Content for  TS 22.104  Word version:  19.1.0

The traditional value chain for the medical device industry, which historically has been driven by innovation and research and development, is currently witnessing a shift in the landscape. As governments and health insurers worldwide implement measures to control costs, public hospitals are operating on tighter budgets, while private facilities are receiving lower reimbursements. In the developed world, decisions that used to be the sole preserve of doctors are now also made by regulators, hospital administrators, and other non-clinicians. This broader set of influencers comes with different objectives, e.g. the prioritization of cost effectiveness or even just costs. This shift in focus from volume-based healthcare to value-based healthcare has led medical devices companies to move to business models based on providing clinical value with cost efficiency. Technological progress and better infrastructures, in particular high-quality wireless networks, have fed this business model transformation, allowing coordinated therapies, services, and health analytics and enabling efficient outcome measurement solutions. On this matter, 5G enables shifting care location from hospitals to homes and others lower cost facilities which mechanically translates into more savings. Additionally, another example showing that 5G can enable cost savings required by the medical industry can be found inside hospitals where wireless transmission of low latency data streams improves operating room planning, enable streamlining equipment usage and simplifies operating theater implementation.

Robotic aided surgery is particularly suitable to invasive surgical procedures that require delicate tissue manipulation and access to areas with difficult exposure. It is achieved through complex systems that translate the surgeon's hand movements into smaller, precise movements of tiny instruments that can generally bend and rotate far more than a human hand is capable of doing inside the patient's body. In addition, those systems are usually able to filter out hand tremor and therefore allow more consistent outcomes for existing procedures, and more importantly the development of new procedures currently made impractical by the accuracy limits of unaided manipulation. A typical robotic setup for telesurgery can be depicted as follows.

The robot and the surgeon's console can be co-located in the same operating room in which case they communicate through a NPN, or, in another deployment option, when specialists and patients are far from each other (hundreds of kilometres) they can exchange data through communication services delivered by PLMNs. The depicted medical application can be instantiated at either side or in the Cloud. Its role consists in:

• Generating appropriate haptic feedback based on instrument location, velocity, effort measurements data and images issued by surgical instruments and 3D pre-operative patient body model. This allows to provide tactile guidance by constraining where the instruments (scalpel, etc.) can go.
• Filtering motion control commands for better closed loop stability

Typical surgery robotic systems can have around 40 actuators and the same number of sensors which allows to compute the data rate requires in each direction in order to execute a given movement. Human sensitivity of touch is very high, tactile sensing has about 400 Hz bandwidth, where bandwidth refers to the frequency of which the stimuli can be sensed. This is why, in general, haptic feedback systems operate at frequencies around 1,000 Hz. This rate naturally applies to the update of all information used in the generation of the haptic feedback, e.g. instruments velocity, position … Therefore, the robot control process involves:

• The surgeon console periodically sending a set of points to actuators
• Actuators executing a given process
• Sensors sampling velocity, forces, positions… at the very same time and returning that information to the surgeon console at the rate of 1 kHz

As opposed to machine to machine communication, robotic aided surgery implies there is a human being in the middle of the control loop, which means that the console generates new commands based on the system state collected in the previous 1 kHz cycle and also on surgeon's hand movement. Each equipment involved in a robotic telesurgery setup (endoscopes, image processing system, displays, motion controller and haptic feedback systems) is synchronized thanks to a common clock either external or provided by the 5G system. The synchronization is often achieved through dedicated protocols such as e.g. PTP version 2 and allows to e.g. guarantee the consistency of the haptic feedback and displayed images at the master console, or enable the recording and offline replay of the whole procedure.

  Periodic communication for the support of precise cooperative robotic motion control and haptic feedback in case of robotic aided surgery where the surgeon console and the robot are collocated in the same operating room Periodic communication for the support of cooperative robotic motion control and haptic feedback in case of telesurgery. In this case, the surgeon console and the robot are not collocated and communicate with each other through a connection established over a PLMN possibly spanning an entire country. Relaxed requirements imply that much less complex surgical procedures are achievable in use case 2 than in use case 1. It shall be noted that this use case also involves more experienced and trained surgeons, who can cope with longer latencies in the communication system.

Robotic aided diagnosis involves a remote expert in a large central hospital who controls a diagnosis robotic system deployed in a local medical facility. Such robotic systems can be e.g.:

• Haptic feedback tool used for palpating and deployed in e.g. a Mobile Specialist Practise facility
• Ultrasound probe deployed in an ambulance or a medical facility

A typical robotic setup for tele diagnosis can be depicted as follows:

Specialists and patients are far from each other (typically dozens of kilometres) and can exchange data through communication services delivered by PLMNs. The depicted medical application can be instantiated at either side or in the Cloud. Its role consists in:

• Generating appropriate haptic feedback based on instrument location, velocity, effort measurements data and images issued by instruments.
• Filtering motion control commands for better closed loop stability

  Periodic communication for the support of precise cooperative robotic motion control and haptic feedback in case of robotic aided diagnosis where the expert and the patient are not collocated and communicate with each other through a connection established over a PLMN.

Positioning is particularly important for cyber-physical control applications in vertical domains like factories. The reason for this is that mobile devices and mobile assets are becoming increasingly common in the flexible production and subsequently the need for real-time locations data is increasing. In this context, positioning is especially important for warehousing and logistics processes, autonomous driving systems and fleet management and flexible adaptation in production. In the best case all relevant goods and products are continuously tracked from the moment they are received to the moment they are made available. The tracking process provides the relevant context information that is needed for real-time control and optimization of the material flow and subsequent production processes. In this scenario, autonomous driving systems fetch parts from the warehouse independently and transport them to flexible assembly cells on the shop floor. As part of the flexible fleet management system, these autonomous driving systems are continuously localized and move quickly and in constant interaction with their environment. In the process, production machinery and assembly cells and their given status are monitored seamlessly while relevant objects like tools and workpieces being localized. This makes it possible to adapt quickly to changes in circumstances. The result is flexible, autonomously controlled production that is capable of adapting to new situations at any time. Wireless positioning for human machine interfaces like AR/VR should also be possible. The requirements for positioning vary widley between different use cases.

Low power high accuracy positioning is an integral part of a considerable number of industrial applications. The total energy needed for a specific operation time for such a low power high accuracy positioning optimized IoT-device is a combination of energy for positioning (varies depending on the used positioning method), energy for communication/synchronization and a difficult to predict factor to take additional losses through e.g. security, power management, microcontroller, and self-discharge of batteries into account. Examples of target applications for low power high accuracy positioning are asset tracking in process automation, tracking of vehicles, and tool tracking. Table A.7.2-1 gives an indication of the required operation time of the 5G enabled IoT device and duty cycle of the updated position information for different use cases.

  Process automation: Dolly tracking (outdoor). Process automation: Asset tracking. Flexible modulare assembly area: Tool tracking in flexible, modular assembly areas in smart factories. Process automation: Sequence container (Intralogistics). Process automation: Palette tracking (e.g. in turbine construction). Flexible modulare assembly area: Tracking of workpiece (in- and outdoor) in assembly area and warehouse. Flexible modulare assembly area: Tool assignment (assign tool to vehicles in a production line, left/right) in flexible, modular assembly area in smart factories. Flexible modulare assembly area: Positioning of autonomous vehicles for monitoring purposes (vehicles in line, distance 1.5 meter). (Intra-)logistics: Asset tracking