resonance imaging, biosensors, body networks and wireless power transfer. We also consider developments
in materials science and artificial intelligence that can enhance the properties of metasurfaces for bioelectronics.

W
ireless technologies are widely used in bioelectronic miniaturized, robust and high-performance wireless bioelectronic
devices for diagnostics and therapy1–3. An early example components for sensing and therapy.
is the first implantable pacemaker, built in 1958, which Metasurfaces are flat electromagnetic devices that are structured
incorporated a radiofrequency coil for inductive wireless charging4. at subwavelength scale with metallic or dielectric inclusions13,14 and
Today, wireless power transfer is used in implantable biomedical offer unique properties that can complement, and in some cases
devices, including cochlear implants that assist hearing5 and reti- replace, conventional components for bioelectronics (Table 1). First,
nal implants that can restore sight6. Devices that are worn on or metasurfaces can amplify or suppress interactions between biological
implanted in the body also rely on wireless technologies to com- matter and electromagnetic fields at the deep subwavelength scale15.
municate with the external world. Examples of such devices include Second, metasurfaces can engineer the electromagnetic properties of
wearable health monitors that notify family when abnormalities are radiofrequency devices and freely manipulate the amplitude, phase
detected7, ingestible cameras that can transmit diagnostic images of and polarization of electromagnetic wavefronts16. Third, they can be
the gastrointestinal tract8 and implanted spinal cord stimulators that fabricated in flat, compact and flexible formats17 that could poten-
are remotely adjusted by patients for optimal pain relief9. Recent tially be placed near otherwise inaccessible physiological regions,
developments in sensors and mobile computing have enabled addi- and be integrated into wearable or implantable devices.
tional functionalities and wearable devices that sense, track and In this Review, we examine recent advances in metasurfaces that
transmit physiological signals in real time to provide rich data sets can manipulate electromagnetic fields around, on and in the human
about human health. The widespread acceptance of these devices by body (Fig. 1). We discuss the design and features of these metasur-
clinicians and patients has empowered patients to remotely moni- faces, and their applications in medical imaging, sensor networks,
tor their health and receive care electronically, outside traditional wireless sensing and wireless power transfer (Fig. 1b–f). We also
healthcare settings. identify emerging functionalities of metasurfaces for bioelectronics
Radiofrequency techniques are the dominant wireless technol- based on recent advances in materials science and artificial intel-
ogy used for bioelectronic applications due to their relative safety ligence (Table 2).
and maturity, but other modalities are also being actively explored10.
These systems use components such as antennas, waveguides and Controlling fields around the body
phased arrays to control the propagation of electromagnetic fields10, Metasurfaces could potentially be integrated into our everyday
which are usually the largest and most energy-demanding part of a environments18 to monitor physiological signals and help under-
bioelectronic device and thus determine the safety and efficacy of stand and manage chronic conditions wherever and whenever they
the system. However, the human body is a lossy, heterogeneous and occur. For example, metasurfaces installed in homes may be able to
dispersive medium, presenting major challenges for wireless tech- continuously measure physiological motions to detect elderly falls
nologies. Biological tissues, in particular, absorb electromagnetic and notify family, or identify asthma attacks and reveal underlying
radiation, which must be within safety limits to prevent adverse environmental factors19. Challenges remain in optimizing the size,
thermal or stimulatory effects11. Because tissue absorption increases power consumption and computational demands of metasurfaces20,
with higher electromagnetic field frequencies, an operating fre- although innovations in algorithms and low-power electronics
quency of less than 5 GHz is required to access regions deep in the can help lower their cost. Rigorous evaluation will also be needed
body12. However, this requirement also limits the miniaturization to show that they can provide sufficient accuracy and precision to
of the components and the ability to focus the electromagnetic field benefit patients.
because the wavelength in biological tissues exceeds a centimetre
at such frequencies. Furthermore, the human body is in constant Microwave imagers. Microwave imaging can provide informa-
motion and its size and composition greatly vary between individu- tion about objects through walls and clothing without ionizing
als. These features present formidable challenges for the design of radiation. It is widely used for security screening applications, and

Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore. 2The N.1 Institute for Health, National
1

University of Singapore, Singapore, Singapore. 3Institute for Health Innovation and Technology, National University of Singapore, Singapore, Singapore.
✉e-mail: chengwei.qiu@nus.edu.sg; johnho@nus.edu.sg

382 Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics

NaTure ElecTronics Review Article
reasonable scan times, methods to increase the signal-to-noise ratio
Table 1 | Applications of metasurfaces for bioelectronics (SNR) of the measured radiofrequency nuclear magnetic resonance
Electromagnetic Application Enhancement
signal are needed. Metasurfaces could potentially improve the signal
control by directly manipulating the radiofrequency field around the body
to increase the SNR in a particular region of interest. In particular,
Around the body Microwave imaging Resolution and speed they can resonantly enhance the field strength, as well as spatially
Power consumption redistributing the magnetic field to increase the coupling between
Compactness
the region of interest and the radiofrequency coils. Because of their
MRI SNR and speed flat profiles, metasurfaces can be placed near the surface of the body
On the body Biosensors Sensitivity for maximum sensitivity without causing obvious discomfort and
Operating range can be used with existing MRI scanners and pulse sequences with
Body sensor networks Power consumption compatible operating frequency. Metasurfaces are also complemen-
Data rate tary to other approaches for increasing the sensitivity of MRI, such
Security and privacy as using a larger static magnetic field31, multiple receiver coils32,33
and dielectric pads34, and have been recently demonstrated in
In the body Wireless power transfer Transfer efficiency
human trials35, which highlighted their potential for clinical use in
Operating range
demanding imaging applications.
Robustness
Most reported metasurfaces for enhancing MRI are passive
devices that alter the radiofrequency field over the physiological
area of interest. An early example is a metasurface comprised of a
is also the basis for clinical sleep monitoring21 and fall detection22 14 × 2 wire array of metallic wires exhibiting a fundamental Fabry–
technologies owing to its ability to detect physiological activity, Perot resonance at 63.8 MHz (Fig. 2c)36. MRI scans of a biological
including small motions arising from respiration and heartbeat. specimen showed that the SNR was enhanced by more than two-
Conventional designs for microwave imagers are based on phased fold compared with the case without the metasurface. Similar signal
arrays, which require a large number of antennas and complicated enhancement has also been achieved using negative-permeability
feeding networks. As a result, their cost, power consumption and metasurfaces composed of split-ring resonators37. To accommodate
data processing demands are currently prohibitive for many practi- the curved surface of the human body, flexible metasurfaces for MRI
cal applications23,24. have been developed. For example, a head-conforming metasurface
Metasurfaces can be used to build microwave imagers that meet consisting of thin conductor strips on a high-permittivity substrate
the speed, resolution and cost requirements for health monitor- (CaTiO3) was used to enhance brain imaging in an ultrahigh-field
ing25. In one approach, the metasurfaces act as passive apertures MRI system (Fig. 1c)38. When placing the metasurface near the
that generate spatially diverse illumination patterns that vary with occipital cortex, the SNR of the image was enhanced by 50%, cor-
frequency, which are used for image reconstruction after compu- responding to a twofold decrease in the total scan time. In vivo
tational analysis25. This frequency scanning operation can remove imaging with a metasurface resonator at 1.5 T improved the local
the need for the mechanical aperture scanning in conventional radiofrequency transmission efficiency by a factor of 3.3 (ref. 39).
approaches and requires only a single active antenna. An early dem- Similarly to other approaches that rely on non-volumetric receivers,
onstration of the concept used a metasurface aperture consisting of an inherent limitation is that the SNR degrades with depth.
passive microstrip lines (acting as waveguides) loaded with com- To optimize image quality, reconfigurable metasurfaces can be
plementary electric inductor–capacitor metamaterial elements26, used to tailor the local field to the curvature and composition of
where each element functions as a resonator coupling microwaves the region of interest. For example, a hybrid dielectric and metal-
from the guided mode to free space, allowing different radiation lic metasurface with dynamically tunable effective permittivity was
patterns to be generated. The concept was also implemented for implemented by controlling the water level at the edges of a wire
imaging at the human scale27, on the basis of a metasurface design array40. The metasurface could enhance the SNR of an MR image
comprising 24 transmit and 72 receive panels that generate dis- of a grapefruit by 7.6-fold through the optimization of the coupling
tinct illumination patterns as the operating frequency was varied between the metasurface’s eigenmodes and the MRI system’s radio-
from 17.5 to 26.5 GHz. Computational reconstruction of the scene frequency coils. Nonlinear reconfigurable metasurfaces have also
revealed hidden threat objects on a mannequin relevant to security been used to tune the response during the imaging process41. In this
applications (Fig. 2a). design, a helical array was loaded with a varactor (Fig. 2d) that sup-
Reconfigurable metasurfaces, based on programmable unit cells presses the resonance of the metamaterial during the pulse trans-
that dynamically shape electromagnetic fields, can achieve faster mission phase; it recovers during the reception phase to provide
and higher-resolution imaging compared with approaches based on selective enhancement of the magnetic field. These demonstrations
frequency scanning, but require active control28. An imager based suggest the potential of adaptive and reconfigurable metasurfaces
on reconfigurable metasurfaces was developed for real-time imag- that can optimize signal reception in real time to improve imaging
ing and recognition of human body poses (Fig. 2b)29. This meta- resolution and scan times.
surface consisted of digitally programmable meta-atoms—based on
subwavelength-scale square metallic patches that are connected via Controlling electromagnetic fields on the body
a PIN diode—and used machine learning to extract information Metasurfaces can address limitations in wireless communication
from a scene. The metasurface could also be used to manipulate and the interconnection of sensor networks by manipulating elec-
ambient Wi-Fi signals to produce images of the entire human body. tromagnetic fields on the surface of the body. Furthermore, the
These imaging capabilities were used to perform body pose recog- structures can be made to conform on the body surface or be inte-
nition and respiration monitoring, which could have broad applica- grated into clothing for unobtrusive use during daily life.
tions in home-based health monitoring19.
Wireless biosensors. Wireless biosensors can measure a wide range
Magnetic resonance imaging (MRI). MRI is a versatile and ion- of physiological parameters, including respiration, heart rate, body
izing radiation-free medical imaging technique prominently used temperature, pulse oxygenation, blood pressure and blood glu-
in diagnostic medicine30. To acquire high-resolution images within cose42, and transmit the data to patients and doctors. To remove

Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics 383

Review Article NaTure ElecTronics

a Electromagnetic control

Around the body On the body In the body

b Microwave imaging c MRI d Body sensor networks e Wireless biosensors f Wireless power transfer

Fig. 1 | Metasurfaces in bioelectronic applications. a, Metasurfaces can manipulate electromagnetic fields around, on and within the human body
to enhance the diagnostic or therapeutic function of bioelectronic systems. b–f, Examples of healthcare technologies that exploit the capabilities of
metasurfaces include microwave imaging (b), MRI (c), body sensor networks (d), wireless biosensors (e) and wireless power transfer (f). Figure adapted
with permission from: b, ref. 27, under a Creative Commons license CC BY 4.0; c, ref. 38, under a Creative Commons license CC BY 4.0; d, ref. 56, Springer
Nature Ltd; e, ref. 46, Wiley; f, ref. 74, Springer Nature Ltd.

temperature from the wrist46. Passive arrays of resonators fabricated

Table 2 | Emerging research directions in metasurfaces for on soft substrates have also been used for mapping pressure inside
bioelectronics the body47 and for monitoring intracranial pressure in mice when
wirelessly coupled to an external readout coil (Fig. 3b). These sen-
Area Emerging
sors, however, rely on near-field coupling to an external device and
applications
have a maximum readout range of only a few centimetres.
Electromagnetic Polarization control Orientation invariance Metasurfaces that operate in the far-field may provide a platform
control Temporal control Non-reciprocity for battery-free biosensors that communicate with distant wireless
Nonlinearity Frequency conversion devices. Far-field metasurfaces have been previously explored in
the context of ‘chipless’ radiofrequency identification (RFID) tags.
Reconfigurability Motion adaption Whereas conventional RFID tags rely on an integrated circuit to
Materials Flexible and stretchable Wearability generate a temporal backscattering identifier, chipless RFID tags are
materials Conformability based on electromagnetic structures with unique scattering signa-
Bioresponsive materials Biochemical sensing tures48. For example, metasurfaces with sharp frequency-selective
Artificial intelligence Inverse design Personalization reflections can be used to encode identification bit sequences
through the presence and absence of resonant peaks in the reflection
Data interpretation Classification spectrum49. They can also provide distinct polarization responses,
Medical diagnosis
such as cross-polarized reflection, to enable the signal from the
Adaptive control Closed-loop therapy RFID to be distinguished from the background50. These scattering
signatures may be engineered to respond to physiological signals
for low-cost and potentially disposable wireless sensors. Because no
the need for batteries, passive wireless telemetry techniques can be batteries or fragile silicon components are used, such sensors could
employed for the remote readout of data from a battery-free sen- be fabricated on flexible substrates suitable for mounting on the skin
sor. Most telemetry approaches are based on the resonant sensor or incorporated into clothing51. Challenges include distinguishing
architecture, where the physiological parameter of interest produces the reflection of the metasurface from that of the background, and
shifts in the resonant frequency of the sensor’s capacitive or induc- designing sensors that can transduce small physiological signals
tive circuit43. Several wireless pressure sensors are based on this into large changes in conductivity or dielectric permittivity.
architecture, including medical devices that can be inserted into the
heart for heart failure detection44 and contact lenses for monitoring Body sensor networks. Multiple wearable sensors can form a net-
glaucoma45. work of connected devices—called a body sensor network—that can
Resonant sensors can be arranged in arrays reminiscent of meta- continuously track physiological signals and transmit data to a cen-
surfaces to provide wireless sensing at multiple locations (Fig. 3a,b). tral hub to support health monitoring and clinical decision-making.
Skin-mounted sensors comprising an array of bilayered split-ring Wireless communication is essential to interconnect sensor nodes
resonators have been used to wirelessly monitor pressure, sweat and without cumbersome wires, but the reflection and absorption of

384 Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics

NaTure ElecTronics Review Article
Microwave imagers MRI
a c

b Choke inductance d
PIN 3
PIN 2
PIN 1
Substrate
Via
hole

Ground

Real-time
metasurface Varactor
imager

Fig. 2 | Metasurfaces for electromagnetic control around the body. a, A human-scale microwave imager. The metasurface consists of 24 transmit and
72 receive frequency-diverse panels, which can acquire images for security screening. b, A real-time, reconfigurable metasurface imager operating at
around 3 GHz. Following an initial training step, a machine learning algorithm was used to identify configurations of the meta-atoms that generate radiation
patterns that are superior to random projection for extracting information from the scene. c, A metasurface for enhancing MRI. Images show the SNR
when imaging a fish with and without the metasurface. d, A reconfigurable metasurface for adaptive MRI. Images show the SNR when imaging an onion
with and without the metasurface. A 15-fold enhancement of SNR was achieved using a metasurface. Figure adapted with permission from: a, ref. 27, under
a Creative Commons license CC BY 4.0; b, ref. 29, under a Creative Commons license CC BY 4.0; c, ref. 36, Wiley; d, ref. 41, Wiley.

electromagnetic waves by the human body present major obstacles plasmon-like modes have been incorporated into clothing covering
for radiofrequency signal transmission52. Metasurfaces that can the upper body (Fig. 3d). These textiles allow 2.4–2.5 GHz wireless
control the propagation of electromagnetic fields on the surface of signals emitted by devices near the clothing to propagate as surface
the body can be used to overcome these challenges and enable new waves confined within 10 cm of the body56. The use of this metama-
sensor network functionalities. terial textile can increase the signal transmission efficiency between
Metasurfaces can enable more compact and efficient wearable two sensors on the body by up to three orders of magnitude com-
antennas. An important use of metasurfaces is to provide a func- pared with radiative transmission. In addition, networks that are
tional plane between the antenna and human skin that both reduces wirelessly interconnected by the metamaterial textiles can provide
tissue absorption and acts as a reflector to increase high antenna functionalities in wireless power transfer and touch sensing (Fig. 3d).
gain. Metasurface concepts relevant for this purpose include electro- Such textiles can also be designed to redirect the propagation of sig-
magnetic band-gap structures, high-impedance surfaces and artifi- nals around the torso to provide a near-omnidirectional radiation
cial magnetic conductors. For example, using arrays of alternating pattern for a wearable wireless device, overcoming the obstruction
high- and low-dielectric-permittivity regions, band-gap structures of the human body52. Clothing integrated with metamaterial tex-
have been used to prevent radiation from wearable devices in the tiles is potentially robust to washing, sweat and daily use because
direction of the human body53. The flat profile of such ground-plane they do not involve fragile silicon components or wired connectors.
structures has been used to realize a flexible antenna that can con- However, losses associated with sharp corners and proximity to bio-
form to non-planar body surfaces while maintaining stable gain logical tissues remain challenges, and further evaluation is needed
and impedance54 (Fig. 3c). Reconfigurable wearable antennas based to establish their long-term reliability.
on metasurfaces with reconfigurable elements, such as loaded vias Wearable metasurfaces that provide enhanced wireless connec-
and switchable stubs, have also been developed55. Such antennas tivity may open opportunities for mapping physiological param-
can, for example, switch between an omnidirectional radiation pat- eters across the body. Such physiological maps can provide more
tern desirable for the communication between sensor nodes and a detailed health information than conventional wearables, which
broadside radiation pattern that favours communication with an measure parameters from a single anatomical location. For exam-
external device. ple, wireless and battery-free sensors based on near-field commu-
Metasurfaces fabricated from conductive textiles can also be nication have been used to create full-body spatiotemporal maps
used to enable wireless signals to propagate along the surface of of the temperature and pressure distribution for monitoring circa-
the body instead of radiating into surrounding space. This strategy dian rhythms and mitigating risk of pressure-induced ulcers dur-
can enhance the energy efficiency of radiative wireless communi- ing sleep57. Another example is non-invasive monitoring of systolic
cation and limit its vulnerability to eavesdropping. Metamaterial blood pressure, which can be achieved by synchronously measur-
textiles comprising comb-shaped patterns that support surface ing the pulse arrival time and pulse transit time from multiple

Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics 385

Review Article NaTure ElecTronics

Wireless biosensors Body sensor networks

a c
Sweat sensing 0
0
–5
Temperature
sensor –10

S11 (dB)

S11 (dB)
Increase time
–4 –15
Pressure Time (min) Free space
sensor 0 –20 On chest
Sweat 1
sensor 5 On leg
–25 On arm
10
–8
0.8 1.0 1.2 –30
1.50 1.75 2.00 2.25 2.50 2.75 3.00
Frequency (GHz)
Frequency (GHz)

b d
Pressure mapping Touch S2 Touch S1

Humidity (%) Temperature (°C)

0.25 32
0 mm Hg s3 S1
0.20 50 mm Hg S2
s4
0.15 s1
GDD (ns)

s4 s2 0.10 22
s2
0 2 4 6 8 10
0.05 80
s1
0
s3
–0.05
–0.10
50
4,000 5,000 6,000 7,000
0 2 4 6 8 10
Frequency (MHz)
Time (min)

Fig. 3 | Metasurfaces for electromagnetic control on the body. a, A wearable wireless biosensor. The sensor consists of split-ring resonators that convert
changes in sweat, pressure and temperature into resonant frequency shifts. These resonators feature a hydrogel interlayer, whose dielectric permittivity
varies with the physiological parameters, and each sensor can be individually addressed through its unique resonant frequency. b, A soft wireless pressure
sensor array. The array maps pressure through shifts in multiple resonances. c, A metasurface-based antenna for wearable wireless communications. The
metasurface ground plane enables robust operation when worn on different parts of the body. d, A metasurface textile for body sensor networks. The
conductive textile design supports surface plasmon-like modes that enable wireless signals to efficiently propagate between sensor nodes. Figure adapted
with permission from: a, ref. 46, Wiley; b, ref. 47, Springer Nature Ltd; c, ref. 54, IEEE; d, ref. 56, Springer Nature Ltd.

biosensors placed on the chest and limb. A wireless and battery-free as an alternative approach, operating with electromagnetic waves at
system for monitoring core vital signs in a neonatal and paediatric gigahertz frequencies, which propagate deeper and are compatible
intensive care unit has been demonstrated using this approach58. with miniaturized antennas60. Tissue absorption and the efficiency
The operation of such multinode networks, however, has so far been limits of subwavelength antennas, however, pose fundamental chal-
limited to patients in close proximity to a readout coil integrated in lenges for this approach. Leveraging the wide use of ultrasound in
a hospital bed. Clothing integrated with metasurfaces and advanced clinical imaging62, ultrasonic techniques have emerged as an attrac-
electromagnetic structures could facilitate the exchange of data and tive modality for a wireless power transfer63. This approach ben-
power across the body, and open new opportunities for mapping efits from the lower attenuation of ultrasound in biological tissues
physiological signals relevant to health during daily activity. compared with electromagnetic waves64 and shorter wavelengths,
which provides smaller resonant dimensions and improved capac-
Controlling electromagnetic fields in the body ity for focusing. However, reflections at soft–hard tissue interfaces
Metasurfaces can systematically control electromagnetic fields and losses related to electroacoustic conversion, including sensitiv-
within the body to wirelessly interface with implanted or ingested ity to orientation, are major challenges65. Photonic techniques have
bioelectronic devices. Furthermore, they can manipulate inter- also been explored for wireless power transfer66, although optical
actions between radiofrequency waves and biological tissues for scattering has so far limited the operating depth to less than a cen-
non-invasive sensing and therapy. timetre even at near-infrared wavelengths67. Although all of these
approaches are active areas of research, we focus here on the use of
Wireless power transfer. Power is a fundamental bottleneck for metasurfaces for radiofrequency wireless power transfer.
implantable devices that limits the operating lifetime and available Near-field metasurfaces can be used to extend the range of wire-
range of function. Today, most clinically used devices are pow- less power transfer. These designs generally exploit the collective
ered by an on-board battery, which occupies a large portion of the resonances of multiple unit cells to enhance wireless power transfer
device’s volume and needs to be surgically replaced when depleted59. from the transmitter to the receiver with efficiency greater than that
Wireless power transfer can overcome these challenges by enabling of conventional coil-based relays68. For example, a wearable meta-
the battery to be remotely recharged, or in some cases removed alto- surface composed of a dual-layer structure of square spirals was
gether60. Near-field inductive coupling has been used for wireless used to increase magnetic coupling between an external transmitter
power transfer since the first implantable pacemaker and remains coil and an implant at 3 mm depth under the skin69. Beyond power
the dominant approach for powering devices more than a centimetre transfer efficiency, clinical applications also require techniques to
in size, such as cochlear implants. However, because this approach ensure a reliable supply of power under a wide range of conditions.
is based on the near-field, it suffers from inherently low efficien- Nonlinear parity–time symmetry has recently been shown to pro-
cies when the device dimensions are much smaller than the oper- vide robust wireless power transfer without the need for manual
ating depth61. Mid-field wireless power transfer has been explored tuning of system parameters70, and might be applied to near-field

386 Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics

NaTure ElecTronics Review Article
a b c d

Electronic
control
system

Varactor
diode Varactor
diodes

y
Bias lines X

Fig. 4 | Metasurfaces for electromagnetic control in the body. a, A conformal metasurface for wireless power transfer. When excited from a single port,
mutual coupling between the rings resonates with the reactive loads, resulting in a phase response that was optimized for wireless power transfer at about
5 cm depth in tissue. b, A reconfigurable metasurface for manipulating electromagnetic focusing. The metasurface consists of an array of copper strips
printed on a copper-backed dielectric substrate. c, A metasurface-integrated microwave imager for breast tumour detection. d, A flexible metasurface
for wearable microwave imaging. Figure adapted with permission from: a, ref. 74, Springer Nature Ltd; b, ref. 75, APS; c, ref. 79, under a Creative Commons
license CC BY 4.0; d, ref. 80, IEEE.

metasurfaces. These designs are, in principle, compatible with many Communication. Metasurfaces have been used to enhance wireless
clinically used wireless power transfer systems, but testing is needed communication between devices in the body and the external world.
to establish potential clinical advantages over the current standard. In one approach, metasurfaces were used to eliminate the imped-
Metasurfaces that operate at low-gigahertz frequencies have ance mismatch between free space and the body, which accounts
been employed to focus electromagnetic energy in the vicinity of for more than 80% of total transmission loss from an implanted
the microdevice for wireless power transfer. In contrast to induc- device emitting in the 100 MHz to 10 GHz frequency range76,77. In
tive wireless power transfer, this approach operates in the mid-field contrast to dielectric matching layers, the thickness of these meta-
(distance comparable to the wavelength in tissue), where both the surfaces can be deeply subwavelength (less than 1 cm), enabling the
evanescent and propagating components of the field are dominant71. metasurfaces to be placed on the body as a flexible adhesive patch
In this regime, the distribution of electromagnetic energy within the or even integrated into clothing78. However, practical use of such
body can be controlled by interfering components of the field radi- metasurfaces will require design techniques to address the variabil-
ated by different elements to improve the efficiency of power trans- ity of the tissue composition between different body regions and
fer to the implanted device72. While this can be accomplished using individuals as well as uncertainty in the angle and polarization of
multiple antennas placed on the surface of the body, such phased the electromagnetic wave.
arrays are generally very complex and bulky because they rely on
phase-control circuitry. In addition, the mutual coupling between Imaging, localization and hyperthermia therapy. Microwave
adjacent antennas limits the spatial phase resolution of such arrays imaging inside the body is of clinical interest for cancer detection,
and thus the optimal shaping of the field within the body, which has stroke monitoring and other diagnostic applications because of the
a much higher dielectric permittivity than free space73. To overcome large difference in dielectric permittivity between normal and path-
this challenge, a conformal metasurface (Fig. 4a) based on reactive ological tissues27,29. Metasurfaces can be used to realize high-gain
loading elements to control the spatial phase distribution of the elec- and low-profile imaging antennas that provide highly directive
tromagnetic field in the body was designed74. The metasurface was transmission into the body. For example, an array of 16 microstrip
fabricated on a soft substrate and could be placed on curved body antennas loaded by index-zero metasurfaces (Fig. 4c) was used to
surfaces with minimal distortion of the generated field pattern for improve imaging resolution in a breast phantom79. To circumvent
moderate curvatures comparable to those of the adult human torso. the reflection of radiofrequency waves from the air–tissue interface,
Experiments in a porcine animal model demonstrated the wireless conformal metasurfaces have been applied for brain stroke diag-
transfer of 0.45 mW to a light-emitting microdevice (1.5 mm diame- nosis80. This design consisted of a head-mounted antenna array in
ter, 3 mm length) at a depth of 4.3 cm under safety limits correspond- which the antenna elements are 4 × 4 radiating patches with an elec-
ing to less than 1 °C heating of the skin. This level of power transfer tromagnetic band-gap metamaterial reflector fabricated on a soft
was sufficient to activate a wireless stimulator of the same dimensions polydimethylsiloxane substrate (Fig. 4d). Using an array of eight
inserted into the heart using a catheter, and regulate cardiac rhythm such antenna elements, confocal microscopy imaging experiments
in an adult pig74. However, a limitation of the design is that the phases demonstrate the ability to detect abnormalities within a head phan-
imposed by the metasurface are fixed and cannot be reprogrammed tom80. Several clinical trials have demonstrated increasing evidence
in real time to adapt to variations in the tissue environment. of the contrast in dielectric properties of healthy and cancerous tis-
Reconfigurable metasurfaces have been explored for wireless sue, although variations in the design of microwave imaging sys-
power transfer in free space. Using programmable electronic ele- tems still impede adoption into clinical practice81.
ments, such metasurfaces can adaptively optimize the field distribu- In applications ranging from endoscopy8 and inductor–capaci-
tion to maintain high powering efficiency in dynamic environments. tor biosensors82 to drug delivery systems83, accurate localization is
For example, a metasurface capable of creating microwave focal important to diagnose diseases and deliver therapeutics at the cor-
spots with desired number and positions has been developed rect anatomical location. Metasurfaces can be used to improve the
(Fig. 4b)75. Programmable voltage-controlled varactor diodes were localization of implantable and ingestible devices within the body.
used to reconfigure the phase profile and control the position of the Compared with imaging methods based on ultrasound, magnets
focal point. Reconfigurable metasurfaces that can be conformally and X-rays84, which require relatively complex equipment, radio-
placed over the surface of the body could provide near-complete con- frequency localization is based on low-cost receivers and can be
trol over the electromagnetic field for efficient and robust powering. combined with wireless data transmission. Most radiofrequency

Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics 387

Review Article NaTure ElecTronics
Electromagnetic functionalities Materials AI metasurfaces
a b c
Reconfigurability Polarization control Flexibility/stretchablility AI design
LCP RCP LCP Device generation Device filtering and
topology refinement
Iteration 1
800
400

me
3 0 Final design
a e2 e1
Fr
Fr
am
Fr
am Incidence 0 40 80
Output ‘0’ Abs. efficiency
Output ‘1’ Additional data for GAN training

Time-varying control Nonlinearity Chemical response AI control

Holography Color printing 0
Ph 1 Ph
as 3 2 as
em 4 em
od 5 od
ula 6 ula
tio 8 tio
n n
H2 9

O2

ω – Δω ω ω + Δω Classifier Imaging

Fig. 5 | Emerging research directions. a, Electromagnetic functionalities such as reconfigurability, polarization control, time-varying control and nonlinearity
can create more robust wireless interfaces with bioelectronics. LCP, left-handed circular polarization; RCP, right-handed circular polarization. ω, operating
frequency; Δω, modulation frequency. b, Flexible, stretchable and chemically responsive materials can address challenges in integration and sensing.
c, Artificial intelligence (AI) can be used to design metasurfaces and control their reconfigurable elements to adapt to changing physiological environments.
GAN, generative adversarial network. Figure adapted with permission from: a (top left), ref. 115; a (bottom right), ref. 97; b (top left), ref. 17; b (bottom), ref. 106,
under a Creative Commons license CC BY 4.0; a (top right), ref. 96, Wiley; a (bottom left), ref. 98; c (bottom), ref. 113, AAAS; b (top right), ref. 116; c (top), ref. 111,
American Chemical Society.

localization techniques are based on triangulation of the device Full electromagnetic control. Despite impressive progress in
position using multiple receiver antennas placed around the body, reconfigurable metasurfaces, achieving full control of the electro-
with various propagation models to account for variations in the magnetic field in the vicinity of the human body remains a chal-
tissue properties85–87. Reconfigurable metasurfaces with dense lenge. In particular, current designs have a limited number of unit
arrays of unit cells could increase the effective number of receiving cells and degree of tunability due to the complexity of the control
antennas to improve the localization in real time. Negative-index circuitry. New circuits and control architectures, such as mechanical
metasurfaces have also been developed to focus electromagnetic actuation, phase-change materials and optical control, may provide
fields beyond the diffraction limit88, including in disordered media. higher resolution and tunability95. Dynamic control of the polar-
Such concepts may be applied in the medium of the human body ization response could potentially address important challenges
to enable localization with subwavelength resolution. An alternative related to the uncertain orientation of bioelectronic devices worn
localization concept is based on microdevices that can vary their on or implanted in the body. These concepts have been explored
transmission frequency in proportion to applied magnetic field gra- in optical16 and radiofrequency metasurfaces96, but have not been
dients, in analogy to magnetic spins in MRI89. The advantages that widely implemented in bioelectronic wireless systems. In addition,
metasurfaces offer for MRI may be translated here for enhancing emerging concepts in nonlinear97 and time-varying98 metasur-
local reception of the radiofrequency field36,38,41. faces can introduce novel features based on Doppler shifts, bro-
Microwaves are clinically used in cancer hyperthermia therapy to ken Lorentz reciprocity and time-reversed fields. Such phenomena
thermally increase perfusion for drug uptake, stimulate the immune could potentially increase the sensitivity of biosensors, allow the
response and/or directly destroy cancer cells, often in combination control of multiple bioelectronic devices and achieve power transfer
with radiotherapy90,91. Metasurfaces have been explored for improv- to moving devices.
ing the therapeutic application of microwaves by focusing them to Due to the scale invariance of Maxwell’s equations, many of the
selectively heat the tumours while minimizing damage to healthy powerful capabilities developed for optical metasurfaces can be
tissues. Left-handed and zero-index metamaterials have been theo- translated to radiofrequencies for application to bioelectronics13,14.
retically analysed for microwave hyperthermia92,93. In particular, However, fundamental differences beyond the scaling of the wave-
a left-hand metamaterial lens92 has been used to focus microwave length exist between metasurfaces in the optical and radiofrequency
fields (2.45 GHz) into a tissue region 1 cm in width and 1.2 cm in regimes. For example, metals with excellent conductivity are readily
depth and elevate the temperature above 42 °C. The use of meta- available at radiofrequencies, but dielectric materials are preferred
surfaces in microwave therapy is currently in the exploratory stage at optical frequencies because of the high loss exhibited by metals13.
and has so far been limited to theoretical and numerical studies92. In addition, optical metasurfaces can exploit the molecular selectiv-
However, they are of increasing interest in view of recent advances ity of light in interacting with biological matter99, while the ability of
in precision nanomedicine, particularly metallic nanoparticles that radiofrequency metasurfaces to analyse the molecular composition
have strong radiofrequency absorption94. of tissues and organs is limited. Conversely, the penetration depth
of light is limited to about a centimetre in biological tissue, even
Outlook at near-infrared wavelengths67, whereas radio waves can penetrate
To address the challenges involved in the development of many centimetres into the body.
metasurface-based bioelectronics, innovations on terms of circuit
design and materials will be required. Advances in artificial intel- Functional materials. In contrast to conventional radiofrequency
ligence can also optimize the design of metasurfaces and enhance components, metasurfaces designed for bioelectronics need to be
their functionality. flexible and even stretchable to comfortably interface with the human

388 Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics

NaTure ElecTronics Review Article
body100. Materials and layouts developed for flexible electronics radio-wave components in biomedical applications, including med-
provide important fabrication strategies for realizing flexible meta- ical imaging and wireless power transfer. In particular, metasurfaces
surfaces. Metasurfaces can be fabricated on plastic (polyimide, poly- offer optimized control of electromagnetic waves in and around the
ethylene terephthalate), elastomeric (ecoflex, polydimethylsiloxane) body for connected personal healthcare systems. Recent develop-
and textile substrates100 using a wide variety of processes, including ments have illustrated the potential of these structures for the inte-
direct printing and transfer printing101. Due to the relatively long gration of bioelectronics with the body, and the design of devices
wavelength, the resolution requirements are substantially less strin- for wireless health monitoring and therapy. However, further testing
gent than for most electronic and optical applications. Conductors will be needed to verify their use for medical purposes.
that are intrinsically rigid, such as copper, gold and aluminium, can
be made flexible through the structural mechanics of motifs such Received: 30 August 2020; Accepted: 22 April 2021;
as serpentine lines, helical coils and open meshes102. However, the Published online: 14 June 2021
associated inductances and capacitances need to be incorporated
into the electromagnetic design. Intrinsically flexible conductive References
materials, such as conductive polymers, hydrogels and ionogels, 1. Goodman, R. & Blank, M. Insights into electromagnetic interaction
mechanisms. J. Cell. Physiol. 192, 16–22 (2002).
are promising material candidates for metasurfaces, although their 2. Pasek, J., Pasek, T., Sieroń-Stołtny, K., Cieślar, G. & Sieroń, A.
relatively low conductivity remains a major limitation100. Poly(3, Electromagnetic fields in medicine—the state of art. Electromagn. Biol. Med.
4-ethylenedioxythiophene) polystyrenesulfonate (PEDOT:PSS), 35, 170–175 (2016).
in particular, has one of the highest conductivities among conduc- 3. Polk, C. & Postow, E. Handbook of Biological Effects of Electromagnetic
tive polymers and has been explored for use in flexible antennas103. Fields (CRC Press, 1995).
4. Elmqvist, R. & Senning, A. An implantable pacemaker for the heart. In
Liquid metals are also noteworthy in that they are both intrinsically Proceedings of the Second International Conference on Medical Electronics,
flexible and have excellent conductivity. They have been used to real- Paris (ed. Smyth, C. N.) 27 (Iliffe, 1959).
ize microfluidic reconfigurable antennas, pressure sensing fibres and 5. Zeng, F.-G., Rebscher, S., Harrison, W., Sun, X. & Feng, H. Cochlear
fabric-integrated transmission lines104. In addition, composites of implants: system design, integration, and evaluation. IEEE Rev. Biomed.
inorganic conductive materials in soft polymeric matrices are widely Eng. 1, 115–142 (2008).
6. Weiland, J. D. & Humayun, M. S. Visual prosthesis. Proc. IEEE 96,
being studied for flexible electronics, and can achieve both flexible 1076–1084 (2008).
mechanics and high conductivity at radiofrequencies105. 7. Wu, G. & Xue, S. Portable preimpact fall detector with inertial sensors.
Functional materials can also enable sensing by transducing bio- IEEE Trans. Neural Syst. Rehabil. Eng. 16, 178–183 (2008).
chemical quantities into changes in the electromagnetic response of 8. Iddan, G., Meron, G., Glukhovsky, A. & Swain, P. Wireless capsule
a metasurface. For example, hydrogels whose dielectric permittivity endoscopy. Nature 405, 417–417 (2000).
9. Samineni, V. K. et al. Fully implantable, battery-free wireless optoelectronic
changes with the pressure or the presence of sweat produce wirelessly devices for spinal optogenetics. Pain 158, 2108 (2017).
detectable shifts in the resonance frequency of the unit cells46. Using 10. Pozar, D. M. Microwave Engineering (Wiley, 2011).
magnesium pixelated cavities, a chemically tunable optical metasur- 11. Lin, J. C. A new IEEE standard for safety levels with respect to human
face has been demonstrated for hydrogenation-induced switching exposure to radio-frequency radiation. IEEE Antennas Propag. Mag. 48,
between different display modes106. Functionalized two-dimensional 157–159 (2006).
12. Poon, A. S., O’Driscoll, S. & Meng, T. H. Optimal frequency for wireless
materials, including graphene and transition-metal dichalcogenides, power transmission into dispersive tissue. IEEE Trans. Antennas Propag. 58,
may be used to build capacitive or resistive sensors that are sensi- 1739–1750 (2010).
tive to the biological environment, such as the presence of patho- 13. Glybovski, S. B., Tretyakov, S. A., Belov, P. A., Kivshar, Y. S. & Simovski, C. R.
genic bacteria107. Biodegradable metasurfaces that disappear after Metasurfaces: from microwaves to visible. Phys. Rep. 634, 1–72 (2016).
14. Zhang, L., Mei, S., Huang, K. & Qiu, C. W. Advances in full control
their functional lifetime can also be made from materials that are
of electromagnetic waves with metasurfaces. Adv. Opt. Mater. 4,
transient in biological media, such as magnesium, silk and cellulose. 818–833 (2016).
Such materials may be used to avoid the need for retrieval of devices 15. Willets, K. A. & Van Duyne, R. P. Localized surface plasmon resonance
that are implanted in the body108. Conversely, self-healing electronic spectroscopy and sensing. Annu. Rev. Phys. Chem. 58, 267–297 (2007).
materials that can repair damage could be used to fabricate meta- 16. Arbabi, A., Horie, Y., Bagheri, M. & Faraon, A. Dielectric metasurfaces for
complete control of phase and polarization with subwavelength spatial
surfaces that are robust and last longer when worn on the body109,110. resolution and high transmission. Nat. Nanotechnol. 10, 937–943 (2015).
17. Wu, K., Coquet, P., Wang, Q. J. & Genevet, P. Modelling of free-form
Artificial intelligence. Generative adversarial neural networks conformal metasurfaces. Nat. Commun. 9, 3494 (2018).
have been explored for inverse design of metasurfaces, in which 18. Liaskos, C. et al. A new wireless communication paradigm through
designs are automatically generated from a desired input–output software-controlled metasurfaces. IEEE Commun. Mag. 56, 162–169 (2018).
19. Li, L. et al. Intelligent metasurface imager and recognizer. Light Sci. Appl. 8,
relationship111,112 (Fig. 5c). Such algorithms may facilitate rapid pro- 97 (2019).
totyping or even personalized designs that address the variability in 20. Yoo, I., Imani, M. F., Pulido-Mancera, L., Sleasman, T. & Smith, D. R.
tissue structure between individuals. Recent developments in deep Analytic model of a coax-fed planar cavity-backed metasurface antenna for
neural networks have yielded remarkable success in medical image pattern synthesis. IEEE Trans. Antennas Propag. 67, 5853–5866 (2019).
analysis. Similar techniques may be leveraged to perform classifi- 21. Liu, X., Cao, J., Tang, S. & Wen, J. Wi-Sleep: Contactless sleep monitoring
via WiFi signals. In 2014 IEEE Real-Time Systems Symposium 346–355
cation and diagnosis with data obtained from metasurface-based (IEEE, 2014).
monitoring devices, which are generally multidimensional in time, 22. Wang, Y., Wu, K. & Ni, L. M. Wifall: device-free fall detection by wireless
frequency and range113. Finally, reinforcement learning techniques networks. IEEE Trans. Mob. Comput. 16, 581–594 (2016).
may be used for optimal control reconfigurable metasurfaces in 23. Fear, E. C., Hagness, S. C., Meaney, P. M., Okoniewski, M. & Stuchly, M. A.
tasks such as power transfer, tracking and sensing in the presence of Enhancing breast tumor detection with near-field imaging. IEEE Microw.
Mag. 3, 48–56 (2002).
uncertainty29. Intelligent metasurfaces may be essential components 24. Meaney, P. M., Fanning, M. W., Li, D., Poplack, S. P. & Paulsen, K. D. A
in envisioned ‘closed-loop’ therapies in which bioelectronic devices clinical prototype for active microwave imaging of the breast. IEEE Trans.
are used to sense abnormalities and deliver the appropriate treat- Microw. Theory Tech. 48, 1841–1853 (2000).
ment without human intervention114. 25. Imani, M. F. et al. Review of metasurface antennas for computational
microwave imaging. IEEE Trans. Antennas Propag. 68, 1860–1875 (2020).
26. Hunt, J. et al. Metamaterial apertures for computational imaging. Science
Conclusions 339, 310–313 (2013).
Because of their versatility and compactness, metasurfaces can pro- 27. Gollub, J. et al. Large metasurface aperture for millimeter wave
vide functionalities that are not possible with conventional bulky computational imaging at the human-scale. Sci. Rep. 7, 42650 (2017).

Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics 389

Review Article NaTure ElecTronics
28. Tsilipakos, O. et al. Toward intelligent metasurfaces: the progress from 57. Han, S. et al. Battery-free, wireless sensors for full-body pressure and
globally tunable metasurfaces to software‐defined metasurfaces with an temperature mapping. Sci. Transl. Med. 10, eaan4950 (2018).
embedded network of controllers. Adv. Opt. Mater. 8, 2000783 (2020). 58. Chung, H. U. et al. Skin-interfaced biosensors for advanced wireless
29. Li, L. et al. Machine-learning reprogrammable metasurface imager. physiological monitoring in neonatal and pediatric intensive-care units.
Nat. Commun. 10, 1082 (2019). Nat. Med. 26, 418–429 (2020).
30. Lauterbur, P. C. Image formation by induced local interactions: examples 59. Mond, H. G. & Proclemer, A. The 11th World Survey of Cardiac Pacing
employing nuclear magnetic resonance. Nature 242, 190–191 (1973). and Implantable Cardioverter‐Defibrillators: calendar year 2009—a
31. Hartwig, V. et al. Biological effects and safety in magnetic resonance World Society of Arrhythmia’s project. Pacing Clin. Electrophysiol. 34,
imaging: a review. Int. J. Environ. Res. Public Health 6, 1778–1798 (2009). 1013–1027 (2011).
32. Mueller, M. F. et al. Double spiral array coil design for enhanced 3D 60. Lee, P. M., Xiong, Z. & Ho, J. Methods for powering bioelectronic
parallel MRI at 1.5 Tesla. Concepts Magn. Reson. B 35, 67–79 (2009). microdevices. Bioelectron. Med. 1, 201–217 (2018).
33. Roemer, P. B., Edelstein, W. A., Hayes, C. E., Souza, S. P. & Mueller, O. M. 61. Hannan, M. A., Mutashar, S., Samad, S. A. & Hussain, A. Energy harvesting
The NMR phased array. Magn. Reson. Med. 16, 192–225 (1990). for the implantable biomedical devices: issues and challenges. Biomed. Eng.
34. Teeuwisse, W. M., Brink, W. M. & Webb, A. G. Quantitative assessment of Online 13, 79 (2014).
the effects of high‐permittivity pads in 7 Tesla MRI of the brain. Magn. 62. Sinisterra, J. Application of ultrasound to biotechnology: an overview.
Reson. Med. 67, 1285–1293 (2012). Ultrasonics 30, 180–185 (1992).
35. Shchelokova, A. et al. Enhancement of magnetic resonance imaging with 63. Hinchet, R. et al. Transcutaneous ultrasound energy harvesting using
metasurfaces: From concept to human trials. In 2017 11th International capacitive triboelectric technology. Science 365, 491–494 (2019).
Congress on Engineered Materials Platforms for Novel Wave Phenomena 64. Charthad, J. et al. A mm-sized wireless implantable device for electrical
(Metamaterials) 31–33 (IEEE, 2017). stimulation of peripheral nerves. IEEE Trans. Biomed. Circuits Syst. 12,
36. Slobozhanyuk, A. P. et al. Enhancement of magnetic resonance imaging 257–270 (2018).
with metasurfaces. Adv. Mater. 28, 1832–1838 (2016). 65. Nelson, B. D., Karipott, S. S., Wang, Y. & Ong, K. G. Wireless technologies
37. Freire, M. J., Marques, R. & Jelinek, L. Experimental demonstration of a for implantable devices. Sensors 20, 4604 (2020).
μ = −1 metamaterial lens for magnetic resonance imaging. Appl. Phys. Lett. 66. Goto, K., Nakagawa, T., Nakamura, O. & Kawata, S. An implantable power
93, 231108 (2008). supply with an optically rechargeable lithium battery. IEEE Trans. Biomed.
38. Schmidt, R., Slobozhanyuk, A., Belov, P. & Webb, A. Flexible and compact Eng. 48, 830–833 (2001).
hybrid metasurfaces for enhanced ultra high field in vivo magnetic 67. Jelínková, H. Lasers for Medical Applications: Diagnostics, Therapy and
resonance imaging. Sci. Rep. 7, 1678 (2017). Surgery (Elsevier, 2013).
39. Shchelokova, A. V. et al. Experimental investigation of a metasurface 68. Wang, B. et al. Experiments on wireless power transfer with metamaterials.
resonator for in vivo imaging at 1.5 T. J. Magn. Reson. 286, 78–81 (2018). Appl. Phys. Lett. 98, 254101 (2011).
40. Shchelokova, A. V. et al. Locally enhanced image quality with tunable 69. Li, L., Liu, H., Zhang, H. & Xue, W. Efficient wireless power transfer system
hybrid metasurfaces. Phys. Rev. Appl. 9, 014020 (2018). integrating with metasurface for biological applications. IEEE Trans. Ind.
41. Zhao, X., Duan, G., Wu, K., Anderson, S. W. & Zhang, X. Intelligent Electron. 65, 3230–3239 (2017).
metamaterials based on nonlinearity for magnetic resonance imaging. 70. Assawaworrarit, S., Yu, X. & Fan, S. Robust wireless power
Adv. Mater. 31, 1905461 (2019). transfer using a nonlinear parity–time-symmetric circuit. Nature 546,
42. Pantelopoulos, A. & Bourbakis, N. G. A survey on wearable sensor-based 387–390 (2017).
systems for health monitoring and prognosis. IEEE Trans. Syst. Man 71. Kim, S., Ho, J. S. & Poon, A. S. Midfield wireless powering
Cybern. C 40, 1–12 (2009). of subwavelength autonomous devices. Phys. Rev. Lett. 110,
43. Huang, Q.-A., Dong, L. & Wang, L.-F. LC passive wireless sensors 203905 (2013).
toward a wireless sensing platform: status, prospects, and challenges. 72. Hui, S. Y. R., Zhong, W. & Lee, C. K. A critical review of recent progress in
J. Microelectromech. Syst. 25, 822–841 (2016). mid-range wireless power transfer. IEEE Trans. Power Electron. 29,
44. Heywood, J. T. et al. Impact of practice-based management of pulmonary 4500–4511 (2013).
artery pressures in 2000 patients implanted with the CardioMEMS sensor. 73. Wu, L., McGough, R. J., Arabe, O. A. & Samulski, T. V. An RF phased array
Circulation 135, 1509–1517 (2017). applicator designed for hyperthermia breast cancer treatments. Phys. Med.
45. Dunbar, G. E., Shen, B. Y. & Aref, A. A. The Sensimed Triggerfish contact Biol. 51, 1 (2005).
lens sensor: efficacy, safety, and patient perspectives. Clin. Ophthalmol. 11, 74. Agrawal, D. R. et al. Conformal phased surfaces for wireless powering of
875 (2017). bioelectronic microdevices. Nat. Biomed. Eng. 1, 0043 (2017).
46. Dautta, M. et al. Multi‐functional hydrogel‐interlayer RF/NFC resonators as 75. Ratni, B. et al. Dynamically controlling spatial energy distribution
a versatile platform for passive and wireless biosensing. Adv. Electron. with a holographic metamirror for adaptive focusing. Phys. Rev. Appl. 13,
Mater. 6, 1901311 (2020). 034006 (2020).
47. Chen, L. Y. et al. Continuous wireless pressure monitoring and mapping 76. Nikolayev, D., Zhadobov, M., Karban, P. & Sauleau, R. Electromagnetic
with ultra-small passive sensors for health monitoring and critical care. radiation efficiency of body-implanted devices. Phys. Rev. Appl. 9,
Nat. Commun. 5, 5028 (2014). 024033 (2018).
48. Finkenzeller, K. RFID Handbook: Fundamentals and Applications in 77. Yang, F., Lee, P. M., Dong, Z., Tian, X. & Ho, J. S. Enhancing wireless
Contactless Smart Cards, Radio Frequency Identification and Near-Field transmission from the body with wearable diffractive patterns. Phys. Rev.
Communication (Wiley, 2010). Appl. 12, 054020 (2019).
49. Preradovic, S. & Karmakar, N. C. Chipless RFID: bar code of the future. 78. Genovesi, S., Butterworth, I. R., Serrallés, J. E. C. & Daniel, L. Metasurface
IEEE Microw. Mag. 11, 87–97 (2010). matching layers for enhanced electric field penetration into the human
50. Andriamiharivolamena, T., Vena, A., Perret, E., Lemaitre-Auger, P. & body. IEEE Access 8, 197745–197756 (2020).
Tedjini, S. Chipless identification applied to human body. In 2014 IEEE 79. Islam, M. T., Samsuzzaman, M., Kibria, S., Misran, N. & Islam, M. T.
RFID Technology and Applications Conference (RFID-TA) 241–245 Metasurface loaded high gain antenna based microwave imaging using
(IEEE, 2014). iteratively corrected delay multiply and sum algorithm. Sci. Rep. 9,
51. Vena, A. et al. Design and realization of stretchable sewn chipless RFID 17317 (2019).
tags and sensors for wearable applications. In 2013 IEEE International 80. Alqadami, A. S., Bialkowski, K. S., Mobashsher, A. T. & Abbosh, A. M.
Conference on RFID (RFID) 176–183 (IEEE, 2013). Wearable electromagnetic head imaging system using flexible wideband
52. Tian, X., Zeng, Q., Nikolayev, D. & Ho, J. S. Conformal propagation and antenna array based on polymer technology for brain stroke diagnosis.
near-omnidirectional radiation with surface plasmonic clothing. IEEE IEEE Trans. Biomed. Circuits Syst. 13, 124–134 (2018).
Trans. Antennas Propag. 68, 7309 (2020). 81. O’Loughlin, D. et al. Microwave breast imaging: clinical advances and
53. Salonen, P., Yang, F., Rahmat-Samii, Y. & Kivikoski, M. WEBGA-wearable remaining challenges. IEEE Trans. Biomed. Eng. 65, 2580–2590 (2018).
electromagnetic band-gap antenna. In IEEE Antennas and Propagation 82. Collins, C. C. Miniature passive pressure transensor for implanting in the
Society Symposium 451–454 (IEEE, 2004). eye. IEEE Trans. Biomed. Eng. 2, 74–83 (1967).
54. Jiang, Z. H., Brocker, D. E., Sieber, P. E. & Werner, D. H. A compact, 83. Nelson, B. J., Kaliakatsos, I. K. & Abbott, J. J. Microrobots for minimally
low-profile metasurface-enabled antenna for wearable medical body-area invasive medicine. Annu. Rev. Biomed. Eng. 12, 55–85 (2010).
network devices. IEEE Trans. Antennas Propag. 62, 4021–4030 (2014). 84. Than, T. D., Alici, G., Zhou, H. & Li, W. A review of localization
55. Yan, S. & Vandenbosch, G. A. Radiation pattern-reconfigurable wearable systems for robotic endoscopic capsules. IEEE Trans. Biomed. Eng. 59,
antenna based on metamaterial structure. IEEE Antennas Wirel. Propag. 2387–2399 (2012).
Lett. 15, 1715–1718 (2016). 85. Pourhomayoun, M., Jin, Z. & Fowler, M. L. Accurate localization of in-body
56. Tian, X. et al. Wireless body sensor networks based on metamaterial medical implants based on spatial sparsity. IEEE Trans. Biomed. Eng. 61,
textiles. Nat. Electron. 2, 243 (2019). 590–597 (2013).

390 Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics

NaTure ElecTronics Review Article
86. Bao, G., Pahlavan, K. & Mi, L. Hybrid localization of microrobotic 106. Li, J., Chen, Y., Hu, Y., Duan, H. & Liu, N. Magnesium-based metasurfaces
endoscopic capsule inside small intestine by data fusion of vision and RF for dual-function switching between dynamic holography and dynamic
sensors. IEEE Sens. J. 15, 2669–2678 (2014). color display. ACS Nano 14, 7892–7898 (2020).
87. Chandra, R., Johansson, A. J., Gustafsson, M. & Tufvesson, F. A microwave 107. Mannoor, M. S. et al. Graphene-based wireless bacteria detection on tooth
imaging-based technique to localize an in-body RF source for biomedical enamel. Nat. Commun. 3, 763 (2012).
applications. IEEE Trans. Biomed. Eng. 62, 1231–1241 (2014). 108. Lei, T. et al. Biocompatible and totally disintegrable semiconducting
88. Pendry, J. B. Negative refraction makes a perfect lens. Phys. Rev. Lett. 85, polymer for ultrathin and ultralightweight transient electronics. Proc. Natl
3966 (2000). Acad. Sci. USA 114, 5107–5112 (2017).
89. Monge, M., Lee-Gosselin, A., Shapiro, M. G. & Emami, A. Localization of 109. Wool, R. P. Self-healing materials: a review. Soft Matter 4, 400–418 (2008).
microscale devices in vivo using addressable transmitters operated as 110. Cao, Y. et al. Self-healing electronic skins for aquatic environments.
magnetic spins. Nat. Biomed. Eng. 1, 736–744 (2017). Nat. Electron. 2, 75–82 (2019).
90. Falk, M. & Issels, R. Hyperthermia in oncology. Int. J. Hyperth. 17, 111. Jiang, J. et al. Free-form diffractive metagrating design based on generative
1–18 (2001). adversarial networks. ACS Nano 13, 8872–8878 (2019).
91. Simon, C. J., Dupuy, D. E. & Mayo-Smith, W. W. Microwave ablation: 112. Wen, F., Jiang, J. & Fan, J. A. Robust freeform metasurface design
principles and applications. Radiographics 25, S69–S83 (2005). based on progressively growing generative networks. ACS Photon. 7,
92. Gong, Y. & Wang, G. Superficial tumor hyperthermia with flat left-handed 2098–2104 (2020).
metamaterial lens. Prog. Electromagn. Res. 98, 389–405 (2009). 113. Lin, X. et al. All-optical machine learning using diffractive deep neural
93. Vrba, D. & Vrba, J. Novel applicators for local microwave hyperthermia networks. Science 361, 1004–1008 (2018).
based on zeroth-order mode resonator metamaterial. Int. J. Antennas 114. Topol, E. J. High-performance medicine: the convergence of human and
Propag. 2014, 631398 (2014). artificial intelligence. Nat. Med. 25, 44–56 (2019).
94. Paulides, M., Trefna, H. D., Curto, S. & Rodrigues, D. Recent technological 115. Li, L. et al. Electromagnetic reprogrammable coding-metasurface
advancements in radiofrequency- and microwave-mediated hyperthermia holograms. Nat. Commun. 8, 197 (2017).
for enhancing drug delivery. Adv. Drug Deliv. Rev. 163, 3–18 (2020). 116. Ee, H.-S. & Agarwal, R. Tunable metasurface and flat optical zoom lens on
95. Bao, L. & Cui, T. J. Tunable, reconfigurable, and programmable a stretchable substrate. Nano Lett. 16, 2818–2823 (2016).
metamaterials. Microw. Opt. Technol. Lett. 62, 9–32 (2020).
96. Zhang, X. G. et al. Polarization‐controlled dual‐programmable Acknowledgements
metasurfaces. Adv. Sci. 7, 1903382 (2020). J.S.H. acknowledges support from the National Research Foundation Singapore
97. Almeida, E., Bitton, O. & Prior, Y. Nonlinear metamaterials for holography. (NRFF2017-07), Ministry of Education Singapore (MOE2016-T3-1-004) and Institute
Nat. Commun. 7, 12533 (2016). for Health Innovation and Technology grants.
98. Shaltout, A. M. et al. Spatiotemporal light control with frequency-gradient
metasurfaces. Science 365, 374–377 (2019).
99. Lee, Y., Kim, S.-J., Park, H. & Lee, B. Metamaterials and metasurfaces for Author contributions
sensor applications. Sensors 17, 1726 (2017). All authors wrote and commented on the manuscript.
100. Ray, T. R. et al. Bio-integrated wearable systems: a comprehensive review.
Chem. Rev. 119, 5461–5533 (2019). Competing interests
101. Torrisi, F. et al. Inkjet-printed graphene electronics. ACS Nano 6, The authors declare no competing interests.
2992–3006 (2012).
102. Chung, H. U. et al. Binodal, wireless epidermal electronic systems with
in-sensor analytics for neonatal intensive care. Science 363, eaau0780 (2019). Additional information
103. Manzari, S. et al. Humidity sensing by polymer-loaded UHF RFID Correspondence should be addressed to C.-W.Q. or J.S.H.
antennas. IEEE Sens. J. 12, 2851–2858 (2012). Peer review information Nature Electronics thanks the anonymous reviewers for their
104. Leber, A. et al. Soft and stretchable liquid metal transmission lines contribution to the peer review of this work.
as distributed probes of multimodal deformations. Nat. Electron. 3, Reprints and permissions information is available at www.nature.com/reprints.
316–326 (2020).
105. Zhang, Y. et al. High precision epidermal radio frequency antenna via Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in
nanofiber network for wireless stretchable multifunction electronics. published maps and institutional affiliations.
Nat. Commun. 11, 5629 (2020). © Springer Nature Limited 2021

Nature Electronics | VOL 4 | June 2021 | 382–391 | www.nature.com/natureelectronics 391