Medical, Health, & WearableActive Matrix Flat Panel Imagers (AMFPI) ACF Bond to readout input pads and X-ray panel. ... – Use mobile phone/internet to provide information to care

© 2018 TechSearch International, Inc.

Medical, Health, & Wearable

E. Jan Vardaman, President and Founder


Chapter in Progress!!

• Mark D. Poliks (Binghamton University) & Nancy Stoffel (GE)• Jason Marsh & Wilfred Bair (NextFlex) and the NextFlex Community


Medical Wearable Electronics

Source: IPDiA.

• Traditional medical implantables

• From fitness accessory to clinical tool

• Wearable technology to help senior citizens remain mobile and live independent lives

• Non-invasive wearable transdermal microsystems for continuous monitoring

• Textiles for muscle stimulation, continuous ECG monitoring, etc.

• Wearables with sensors for targeted clinical applications in disease treatment


Products Covered

• Imaging (CT, X-ray, MRI, Ultrasound) including capsule endoscopes• Human health monitoring (disease state, fatigue, hydration, stress, wound care)• Implantable devices (neural implants, pacemakers and defib, hearing aids and cochlear

implant, retina implant)• Diagnostic systems (on and in-body) including fitness bands and smartwatch


Wearable Basics

• Increased number of products with connectivity• IoT/IoE demand for

– Connectivity devices– Sensors– Data storage and processing

• No single package format– No “one size fits all” solution, but economics and business

considerations will drive package adoption– Package selection important: Can’t stretch the selected package option

past its capability– Many applications may adopt system-in-package (SiP)

Source: SPIL.


Sensors Classes

• Motion-Tracking– Accelerometer– Gyro– Magnetometer– GNSS (GPS, GLONA, Galileo, Beidou)

• Bodily Function– Heart rate – Pulse oximetry– Temperature

• Other– Chemical– Electrical– RF


Packaging Trends

• Die thinning• Die placement • Interconnect methods and assembly• Substrates and materials

– Rigid, flexible, and ultra-thin– Silicon, glass, ceramic, polymer (PI, PET, LCP, TPU), fabric, paper– Plated materials (Au, Pt, Cu, etc.)– Printed and dispensed materials including methods

• New manufacturing methods including panels and rolls– Thin die handling and pick and place– Direct printed interconnects– Thin substrate handling (frames, fixtures, or R2R)– Stretchable substrate handling– Embedded components

• Challenges


Medical Electronics Product Drivers

• Miniaturization– Form factor (package height, footprint, etc.)

• Heterogeneous technology integration– RF, analog, memory– Sensors– Passives– Increase in number of components

• Performance– Increase in function– Noise reduction– With low power

• Total system cost reduction– Package/device cost– Development cost– Time to market

Source: Starkey.

No more room!


Medical Imaging

• Radiographic– X-ray– Computed Tomography (CT)– Angiography– Mammography

• Magnetic– Magnetic Resonance Imaging

• Nuclear– Positron Emission Spectroscopy (PET)– Single-proton Emission Computed Tomography

• Ultrasound


Key Drivers for Imaging

• Improve image quality• Increase image acquisition

speed• Flexible application• Ease of use• Move to portability

– Bring advanced technology to field

– Shorten period from evaluation to treatment

– Reduce patient transport– Increase accuracy of patient

information– Reduce cost

• Integration of devices to provide functions instead of single chip


COF Module: Chip/Die on Flex by ACF for X-Ray Detector

Scintillator

ReadoutADC Addressing

Active Matrix Flat Panel Imagers (AMFPI)

ACF Bond to readout input pads and X-ray panel.

Output/Input Digital Signal:ZIF Connector or ACF direct bond to board

ACF-COF(Chip-on-Flex)

Readout COF Module: ASIC/Die Size 12mmx5mm Bump Size: 80 µm x 80 µm Total > 220 I/Os

(Analog Input 128 Channels, Digital Output 16 Channels)

Flex Size: 70x15 mm60 μm pitch

Gate Driver, COF Module:ASIC/Die Size 12mmx0.90mm Bump Size: 30 µm x 60 µm Total > 450 I/Os

(Digital Output 263 Channels)

Flex Size: 20x20mm40 μm pitch

Source: ITO Corporation


• Endicott Interconnect substrate• CoreEZ® 2-4-2 substrate• SiP assembly with flip chip

Medical Imaging: Ultrasound Application

Source: i3 Electronics.


Capsule Endoscopy (Smart Pill)

• Packaging of microprocessors and sensors

• All components had to fit into a pill 26 mm x 13 mm

• Sensors had to measure– Pressure– pH– Temperature

Source: Valtronic.


Wireless Applications for Medical Electronics

• Home Health Care– Insulin delivery– Monitor heart rate and blood pressure

• Management of chronic diseases (heart failure, infectious disease, psychiatric disorders)– Digestible sensors (activated by stomach

fluids after swallowing)– Sends signal to microelectronic receiver

under patient’s skin storing info on drug, monitors body’s response to medication

– Use mobile phone/internet to provide information to care givers and health care professionals

• Working with implantable devices– Wireless sensing and communication to

manage heart failure and aneurysms

Source: Proteus Biomedial


Blood Sugar Sensor

• Cicor provides flex circuit for blood sugar sensor• Flex circuit with 25µm lines and spaces

Source: Courtesy of Cicor


Implantable Cardioverter Defibrillator & Pacemaker

• Smaller, less intrusive applications for implantable devices

• High density interconnect substrate– 8 layers– 1.2-inch x 0.5-inch & 1.7-

inch x 1.6-inch– Components such as WLP

Source: i3 Electronics.


12.7 mm x 8.1 mmx 1.5 mm

Microsemi Embedded Die Module for ICD

• Qualified to MIL standard for implantable devices

• Applicable in other high-rel spaces such as wearables, security, military, and industrial sensing

• Evolution toward ultra-thin embedded die, enabling lamination thickness of 0.5 mm; overall module height typically 1.0 mm (discrete component limit)

• Integrated passives on the horizon

1.5 mm

4.6 mm

5.6 mm

Die embedded in the PCB

New embedded die design reduces area 400%

Source: Microsemi.


Size Reduction in Hearing Aids

2.43

5.74 x 3.45 mm 4.39 x 3.44 mm

1.33

NewChip-in-FlexOld

Ceramic Hybrid

Source: Starkey.


Second Sight Medical Products

• Video camera sends images to a computer worn on a belt (computer converts the video to a simplified signal)

• Transmitter send signal wirelessly to implant in the eye• Receiver send signal to electrode array (1/3-inch wide, 60 electrodes) to stimulate retina• Optic nerve carries signal from retina to brain which perceives visual patterns

corresponding to the electrodes stimulated

Source: Second Sight Medical Products


ARGUS II Retinal Prosthesis System

• How it works– Miniature video camera captures scene – Communicate to the VPU and implant– System bypasses dead photoreceptor and underlying

neurons– Process video and transforms into instructions for input

• Scaling manufacturing from 10 systems/month to 100/month

Source: Second Sight.


Healthcare and Fitness/Sports

• User friendly, comfortable• Products always on (low power

design critical)• Environmental exposure (UV light,

sweat, stress, washer/dryer, cleaning fluids, mud, dust, wafer, sunscreen, etc.)

• Low cost


Smart Watch Have Become Medical Devices

• More fashionable device to provide monitoring of elderly patients

– Monitor blood pressure– Levels of hydration– Medication

• Many sensors• First Apple watch

– STMicroelectronics digital gyroscope and accelerometer (packaged in 3mm x 3mm LGA)

– MEMS sensor and control ASIC stacked together with wire bond

• STMicroelectronics optical emitter/sensor encoder die

• Knowles microphone

Source: Apple.


SiPs in Apple Watch Series 2

• Contains 3 SiPs packaged as stacked die CSP• SiP essential to miniaturization of product• EMI shielding important

NFC Controller w/eSE

AP + DRAM in Same Package

6-axis Inertial Sensor

NXP 67V04Stacked-die CSP4.3 mm x 4.0 mm49 Leads

Apple Dual-core MPUwith 512MB DRAMStacked-die CSP10.10 mm x 8.7 mm700 Leads

STMicroelectronicsLSM6DS3Stacked-die CSP3.0 mm x 3.0 mm16 Leads

Source: eWiseTech, image from TPSS.

https://www.ifixit.com/Teardown/Apple+Watch+Series+2+Teardown/67385


Cross-Section of Apple S4 FO-WLP + Memory PoP

• Apple S4 watch uses InFO FO-WLP for application processor

Images courtesy of TechInsights.


SEMCO in Production with Panel FO for Smartwatch

• Samsung/SEMCO panel line in production for multiple die package– Uses FO-WLP in panel form

• PoP for Samsung’s Gear watch– ASIC and PMIC with backside RDL– Backside RDL for memory stacking to

form PoP

Images courtesy of Samsung.


Wearable Skin Patch

• Skin patch with sensors• Multiple applications including monitoring medications for disease treatment,

monitoring sweat, etc.• Start-up MC10 experiments show 71,950 cycles without electrical or mechanical

degradation


Sensor Patch for for Skin Swelling Detection

• Sensor electrodes are patterned on tegaderm film which adheres to patient’s hand at the site of the cannula needle

• Function is to detect swelling in the skin tissue (sensor patch system)


Conductive Fabrics

• Knitting or weaving conductive threads into textiles– Metalized threads with allow of silver, copper, tin, nickel– Deposition or coating of conductive polymers– Printing conductive inks– UK’s NPL development of stretch nylon fabric processed using its technology (nano-silver

coating of fibers)

Source: NPL.


3D Printed Electronics

• Using high-resolution printers (including inkjet) to print circuits

• Involving multiple materials including conductive inks and dielectrics that, in some cases, can be printed simultaneously

• Using software capable of converting complex schematics into layer-by-layer print instructions

• Many potential applications including– Wearable sensors that attach directly to

the skin– Spiral antennas– Implantable bio systems– Displays and lighting


Material Examples

• Inks– Ag nanoparticles that sinter at low temperatures and work on a variety of substrates

such as paper, polymers, glass– Cu paste, etc. – Many ink suppliers including Applied Nanotech, Dow, Intrinsiq Materials, JNC, Xjet,

Kuprion, PV Nano Cell, NOF, Taiyo, etc.

• Dielectrics– Insulating dielectric inks compatible with conductive ink

L ~ 135 µm

Inkjet printed, Nano-Silver ink (Harima NPS-JL)


NOF Example

• Cu paste for screen printing with high adhesive strength to glass, PET, polyimide, FR-4, and ITO

• Conductivity 20 to 30 microOhm/cm using a low temperature 120°C sintering process

• Capable of printing 50µm lines and spaces• Reliability test

– Humidity resistance: 65°C, 95% humidity, 1,000 hours and 70°C for 1,000 hours

– Thermal resistance: 128°C for 240 hours and -40°C for 1,000 hours– Thermal cycle testing: 80°C for 1 hour, -30°C for one hour, 100

cycles

• Reliability test results– ≤5% change in volume resistivity in all test– Passed 85°C, 85% humidity, and DC vias 50V for 1,000 hours– No short circuits in samples with 318 lines and spaces


Conformal Printed Antenna for Mobile Device Application

• Aerosol jet printing process • Antenna on plastic device case• Utilizes conductive nanoparticle

silver inks • No plating or environmentally

harmful materials• Process produces a smooth

mirror-like surface finish optimizing antenna performance

• Up to 4 cases simultaneously on a single machine

• Throughput of 30K units per week for typical 300mm2

antenna pattern• Flexible, digital tooling• Similar antenna performance to

other methods

Insert picture here from Optomec

Source: Optomec. “Courtesy of a leading cell phone manufacturer.”


SCREEN Holdings UP-5000S Ultra-Precision Gravue Offset Printer

• Offset cut sheet printer for printed electronics • Enables batch formation of complex electronic circuits• Solves problems of line disconnection due to transfer errors and

uneven film thickness• Ink filled in grove in plate using doctor blade and pattern formed

by ink is received by the blanket then transferred onto the substrate side (glass, PET, or combo)

• Effective printing area 510 mm x 610 mm


Toray Engineering Roll-to-Roll Inkjet Pattern Coater

• Roll-to-Roll coating of materials including– Water-soluble inks– Oil-based inks– Solvent-based inks– Inks containing pigment– Silver nano-inks

• Coating methods– Pattern coating– Block coating– High-precision patterning (fine wiring)

• Inkjet head of coater is optimized for each material and coating format


Tatsuta Electronic Materials

• Conductive paste– Via filling paste– Copper past for shielding– Paste for a circuit trace with low temperature– Thermoplastic anisotropic conductrive adhesive paste

• Functional film• EMI shielding film for FPC


Advantages and Disadvantages 3D Printing for Electronic Circuits

• Advantages – Quick prototyping allowing designers to print electronics, test, and modify

design – Faster designs and shorter design cycles– On-demand manufacturing– Meets needs for flexibility and customization– Environmentally sustainable (potentially cleaner with less waste)

• Disadvantages – Early stages of development– May not be able to print fine features <30 µm– Droplet sizes that are not compatible with front-end semiconductor

processes– Some conductive materials are susceptible to oxidation unless protected

during processing– Materials such as Ag are subject to electromigration– Need more reliability data


Wearable Product Requirements?

• What are reliability requirements?– Lifetime?– Environmental exposure (UV light, sweat, stress,

washer/dryer, cleaning fluids, mud, dust, wafer, sunscreen, etc.)

• Fitness activity bands– Polymer encased electronics– Must withstand twist, bend, flex compression– Must not react with bodily and environmental fluids

• Printed circuit design require environmental protection– Thermal management– Shock and vibration– Electrostatic discharge (ESD)– Bodily and environmental fluids

• Fabrics for wearable electronics– Weaving of metallized yarns– Lamination of circuit boards– Examples T-shirt for muscle stimulation therapy

• Need special reliability tests– Drop test (is it shock proof?)– Thermal stress (simulation) – Is it moisture resistant?


Observations on Packages for Medical Electronics

• Miniaturization trends for many medical electronics products – Hearing aids and Cochlear implants– Sight restoration– Endoscopy– Ultrasound catheters– Pacemakers and defibrillators– Neurostimulators

• Cost consideration increasingly important• Many companies not willing to provide custom solution for medical products

considered “low volume” compared to mobile space• Package options in mobile and wearable space can be adapted to needs of medical

electronics– WLP– FO-WLP– Flip chip– Stacked die– SiP– Embedded die


Challenges and Issues

• Greater need for low power devices• Some segments have small unit volumes• High volume applications have increasing price pressure• Qualification period can be long• Risk of liability can be high• If Pb-free is required, what issues will be encountered?

– Sn whiskers?• Requirements for suppliers can be challenging

– Quality– Testing– Pricing


Low-Power Optimized MCU for Fitness Band

• Trade-off in design is power vs. performance (design is key)• Processor is constantly analyzing data from sensor• Device does not get to go into “sleep mode”• Improved battery life becomes key to product success


Battery Life Remains Important!!!

• Low-power designs for devices– ARM promoting designs for wearables

• New developments in battery technology needed– Alternatives to Li-ion battery– More durable, safer, and smaller

• Energy harvesting (applications including battery charger)– Examples such as SiliconReef (fabless company from Brazil)

IC for 12V/24V applications integrated with battery charger– Vibration energy harvesting IC with 3.3V output regulation

and power tracking• Many U.S. Universities working on 3D thin-film batteries

including– Purdue University, University of Michigan, Northwestern,

Stanford, Rice, Notre Dame, University of Texas• New flexible bendable battery J.Flex from Korean company

Jenax– Bend, fold, twist, or scrunch battery to fit almost any device

or use scenario– Can fold up to 200,000 times without degrading

performance

Source: SiliconReef.


HIR’s 22 Technical Working GroupCoverage Crossover

• HI for Market Applications– Mobile– IoT– Medical, Health, & Wearables– Automotive– High Performance Computing & Data

Center– Aerospace & Defense

• Heterogeneous Integration Components– Single chip and multi chip packaging

(including substrates)– Integrated photonics– Integrated power electronics– MEMS & sensor integration– RF and analog mixed signal

• Cross Cutting TopicsMaterials and emerging research materialsEmerging research devicesInterconnectTest Supply chain SecurityThermal management

• Integration ProcessesSiP3D and 2DWLP (fan-in and fan-out)

• DesignCo-design and simulation – tools and practice

TechSearch International, Inc.4801 Spicewood Springs Road, Suite 150

Austin, Texas 78759 USA+1.512.372.8887

[email protected]

Thank you!

TechSearch International, Inc.4801 Spicewood Springs Road, Suite 150

Austin, Texas 78759 USA+1.512.372.8887

[email protected]

Thank you!


Documents

Medical, Health, & WearableActive Matrix Flat Panel Imagers (AMFPI) ACF Bond to readout input pads and X-ray panel. ... – Use mobile phone/internet to provide information to care