{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:50:27Z","timestamp":1791510627598,"version":"4.3.4"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"MRC","award":["MR\/Y008642\/1"],"award-info":[{"award-number":["MR\/Y008642\/1"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Med Biol Eng Comput"],"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Leakage of orogastric secretions past endotracheal tube (ETT) cuffs contributes to ventilator-associated pneumonia (VAP), yet in vivo tracheal seal testing is impractical, requiring phantom evaluation. As the rigid cylinder specified in EN ISO 5361:2023 does not adequately represent in vivo airway conditions, a benchtop cuff seal testing system was developed incorporating a tracheal model, lung model, mechanical ventilation, and automatic cuff pressure control. A rigid cylinder and a bio-inspired tracheal model with tissue-like mechanical properties were evaluated using five high-volume low-pressure (HVLP) polyvinyl chloride (PVC) cuffed ETTs and five polyurethane (PU) cuffed ETTs, with and without mechanical ventilation, and with and without automatic cuff inflation. For PVC cuffed ETTs, fluid leakage rate was highest in the cylinder phantom compared with the bio-inspired phantom, ~\u200930% lower without mechanical ventilation and ~\u200950% with mechanical ventilation (both p\u2009&lt;\u20090.001). In contrast, PU ETTs exhibited minimal leakage. Long-term testing revealed intracuff pressure decay over 48 h at 37 \u00b0C for both PVC (12.24\u2009\u00b1\u20091.13 cmH2O) and PU (9.06\u2009\u00b1\u20091.00 cmH2O) cuffed ETTs, while automatic cuff pressure control further reduced leakage for PVC ETTs. The bio-inspired phantom revealed sealing behaviours not captured by cylinder testing, supporting clinically relevant evaluation of ETT sealing performance and cuff materials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11517-026-03691-0","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:15:53Z","timestamp":1791508553000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phantom system for endotracheal tube cuff seal testing during mechanical ventilation"],"prefix":"10.1007","author":[{"given":"Delu","family":"Zheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamaralayefa B.","family":"Agbiki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Correia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyang","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergiy","family":"Korposh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandor","family":"Erdody","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barrie R.","family":"Hayes-Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Hewson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Norris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"3691_CR1","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1186\/s13054-024-04991-3","volume":"28","author":"M Fally","year":"2024","unstructured":"Fally M, Haseeb F, Kouta A, Hansel J, Robey RC, Williams T, Welte T, Felton T, Mathioudakis AG (2024) Unravelling the complexity of ventilator-associated pneumonia: a systematic methodological literature review of diagnostic criteria and definitions used in clinical research. Crit Care 28:214. https:\/\/doi.org\/10.1186\/s13054-024-04991-3","journal-title":"Crit Care"},{"key":"3691_CR2","doi-asserted-by":"publisher","first-page":"213","DOI":"10.3390\/microorganisms12010213","volume":"12","author":"M Miron","year":"2024","unstructured":"Miron M, Blaj M, Ristescu AI, Iosep G, Av\u0103danei AN, Iosep DG, Cri\u0219an-Dabija R, Ciocan A, Per\u021bea M, Manciuc CD, Luca \u0218, Grigorescu C, Luca MC (2024) Hospital-acquired pneumonia and ventilator-associated pneumonia: a literature review. Microorganisms 12:213. https:\/\/doi.org\/10.3390\/microorganisms12010213","journal-title":"Microorganisms"},{"key":"3691_CR3","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1007\/s10096-016-2703-z","volume":"36","author":"D Koulenti","year":"2017","unstructured":"Koulenti D, Tsigou E, Rello J (2017) Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP\/CAP study. Eur J Clin Microbiol Infect Dis 36:1999\u20132006. https:\/\/doi.org\/10.1007\/s10096-016-2703-z","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"3691_CR4","doi-asserted-by":"publisher","first-page":"6447","DOI":"10.1038\/s41467-024-50805-z","volume":"15","author":"F Howroyd","year":"2024","unstructured":"Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, Weblin J, Gao-Smith F, Ahmed Z, Duggal NA, Veenith T (2024) Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 15:6447. https:\/\/doi.org\/10.1038\/s41467-024-50805-z","journal-title":"Nat Commun"},{"key":"3691_CR5","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1097\/CCM.0000000000005298","volume":"50","author":"MD Zilberberg","year":"2022","unstructured":"Zilberberg MD, Nathanson BH, Puzniak LA, Shorr AF (2022) Descriptive epidemiology and outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the United States, 2012\u20132019. Crit Care Med 50:460\u2013468. https:\/\/doi.org\/10.1097\/CCM.0000000000005298","journal-title":"Crit Care Med"},{"key":"3691_CR6","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1177\/1751143717740804","volume":"19","author":"H Luckraz","year":"2018","unstructured":"Luckraz H, Manga NN, Senanayake EL, Abdelaziz M, Gopal S, Charman SC, Giri R, Oppong R, Andronis L (2018) Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: results from a propensity-matched cohort study. J Intensive Care Soc 19:94\u2013100. https:\/\/doi.org\/10.1177\/1751143717740804","journal-title":"J Intensive Care Soc"},{"key":"3691_CR7","doi-asserted-by":"publisher","first-page":"e52070","DOI":"10.7759\/cureus.52070","volume":"16","author":"R Turkistani","year":"2024","unstructured":"Turkistani R, Aghashami AS, Badhduoh SS, Fadhel RT, Albaity AO, Malli IA, Osman S, Alshehri RA, Aldabbagh MA (2024) The effect of ventilator-associated pneumonia on the time-to-extubation in adult and pediatric intensive care unit patients requiring mechanical ventilation: a retrospective cohort study. Cureus 16:e52070. https:\/\/doi.org\/10.7759\/cureus.52070","journal-title":"Cureus"},{"key":"3691_CR8","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.hrtlng.2011.09.001","volume":"41","author":"VA Hamilton","year":"2012","unstructured":"Hamilton VA, Grap MJ (2012) The role of the endotracheal tube cuff in microaspiration. Heart Lung 41:167\u2013172. https:\/\/doi.org\/10.1016\/j.hrtlng.2011.09.001","journal-title":"Heart Lung"},{"key":"3691_CR9","doi-asserted-by":"publisher","first-page":"R77","DOI":"10.1186\/cc13837","volume":"18","author":"L Lorente","year":"2014","unstructured":"Lorente L, Lecuona M, Jim\u00e9nez A, Lorenzo L, Roca I, Cabrera J, Llanos C, Mora ML (2014) Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Crit Care 18:R77. https:\/\/doi.org\/10.1186\/cc13837","journal-title":"Crit Care"},{"key":"3691_CR10","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/cc13775","volume":"18","author":"AA Kalanuria","year":"2014","unstructured":"Kalanuria AA, Zai W, Mirski M (2014) Ventilator-associated pneumonia in the ICU. Crit Care 18:208. https:\/\/doi.org\/10.1186\/cc13775","journal-title":"Crit Care"},{"key":"3691_CR11","doi-asserted-by":"publisher","first-page":"1468310","DOI":"10.3389\/fmed.2024.1468310","volume":"11","author":"G Mu","year":"2024","unstructured":"Mu G, Wang F, Li Q, Yu X, Lu B (2024) Reevaluating 30\u00a0cm H\u2082O endotracheal tube cuff pressure: risks of airway mucosal damage during prolonged mechanical ventilation. Front Med 11:1468310. https:\/\/doi.org\/10.3389\/fmed.2024.1468310","journal-title":"Front Med"},{"key":"3691_CR12","doi-asserted-by":"publisher","first-page":"846","DOI":"10.23736\/S0375-9393.19.13133-1","volume":"85","author":"JD Marti","year":"2019","unstructured":"Marti JD, Isetta V, Lazaro MR, Aguilera-Xiol E, Comaru T, Battaglini D, Meli A, Ferrer M, Navajas D, Pelosi P, Chiumello D (2019) An in vitro study to evaluate high-volume low-pressure endotracheal tube cuff deflation dynamics. Minerva Anestesiol 85:846\u2013853. https:\/\/doi.org\/10.23736\/S0375-9393.19.13133-1","journal-title":"Minerva Anestesiol"},{"key":"3691_CR13","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1164\/ajrccm.154.1.8680665","volume":"154","author":"J Rello","year":"1996","unstructured":"Rello J, Sonora R, Jubert P, Artigas A, Ru\u00e9 M, Vall\u00e9s J (1996) Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 154:111\u2013115. https:\/\/doi.org\/10.1164\/ajrccm.154.1.8680665","journal-title":"Am J Respir Crit Care Med"},{"key":"3691_CR14","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s42490-026-00113-y","volume":"8","author":"TB Agbiki","year":"2026","unstructured":"Agbiki TB, Erdody S, Correia R, Korposh S, Hewson DW, Norris AM, Hayes-Gill BR, Morgan SP (2026) Bench testing a contact sensing tracheal tube for monitoring the cuff\u2013trachea interface. BMC Biomed Eng 8:10. https:\/\/doi.org\/10.1186\/s42490-026-00113-y","journal-title":"BMC Biomed Eng"},{"key":"3691_CR15","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1093\/bja\/aeq202","volume":"105","author":"MH Dave","year":"2010","unstructured":"Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M (2010) Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br J Anaesth 105:538\u2013543. https:\/\/doi.org\/10.1093\/bja\/aeq202","journal-title":"Br J Anaesth"},{"key":"3691_CR16","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1007\/s00134-003-1933-6","volume":"29","author":"A Dullenkopf","year":"2003","unstructured":"Dullenkopf A, Gerber A, Weiss M (2003) Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med 29:1849\u20131853. https:\/\/doi.org\/10.1007\/s00134-003-1933-6","journal-title":"Intensive Care Med"},{"key":"3691_CR17","first-page":"169","volume":"4","author":"J Shiotsuka","year":"2012","unstructured":"Shiotsuka J, Lefor AT, Sanui M, Nagata O, Horiguchi A, Sasabuchi Y (2012) A quantitative evaluation of fluid leakage around a polyvinyl chloride tapered endotracheal tube cuff using an in vitro model. HSR Proc Intensive Care Cardiovasc Anesth 4:169\u2013175","journal-title":"HSR Proc Intensive Care Cardiovasc Anesth"},{"key":"3691_CR18","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s00134-010-2106-z","volume":"37","author":"A Zanella","year":"2011","unstructured":"Zanella A, Scaravilli V, Isgr\u00f2 S, Milan M, Cressoni M, Patroniti N, Fumagalli R, Pesenti A (2011) Fluid leakage across tracheal tube cuff: effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med 37:343\u2013347. https:\/\/doi.org\/10.1007\/s00134-010-2106-z","journal-title":"Intensive Care Med"},{"key":"3691_CR19","doi-asserted-by":"publisher","first-page":"100290","DOI":"10.1016\/j.bjao.2024.100290","volume":"10","author":"T Agbiki","year":"2024","unstructured":"Agbiki T, Arm R, Hewson DW, Erdody S, Norris AM, Correia R, Korposh S, Hayes-Gill BR, Shahidi A, Morgan SP (2024) Fabrication and assessment of a bio-inspired synthetic tracheal tissue model for tracheal tube cuff leakage testing. BJA Open 10:100290. https:\/\/doi.org\/10.1016\/j.bjao.2024.100290","journal-title":"BJA Open"},{"key":"3691_CR20","doi-asserted-by":"publisher","first-page":"552","DOI":"10.5935\/1678-9741.20140096","volume":"29","author":"MS Del Negro","year":"2014","unstructured":"Del Negro MS, Barreto G, Antonelli RQ, Baldasso TA, de Meirelles LR, Moreira MM, Tincani AJ (2014) Efic\u00e1cia do balonete do tubo endotraqueal sobre a traqueia: aspectos f\u00edsicos e mec\u00e2nicos. Braz J Cardiovasc Surg 29:552\u2013558. https:\/\/doi.org\/10.5935\/1678-9741.20140096","journal-title":"Braz J Cardiovasc Surg"},{"key":"3691_CR21","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s40560-016-0126-7","volume":"4","author":"J Michikoshi","year":"2016","unstructured":"Michikoshi J, Matsumoto S, Miyawaki H, Niu H, Seo K, Yamamoto M, Tokunaga S, Kitano T (2016) Performance comparison of a new automated cuff pressure controller with currently available devices in both basic research and clinical settings. J Intensive Care 4:4. https:\/\/doi.org\/10.1186\/s40560-016-0126-7","journal-title":"J Intensive Care"},{"key":"3691_CR22","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.accpm.2020.04.007","volume":"39","author":"JE Dauvergne","year":"2020","unstructured":"Dauvergne JE, Geffray AL, Asehnoune K, Rozec B, Lakhal K (2020) Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device: a randomised controlled study. Anaesth Crit Care Pain Med 39:435\u2013441. https:\/\/doi.org\/10.1016\/j.accpm.2020.04.007","journal-title":"Anaesth Crit Care Pain Med"},{"key":"3691_CR23","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s13613-016-0200-2","volume":"6","author":"A Rouz\u00e9","year":"2016","unstructured":"Rouz\u00e9 A, De Jonckheere J, Zerimech F, Labreuche J, Parmentier-Decrucq E, Voisin B, Jaillette E, Maboudou P, Balduyck M, Nseir S (2016) Efficiency of an electronic device in controlling tracheal cuff pressure in critically ill patients: a randomized controlled crossover study. Ann Intensive Care 6:93. https:\/\/doi.org\/10.1186\/s13613-016-0200-2","journal-title":"Ann Intensive Care"},{"key":"3691_CR24","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s00134-006-0417-x","volume":"33","author":"A Duguet","year":"2007","unstructured":"Duguet A, D\u2019Amico L, Biondi G, Prodanovic H, Gonzalez-Bermejo J, Similowski T (2007) Control of tracheal cuff pressure: a pilot study using a pneumatic device. Intensive Care Med 33:128\u2013132. https:\/\/doi.org\/10.1007\/s00134-006-0417-x","journal-title":"Intensive Care Med"},{"key":"3691_CR25","doi-asserted-by":"publisher","first-page":"e0175476","DOI":"10.1371\/journal.pone.0175476","volume":"12","author":"G De Pascale","year":"2017","unstructured":"De Pascale G, Pennisi MA, Vallecoccia MS, Bello G, Maviglia R, Montini L, Di Gravio V, Cutuli SL, Conti G, Antonelli M (2017) CO\u2082-driven endotracheal tube cuff control in critically ill patients: a randomized controlled study. PLoS ONE 12:e0175476. https:\/\/doi.org\/10.1371\/journal.pone.0175476","journal-title":"PLoS ONE"},{"key":"3691_CR26","doi-asserted-by":"publisher","first-page":"e92","DOI":"10.1093\/ejcts\/ezu483","volume":"47","author":"S Gopal","year":"2015","unstructured":"Gopal S, Luckraz H, Giri R, Nevill A, Muhammed I, Reid M, Bickerton S, Jenkins D (2015) Significant reduction in ventilator-associated pneumonia with the Venner-PneuX system in high-risk patients undergoing cardiac surgery: the low ventilator-associated-pneumonia study. Eur J Cardiothorac Surg 47:e92\u2013e96. https:\/\/doi.org\/10.1093\/ejcts\/ezu483","journal-title":"Eur J Cardiothorac Surg"},{"key":"3691_CR27","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1007\/s00540-023-03283-4","volume":"38","author":"K Urabe","year":"2024","unstructured":"Urabe K, Asai T, Okuda Y (2024) Usefulness of an automatic cuff pressure controller (SmartCuff) in inhibiting gas leakage around the cuff after tracheal intubation: a randomized controlled study. J Anesth 38:86\u201391. https:\/\/doi.org\/10.1007\/s00540-023-03283-4","journal-title":"J Anesth"},{"key":"3691_CR28","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1007\/s00134-011-2145-0","volume":"37","author":"I Ouanes","year":"2011","unstructured":"Ouanes I, Lyazidi A, Danin PE, Rana N, Di Bari A, Abroug F, Louis B, Brochard L (2011) Mechanical influences on fluid leakage past the tracheal tube cuff in a benchtop model. Intensive Care Med 37:695\u2013700. https:\/\/doi.org\/10.1007\/s00134-011-2145-0","journal-title":"Intensive Care Med"},{"key":"3691_CR29","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1093\/bja\/78.5.557","volume":"78","author":"PJ Young","year":"1997","unstructured":"Young PJ, Rollinson M, Downward G, Henderson S (1997) Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth 78:557\u2013562. https:\/\/doi.org\/10.1093\/bja\/78.5.557","journal-title":"Br J Anaesth"},{"key":"3691_CR30","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/BF03010825","volume":"33","author":"BA Janson","year":"1986","unstructured":"Janson BA, Poulton TJ (1986) Does peep reduce the incidence of aspiration around endotracheal tubes? Can Anaesth Soc J 33:157\u2013161. https:\/\/doi.org\/10.1007\/BF03010825","journal-title":"Can Anaesth Soc J"},{"key":"3691_CR31","doi-asserted-by":"publisher","first-page":"7","DOI":"10.12809\/hkmj133930","volume":"20","author":"ACW Lau","year":"2014","unstructured":"Lau ACW, Lam SM, Yan WW (2014) Benchtop study of leakages across the Portex, TaperGuard, and Microcuff endotracheal tubes under simulated clinical conditions. Hong Kong Med J 20:7\u201315. https:\/\/doi.org\/10.12809\/hkmj133930","journal-title":"Hong Kong Med J"},{"key":"3691_CR32","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1002\/ca.20815","volume":"22","author":"KS Kamel","year":"2009","unstructured":"Kamel KS, Lau G, Stringer MD (2009) In vivo and in vitro morphometry of the human trachea. Clin Anat 22:571\u2013579. https:\/\/doi.org\/10.1002\/ca.20815","journal-title":"Clin Anat"},{"issue":"Suppl 2","key":"3691_CR33","doi-asserted-by":"publisher","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2015-208209","volume":"71","author":"AC Davidson","year":"2016","unstructured":"Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, Church AC, Creagh-Brown B, Dodd JW, Felton T, Fo\u00ebx B (2016) BTS\/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax 71(Suppl 2):ii1\u201335. https:\/\/doi.org\/10.1136\/thoraxjnl-2015-208209","journal-title":"Thorax"},{"key":"3691_CR34","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1186\/s13054-016-1380-8","volume":"20","author":"SI Blot","year":"2016","unstructured":"Blot SI, Rello J, Koulenti D (2016) The value of polyurethane-cuffed endotracheal tubes to reduce microaspiration and intubation-related pneumonia: A systematic review of laboratory and clinical studies. Crit Care 20:203. https:\/\/doi.org\/10.1186\/s13054-016-1380-8","journal-title":"Crit Care"}],"container-title":["Medical &amp; Biological Engineering &amp; Computing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11517-026-03691-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11517-026-03691-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11517-026-03691-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:15:55Z","timestamp":1791508555000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11517-026-03691-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":34,"alternative-id":["3691"],"URL":"https:\/\/doi.org\/10.1007\/s11517-026-03691-0","relation":{},"ISSN":["0140-0118","1741-0444"],"issn-type":[{"value":"0140-0118","type":"print"},{"value":"1741-0444","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"assertion":[{"value":"2 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"RC, SK, SPM, AN, BRHG are Directors and hold equity in University of Nottingham spin out company Medical Photonics Ltd. Medical Photonics has advised on design of the study and clinical relevance. No patents have been filed relating to the work in this paper.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}