Public opinion on complex scientific topics can have dramatic effects on industrial sectors (e.g. GM crops, fracking, global warming). In order to realise the industrial and societal benefits of Autonomous Systems, they must be trustworthy by design and default, judged both through objective processes of systematic assurance and certification, and via the more subjective lens of users, industry, and the public. To address this and deliver it across the Trustworthy Autonomous Systems (TAS) programme, the UK Research Hub for TAS (TAS-UK) assembles a team that is world renowned for research in understanding the socially embedded nature of technologies. TASK-UK will establish a collaborative platform for the UK to deliver world-leading best practices for the design, regulation and operation of 'socially beneficial' autonomous systems which are both trustworthy in principle, and trusted in practice by individuals, society and government. TAS-UK will work to bring together those within a broader landscape of TAS research, including the TAS nodes, to deliver the fundamental scientific principles that underpin TAS; it will provide a focal point for market and society-led research into TAS; and provide a visible and open door to engage a broad range of end-users, international collaborators and investors. TAS-UK will do this by delivering three key programmes to deliver the overall TAS programme, including the Research Programme, the Advocacy & Engagement Programme, and the Skills Programme. The core of the Research Programme is to amplify and shape TAS research and innovation in the UK, building on existing programmes and linking with the seven TAS nodes to deliver a coherent programme to ensure coverage of the fundamental research issues. The Advocacy & Engagement Programme will create a set of mechanisms for engagement and co-creation with the public, public sector actors, government, the third sector, and industry to help define best practices, assurance processes, and formulate policy. It will engage in cross-sector industry and partner connection and brokering across nodes. The Skills Programme will create a structured pipeline for future leaders in TAS research and innovation with new training programmes and openly available resources for broader upskilling and reskilling in TAS industry.

The range of surgical tools for interventional procedures that dissect or fragment tissue has not changed significantly for millennia. There is huge potential for ultrasonic devices to enable new minimal access surgeries, offering higher precision, much lower force, better preservation of delicate structures, low thermal damage and, importantly, enabling more procedures to be carried out on an out-patient or day surgery basis. To realise this potential, and deliver our vision of ultrasonics being the technology of choice for minimal access interventional surgery, a completely new approach to device design is required, to achieve miniaturisation and to incorporate both a cutting and healing capability in the devices. By integrating with innovative flexible, tentacle-like surgical robots, we will bring ultrasonic devices deep into the human body, along tortuous pathways to the surgical site, to deliver unparalleled precision. Unsurpassed precision in challenging neurological, skull-base and spinal procedures as well as in general surgery is attainable through tailoring the robotic-ultrasonic devices to deliver the exact ultrasonic energy to the exact locations required to optimise the surgery. We will achieve this by quantifying the effects of the ultrasonic excitations typical of surgical devices in tissues, at and surrounding the site of surgery, in terms of precision cutting, tissue damage (mechanical damage, thermal necrosis, cavitation) but also the potential to aid regeneration. We will make world-leading advances in ultra-high speed imaging measurements and biophysical analysis, complementing advances in histology and clinical assessment, to develop a combined approach to the characterisation of both damage and regeneration of tissue. Through this holistic approach to device design, we will create integrated robotic-ultrasonic surgical devices tailored for optimised surgery.

We propose to create the EPSRC Centre for Doctoral Training (CDT) in intelligent integrated imaging in healthcare (i4health) at University College London (UCL). Our aim is to nurture the UK's future leaders in next-generation medical imaging research, development and enterprise, equipping them to produce future disruptive healthcare innovations either focused on or including imaging. Building on the success of our current CDT in Medical Imaging, the new CDT will focus on an exciting new vision: to unlock the full potential of medical imaging by harnessing new associated transformative technologies enabling us to consider medical imaging as a component within integrated healthcare systems. We retain a focus on medical imaging technology - from basic imaging technologies (devices and hardware, imaging physics, acquisition and reconstruction), through image computing (image analysis and computational modeling), to integrated image-based systems (diagnostic and interventional systems) - topics we have developed world-leading capability and expertise on over the last decade. Beyond this, the new initiative in i4health is to capitalise on UCL's unique combination of strengths in four complementary areas: 1) machine learning and AI; 2) data science and health informatics; 3) robotics and sensing; 4) human-computer interaction (HCI). Furthermore, we frame this research training and development in a range of clinical areas including areas in which UCL is internationally leading, as well as areas where we have up-and-coming capability that the i4health CDT can help bring to fruition: cancer imaging, cardiovascular imaging, imaging infection and inflammation, neuroimaging, ophthalmology imaging, pediatric and perinatal imaging. This unique combination of engineering and clinical skills and context will provide trainees with the essential capabilities for realizing future image-based technologies. That will rely on joint modelling of imaging and non-imaging data to integrate diverse sources of information, understanding of hardware the produces or uses images, consideration of user interaction with image-based information, and a deep understanding of clinical and biomedical aims and requirements, as well as an ability to consider research and development from the perspective of responsible innovation. Building on our proven track record, we will attract the very best aspiring young minds, equipping them with essential training in imaging and computational sciences as well as clinical context and entrepreneurship. We will provide a world-class research environment and mentorship producing a critical mass of future scientists and engineers poised to develop and translate cutting-edge engineering solutions to the most pressing healthcare challenges.

Our EPSRC CDT in Advanced Engineering for Personalised Surgery & Intervention will train a new generation of researchers for diverse engineering careers that deliver patient and economic impact through innovation in surgery & intervention. We will achieve this through cohort training that implements the strategy of the EPSRC by working across sectors (academia, industry, and NHS) to stimulate innovations by generating and exchanging knowledge. Surgery is recognised as an "indivisible, indispensable part of health care" but the NHS struggles to meet its rising demand. More than 10m UK patients underwent a surgical procedure in 2021, with a further 5m patients still requiring treatment due to the COVID-19 backlog. This level of activity, encompassing procedures such as tumour resection, reconstructive surgery, orthopaedics, assisted fertilisation, thrombectomy, and cardiovascular interventions, accounts for a staggering 10% of the healthcare budget, yet it is not always curative. Unfortunately, one third of all country-wide deaths occur within 90 days of surgery. The Department of Health and Social Care urges for "innovation and new technology", echoing the NHS Long Term Plan on digital transformation and personalised care. Our proposed CDT will contribute to this mission and deliver mission-inspired training in the EPSRC's Research Priority "Transforming Health and Healthcare". In addition to patient impact, engineering innovation in surgery and intervention has substantial economic potential. The UK is a leader in the development of such technology and the 3rd biggest contributor to Europe's c.150bn euros MedTech market (2021). The market's growth rate is substantial, e.g., an 11.4% (2021 - 2026) compound annual growth rate is predicted just for the submarket of interventional robotics. The engineering scientists required to enhance the UK's societal, scientific, and economic capacity must be expert researchers with the skills to create innovative solutions to surgical challenges, by carrying out research, for example, on micro-surgical robots for tumour resection, AI-assisted surgical training, novel materials and theranostic agents for "surgery without the knife", and predictive computational models to develop patient-specific surgical procedures. Crucially, they should be comfortable and effective in crossing disciplines while being deeply engaged with surgical teams to co-create technology solutions. They should understand the pathway from bench-to-bedside and possess an entrepreneurial mindset to bring their innovations to the market. Such researchers are currently scarce, making their training a key contributor to the success of the UK Government's "Build Back Better - our plan for growth" and UKRI's "five-year strategy". The cross-discipline collaboration of King's School of Biomedical Engineering & Imaging Sciences (BMEIS, host), Department of Engineering, and King's Health Partners (KHP), our Academic Health Science Centre, will create an engineering focused CDT that embeds students within three acute NHS Trusts. Our CDT brings together 50+ world-class supervisors whose grant portfolio (c.£150m) underpins the full spectrum of the CDT's activity, i.e., Smart Instruments & Active Implants, Surgical Data Science, and Patient-specific Modelling & Simulation. We will offer MRes/PhD training pathway (1+3), and direct PhD training pathway (0+4). All students, regardless of pathway, will benefit from continuous education modules which cover aspects of clinical translation and entrepreneurship (with King's Entrepreneurship Institute), as well as core value modules to foster a positive research culture. Our graduates will acquire an entrepreneurial mindset with skills in data science, fundamental AI, computational modelling, and surgical instrumentation and implants. Career paths will range from creating next generation medical innovators within academia and/or industry to MedTech start-up entrepreneurs.

There is a pressing need to improve the precision, control and selectivity of surgical procedures addressing several high-incidence cancers. For example in the UK, the incidence of basal cell carcinoma (BCC) has increased by approximately 250% since the 1990s, with 137,000 new cases of BCC each year. Bowel cancer is the 4th most common cancer and is the second most common cause of cancer death. Some 15% of new bowel cancer cases are early stage and amenable to potential endoluminal surgery; this proportion is increasing with national screening programs. Delayed diagnosis and incomplete excision of tumours are key drivers of patient morbidity, and squander limited surgical resources. Streamlining screening and early diagnosis processes is now even more important with more patient backlog caused by Covid-19. The default surgical practice is to remove cancers wherever possible, along with a margin of healthy tissue. Leaving cancer cells behind leads to reoccurrence, but removing too much healthy tissue increases both the risk of complications and the loss of normal function. Trying to optimise this balance is a global challenge. For example, BCCs often spread out beneath the surface of the skin such that their entirety cannot be detected until surgery. Moh's micrographic surgery is the gold standard for treating BCCs: the tumour is removed section by section and examined under the microscope until no further tumour can be seen. This is both time consuming and traumatic for the patient, typically resulting in larger skin grafts than expected. If the extent of the tumour could be accurately determined, using terahertz (THz) imaging prior to surgery, the procedure would be faster, and grafts better planned. Similarly, if a diagnostic THz imaging capability could be added to a flexible endoscope, more colorectal tumours could be identified in situ and resected without waiting for histology results (typically 2 weeks) and a follow-up procedure. In this programme, a highly interdisciplinary team consisting of investigators at Universities of Warwick, Exeter and Leeds in Physics, Engineering and Medicine, and at the University Hospital of Coventry and Warwickshire and the Leeds Teaching Hospitals NHS Trust, join forces to optimise patient diagnosis and treatment. The team is supported by industry partners including TeraView Ltd, Intuitive Surgical, Kuka (world leader of industrial robots), QinetiQ, the National Physical Laboratory and Lubrizol (an international cosmetics company). THz light is non-ionising, uses low power levels such that thermal effects are insignificant and is consequently safe for in vivo imaging of humans. It is very sensitive to intermolecular interactions such as hydrogen bonds, and probes processes that occur on picosecond timescales. Owing to the high sensitivity of THz light to tissue hydration and composition, THz spectroscopic imaging can help locate and diagnose lesions that cannot be seen by other imaging modalities. In Terabotics, we will integrate THz technology into robotic probes to develop improved platforms for cancer detection and surgical removal. We will develop probes that can be used on the skin as well as in the abdominal cavity and, by miniaturising the technology, we will also develop a new flexible probe for robotic colonoscopy. In this way the project will lead to more efficient cancer diagnosis and surgery, saving surgeons' operating time and reducing the number of surgeries needed. This is because accurately determining the extent of cancers prior to surgery will enable better surgical planning and reduce the need for a second surgery. Being able to diagnose cancers in situ will also give a faster diagnosis to treatment time. These factors will reduce trauma, costs, patient backlog and waiting lists, and improve patient outcomes. In short, our breakthrough in developing in situ diagnosis will bring step changes in the detection and treatment of cancer for many years to come.