Showing papers in "Physiological Measurement in 2002"

Fractal characterization of complexity in temporal physiological signals

Abstract: This review first gives an overview on the concept of fractal geometry with definitions and explanations of the most fundamental properties of fractal structures and processes like self-similarity, power law scaling relationship, scale invariance, scaling range and fractal dimensions. Having laid down the grounds of the basics in terminology and mathematical formalism, the authors systematically introduce the concept and methods of monofractal time series analysis. They argue that fractal time series analysis cannot be done in a conscious, reliable manner without having a model capable of capturing the essential features of physiological signals with regard to their fractal analysis. They advocate the use of a simple, yet adequate, dichotomous model of fractional Gaussian noise (fGn) and fractional Brownian motion (fBm). They demonstrate the importance of incorporating a step of signal classification according to the fGn/fBm model prior to fractal analysis by showing that missing out on signal class can result in completely meaningless fractal estimates. Limitation and precision of various fractal tools are thoroughly described and discussed using results of numerical experiments on ideal monofractal signals. Steps of a reliable fractal analysis are explained. Finally, the main applications of fractal time series analysis in biomedical research are reviewed and critically evaluated.

Quantitative assessment of skin layers absorption and skin reflectance spectra simulation in the visible and near-infrared spectral regions.

Abstract: We have simulated diffuse reflectance spectra of skin by assuming a wavelength-independent scattering coefficient for the different skin tissues and using the known wavelength dependence of the absorption coefficient of oxy- and deoxyhaemoglobin and water. A stochastic Monte Carlo method is used to convert the wavelength-dependent absorption coefficient and wavelength-independent scattering coefficient into reflected intensity. The absorption properties of skin tissues in the visible and near-infrared spectral regions are estimated by taking into account the spatial distribution of blood vessels, water and melanin content within distinct anatomical layers. The geometrical peculiarities of skin histological structure, degree of blood oxygenation and the haematocrit index are also taken into account. We demonstrate that when the model is supplied with reasonable physical and structural parameters of skin, the results of the simulation agree reasonably well with the results of in vivo measurements of skin spectra.

The difference in pulse transit time to the toe and finger measured by photoplethysmography.

Abstract: Blood pressure pulse wave velocity (PWV) is a parameter which is related to arterial distensibility. Its direct assessment, by measuring the appearance time of a pressure pulse in two sites along an artery and the distance between the two sites, is complicated and inaccurate. In the current study, pulse transit time (PTT) to the toes and fingers of 44 normotensive male subjects was measured by photoplethysmography (PPG) and ECG. The arrival time of the pulses at the toe and finger was determined from the foot of the systolic rise of the PPG signal, i.e. at end-diastolic time. Two parameters, which are related to PWV, were tested: the time delay between the ECG R-wave and the arrival time of the pulses at the toe (E-T PTT), and the difference in the transit time of the blood pressure pulses between the toe and finger (T-F PTTD). E-T PTT and T-F PTTD decreased as functions of the subject's age and systolic blood pressure (SBP), but their dependence on the diastolic blood pressure (DBP) was not statistically significant. The decrease of the PTT parameters with age is attributed to the direct structural decrease of the arterial compliance with age and not to functional effects associated with the increase of the blood pressure with age, since the PTT parameters did not depend on DBP though the measurements were performed at end-diastole.

A study on the optimum order of autoregressive models for heart rate variability.

Abstract: Heart rate variability (HRV) has been used as a non-invasive marker of the activity of the autonomic nervous system and its spectrum analysis gives a measure of the sympatho-vagal balance. If short segments are used in an attempt to improve temporal resolution, autoregressive spectral estimation, where the mode] order must be estimated, is preferred. In this paper we compare four criteria for the estimation of the 'optimum' model order for an autoregressive (AR) process applied to short segments of tachograms used for HRV analysis. The criteria used were Akaike's final prediction error, Akaike's information criterion, Parzen's criterion of autoregressive transfer function and Rissanen's minimum description length method, and they were first applied to tachograms to verify (i) the range and distribution of model orders obtained and (ii) if the different techniques suggest the same model order for the same frames. The four techniques were then tested using a true AR process of known order p = 6; this verified the ability of the criteria to estimate the correct order of a true AR process and the effect, on the spectrum, of choosing a wrong model order was also investigated. It was found that all the four criteria underestimate the true AR order; specifying a fixed model order was then looked at and it is recommended that an AR order not less than p = 16, should be used for spectral analysis of short segments of tachograms.

Guided ultrasonic waves in long bones: modelling, experiment and in vivo application

Abstract: Existing ultrasound devices for assessing the human tibia are based on detecting the first arriving signal, corresponding to a wave propagating at, or close to, the bulk longitudinal velocity in bone. However, human long bones are effectively irregular hollow tubes and should theoretically support the propagation of more complex guided modes similar to Lamb waves in plates. Guided waves are attractive because they propagate throughout the bone thickness and can potentially yield more information on bone material properties and architecture. In this study, Lamb wave theory and numerical simulations of wave propagation were used to gain insights into the expected behaviour of guided waves in bone. Experimental measurements in acrylic plates, using a prototype low-frequency axial pulse transmission device, confirmed the presence of two distinct propagating waves: the first arriving wave propagating at, or close to, the longitudinal velocity, and a slower second wave whose behaviour was consistent with the lowest order Lamb antisymmetrical (A0) mode. In a pilot study of healthy and osteoporotic subjects, the velocity of the second wave differed significantly between the two groups, whereas the first arriving wave velocity did not, suggesting the former to be a more sensitive indicator of osteoporosis. We conclude that guided wave measurements may offer an enhanced approach to the ultrasonic characterization of long bones.

Validation of a device to measure arterial pulse wave velocity by a photoplethysmographic method

Abstract: We aimed to validate a new method for measuring arterial pulsewave transit time and pulsewave velocity (a measure of arterial elasticity), based on the principle of photoplethysmography (PPG), and to compare transcutaneous values with those obtained by intra-arterial measurements. Three validation experiments are described. (a) PPG pulse wave delay times (defined as the time interval between the ECG R wave and the foot of the arterial pulse wave measured at the wrist or ankle) were compared to values obtained simultaneously from an established methodology (Doppler ultrasound). (b) Aortic pulsewave delay times in 17 subjects obtained non-invasively by the PPG method were compared with those obtained from the intra-arterial pressure wave. (c) Repeatability measurements of PWV on the same subjects were carried out over two timescales (minutes and hours) in the arm, the leg and the trunk. The Doppler and PPG delay times correlated well, as did intra-arterial and transcutaneous values. Repeatability at short timescales was good (coefficients of variation (CV) < 6% for all measurement sites) and, at the longer timescale, was satisfactory (CVs in the aorta, the arm and leg were 6.3, 13.1 and 16.0, respectively). The PWV values agreed well with others in the literature. We conclude that the PPG technique provides a complement to existing methods for the non-invasive measurement of arterial compliance. Its simplicity and ease of use make it suitable for large-scale epidemiological studies.

In vivo PIV measurement of red blood cell velocity field in microvessels considering mesentery motion.

Abstract: As endothelial cells are subject to flow shear stress, it is important to determine the detailed velocity distribution in microvessels in the study of mechanical interactions between blood and endothelium. Recently, particle image velocimetry (PIV) has been proposed as a quantitative method of measuring velocity fields instantaneously in experimental fluid mechanics. The authors have developed a highly accurate PIV technique with improved dynamic range. spatial resolution and measurement accuracy. In this paper, the proposed method was applied to images of the arteriole in the rat mesentery using an intravital microscope and high-speed digital video system. Taking the mesentery motion into account, the PIV technique was improved to measure red blood cell (RBC) velocity. Velocity distributions with spatial resolutions of 0.8 x 0.8 microm were obtained even near the wall in the centre plane of the arteriole. The arteriole velocity profile was blunt in the centre region of the vessel cross-section and sharp in the near-wall region. Typical flow features for non-Newtonian fluid were shown. Time-averaged velocity profiles in six cross sections with different diameters were compared.

Novel mechano-acoustic technique and instrument for diagnosis of cartilage degeneration.

Abstract: Fibrillation of articular surface and depletion of proteoglycans are the structural changes related to early osteoarthrosis. These changes make cartilage softer and prone to further degeneration. The aim of the present study was to combine mechanical and acoustic measurements towards quantitative arthroscopic evaluation of cartilage quality. The performance of the novel ultrasound indentation instrument was tested with elastomers and bovine articular cartilage in vitro. The instrument was capable of measuring elastomer thickness (r = 1.000, p < 0.01, n = 8) and dynamic modulus (r = 0.994, p < 0.01, n = 13) reliably. Osteochondral plugs were tested before and after enzymatic degradation of cartilage proteoglycans by trypsin or chondroitinase ABC, and of cartilage collagens by collagenase. Trypsin and collagenase induced a mean decrease of −31.2 ± 12.3% (±SD, p < 0.05) and −22.9 ± 20.8% (p = 0.08) in dynamic modulus, respectively. Rate of cartilage deformation, i.e. creep rate, increased by +117.8 ± 71.4% (p < 0.05) and +24.7 ± 35.1% (p = 0.17) in trypsin and chondroitinase ABC treatments, respectively. Collagenase induced a greater decrease in the ultrasound reflection from the cartilage surface (−54.2 ± 29.6%, p < 0.05) than trypsin (−17.1 ± 13.5%, p = 0.08). In conclusion, combined quantitation of tissue modulus, viscoelasticity and ultrasound reflection from the cartilage surface provides a sensitive method to distinguish between normal and degenerated cartilage, and even to discern proteoglycan loss and collagen degradation from each other.

Local elastic modulus of atherosclerotic lesions of rabbit thoracic aortas measured by pipette aspiration method

Abstract: Changes in mechanical properties of arteries during atherogenesis remain controversial. One of the reasons could be that they have been evaluated with parameters measured in a whole vessel, although the lesions are localized. The local elastic modulus of atherosclerotic lesions was measured by the pipette aspiration method in thoracic aortas of rabbits fed a cholesterol diet for 8, 16, 24 and 28 weeks. The global elastic modulus of the whole aorta was measured by the pressure-diameter test. The local modulus decreased from that of the normal tissue in 8 weeks and then increased during the cholesterol feeding period. The global modulus did not change until 24 weeks and increased by 28 weeks. Histological observation revealed that the initial soft lesion was mainly composed of foam cells, and the stiffening accompanied first the appearance of smooth muscle cells in the top layer of the hyperplastic intima and then calcification in its bottom layer. The global elastic modulus did not change until marked calcification occurred in the tissue. These results suggest that change in mechanical properties of atherosclerotic lesion is not simple and has a close correlation with its histology. Assessment of local mechanical properties is important for studying mechanical properties of atherosclerotic arteries.

Quantitative evaluation of the relative contribution ratio of cerebral tissue to near-infrared signals in the adult human head: a preliminary study.

Abstract: Combining spatially- and time-resolved spectroscopies, we attempted to quantitatively evaluate the contribution ratio of the partial mean pathlength of cerebral tissue to the observed overall mean pathlength, in which haemoglobin concentrations were selectively changed by administration of acetazolamide. When acetazolamide was administered, the observed increases in oxygenated haemoglobin depended on the probe distance, which became progressively larger at distances of 2, 3 and 4 cm. Increases in oxygen saturation were detected at 3 and 4 cm spacing, but not at 2 cm. Assuming that the modified Lambert–Beer's law can exist in the inhomogeneous structure of the head, then, we could estimate the contribution ratio of the cerebral tissue to optical signals at the probe distances of 2, 3 and 4 cm as 33%, 55% and 69%, respectively. Using these values, we recalculated acetazolamide-induced concentration changes in oxygenated-haemoglobin in the cerebral tissue, which resulted in the same values at distances of 2, 3 and 4 cm as expected. Thus, our present method opened the door to the possibility of selectively obtaining optical signals attributed to cerebral tissue.

Investigation of oesophageal photoplethysmographic signals and blood oxygen saturation measurements in cardiothoracic surgery patients

Abstract: Pulse oximeter probes attached to the finger may fail to estimate blood oxygen saturation (SpO2) in patients with compromised peripheral perfusion (e.g. hypothermic cardiopulmonary bypass surgery). The measurement of SpO2 from a central organ such as the oesophagus is suggested as an alternative to overcome this problem. A reflectance oesophageal pulse oximeter probe and a processing system implemented in LabVIEW were developed. The system was evaluated in clinical measurements on 50 cardiothoracic surgery patients. Oesophageal photoplethysmographic (PPG) signals with large amplitudes and high signal-to-noise ratios were measured from various depths within the oesophagus from all the cardiothoracic patients. The oesophageal PPG amplitudes from these patients were in good agreement with previous oesophageal PPG amplitude measurements from healthy anaesthetized patients. The oesophageal pulse oximeter SpO2 results agreed well with the estimated arterial oxygen saturation (SaO2) values inferred from the oxygen tension obtained by blood gas analysis. The mean (+/- SD) of the differences between the oesophageal pulse oximeter SpO2 readings and those from blood gas analysis was 0.02 +/- 0.88%. Also, the oesophageal pulse oximeter was found to be reliable and accurate in five cases of poor peripheral perfusion when a commercial finger pulse oximeter probe failed to estimate oxygen saturation values for at least 10 min. These results suggest that the arterial blood circulation to the oesophagus is less subject to vasoconstriction and decreased PPG amplitudes than are the peripheral sites used for pulse oximetry such as the finger. It is concluded that oesophageal SPO2 monitoring may be of clinical value.

Microvascular blood flow and skin temperature changes in the fingers following a deep inspiratory gasp

Abstract: The aims of this study were to quantify the changes in finger pulp skin temperature, laser Doppler flow (LDF, microvascular flux) and photoplethysmogram (PPG, microvascular blood volume pulsatility), induced by a deep inspiration in healthy subjects, and to investigate the repeatability of these responses within a measurement session and between measurement sessions on separate days. A system comprising an electronic thermometer, a laser Doppler flowmeter and a PPG amplifier measured simultaneous vasoconstrictor responses to a deep inspiratory gasp from three adjacent fingers of one hand. Clearly defined responses were obtained in 15 of the 17 subjects studied. Skin temperature fell in all of these subjects after each gasp, with a median fall of 0.089 °C (P < 0.001). The median value of LDF flux reduction was 93% (P < 0.001) indicating a momentary almost complete shut-down of microvascular blood flow; and PPG also showed a large response relative to pulse amplitude of 2.6 (P < 0.001). The median times for waveforms to reach their minimum were 4.6 s (PPG), 6.3 s (LDF) and 29.1 s (skin pulp temperature), with median delays between minima of LDF and PPG of 1.6 s (P < 0.001) and skin temperature and PPG of 23.5 s (P < 0.001). The vascular responses of skin temperature, LDF and PPG to an inspiratory gasp were repeatable, with temperature change repeatable to within 10% of the median subject change.

Progress in Ambulatory Assessment: Computer Assisted Psychological and Psychophysiological Methods in Monitoring and Field Studies

Abstract: Edited by Jochen Fahrenberg and Michael Myrtek 2001 Seattle, Toronto, Bern and Gottingen: Hogrefe and Huber 627 pp hardcover ISBN 0-88937-225-X US$49.95 CAN$74.95 Euro49.95 SFr84.00 £32.45 During the 1950s, Holter and colleagues developed a number of portable recording devices which served to introduce the concept of `ambulatory monitoring'. Early devices were principally for cardiovascular monitoring, intended to allow patients' symptoms to be related to the underlying physiology. More recent devices, especially those based on portable computers, now allow various tests of cognitive and intellectual ability to be carried out on ambulatory subjects, and to relate performance in these tests to the physiological state. The book has its origins in a workshop on ambulatory assessment, which was held at the University of Freiburg, Germany, in 1999. Thirty-five chapters explore the use of computer assisted methods of ambulatory assessment, both as research tools and in applied settings. The perspective is largely a European one, with only a few of the 80 or so contributors from North America. The text is presented in two parts, the first dealing with psychological assessment and the second with more physiological aspects of the subject. While the second part of the book may be of greater interest to readers of this journal, the first part, dealing as it does with mental and emotional testing, may well provide more unfamiliar material. Here the first few chapters deal with posture and activity monitoring using accelerometry, and the influences these can have on other psychological variables. Several chapters follow this on aspects of blood pressure and heart rate monitoring. Several chapters then discuss monitoring of respiratory variables, particularly their role in the assessment of patients suffering from anxiety. Following chapters deal with monitoring in the workplace, in stressful situations such as working at night, as an air traffic controller, and flying an aircraft Towards the end of the book the emphasis is on developments in the technology that has made ambulatory monitoring possible. There is a review of recent recording devices, dealing principally with those that are commercially available. This is followed by a discussion on the transition from ambulatory assessment to telemedicine, reviewing the concepts and the problems to be overcome. The book concludes with an excellent overview of the historical development of ambulatory monitoring and assessment, written by one of the editors. The majority of chapters are supported by extensive bibliographies. In spite of the fact that the book is based on a meeting held in 1999, many chapters have been revised and updated to include references to papers published during 2000. Readers will find these bibliographies particularly useful as many of the papers cited are published in psychology journals which are not included in the popular medical databases.

On-line, simultaneous quantification of ethanol, some metabolites and water vapour in breath following the ingestion of alcohol.

Abstract: Selected ion flow tube mass spectrometry, SIFT-MS, has been used to measure simultaneously the concentrations in exhaled breath of ethanol, acetaldehyde, ammonia, acetone and, routinely, water vapour, following the ingestion of various amounts of ethanol in 500 ml of water. These breath analyses were obtained from only single exhalations, the results being available immediately in real time. The breath ethanol reaches concentrations that are only approximately consistent with its dilution in blood and body water. For moderate ethanol doses the decay quickly exhibits first-order kinetics (a single exponential decay) whereas for relatively large ethanol doses, the initial decay of ethanol from the breath is slow, indicating saturation kinetics. For smaller doses, and following a meal, the breath ethanol increases only slightly indicating that it is largely metabolized in the stomach. We suggest that the time delay (following ethanol ingestion) before the breath ethanol begins to increase is an indicator of the gastric emptying rate. Then the rate of decay of ethanol from the breath/blood is related to its rate of metabolism subsequent to its dispersal into the body water. The much lower breath acetaldehyde levels correlate well with the ethanol levels indicating that it is mostly formed from the metabolism of the ethanol. The breath ammonia is seen to 'dip' following the water/alcohol drink and this is consistent with previous work in which this same phenomenon was observed following the ingestion of comparable volumes of liquid meals. The simultaneous breath acetone concentrations increase somewhat with time as is expected during the fasting state. The water vapour measurements are indicators of the precision and accuracy of the breath analyses, these being sufficient to show the differences between the breath (body) temperatures of the individuals of less than 1 °C. This study demonstrates the potential of SIFT-MS for non-invasive physiological measurement.

Relationship between detrended fluctuation analysis and spectral analysis of heart-rate variability

Abstract: The recently-introduced technique of detrended fluctuation analysis (DFA) for heart-rate variability appears to yield improved prognostic power in cardiovascular disease through calculation of the fractal scaling exponent alpha. However, the physiological meaning of alpha remains unclear. In DFA, the signal is segmented into lengths from 4 to 64 beats. For each segmentation length (n), the individual segments are cumulated, detrended and the sum of the squares (F2) of residuals calculated. Alpha is the slope of log(F) against log(n). We show mathematical equivalence between alpha calculated by DFA and by a novel alternative method using frequency-weighted power spectra. We show F2 (and thus alpha) can be obtained from a frequency-weighted power spectrum without DFA. To do this, we cumulate and detrend the Taylor series of individual Fourier components. F2 is found to depend on the relationship between the signal period and segment length. F2 can therefore be expressed in terms of frequency-weighted power spectra. From this, the alpha coefficient of DFA can then be described in power-spectral terms, which facilitates exploration of its physiological basis. We confirm these findings using samples from 20 healthy volunteers and 40 patients with heart failure.

Dielectric properties of blood: an investigation of temperature dependence.

Abstract: We have investigated the temperature dependence of the electrical parameters (permittivity and conductivity) of blood. The measuring system, composed of an impedancemeter (HP 4291 A), an open-ended coaxial line and a temperature controlling set, was designed for dielectric measurement in the frequency range of 1 MHz to 1 GHz. Measurements were performed on ex vivo blood of humans and animals (cow and sheep). The results obtained show the weak sensibility and a change of sign of the temperature coefficient of the relative permittivity (about 0.3% degrees C(-1) at 1 MHz and -0.3% degrees C(-1) at 1 GHz). The conductivity presents a more significant variation (of the order of 1% degrees C(-1) over the whole operating frequency range.

Design and performance of the UCLH mark 1b 64 channel electrical impedance tomography (EIT) system, optimized for imaging brain function.

Abstract: The UCLH Mark 1b is a portable EIT system that can address up to 64 electrodes, which has been designed for imaging brain function with scalp electrodes. It employs a single impedance-measuring circuit and multiplexer so that electrode combinations may be addressed flexibly using software. It operates in the relatively low frequency band between 225 Hz and 77 kHz, as lower frequencies produce larger changes during brain activity, and has a videocassette-sized headbox on a lead 10 m long, connected to a base box the size of a video recorder, and notebook PC, so that recordings may be made in ambulant subjects. Its performance was assessed using a resistor–capacitor network, and two saline-filled tanks—a cylindrical Perspex one and a latex one which contained a human skull. System signal-to-noise ratio was better than 50 dB and the maximum reciprocity error less than 10% for most frequencies. The CMMR was better than 80 dB at 38 kHz and a sponge, 20 mm across, which caused a local 12% impedance increase, was correctly localized in images. This suggests that the system has adequate performance to image impedance changes of 5–50% known to occur in the brain during normal activity, epilepsy or stroke; clinical trials to image these conditions are in progress.

Human factors error and patient monitoring

Abstract: A wide range of studies have shown that human factors errors are the major cause of critical incidents that threaten patient safety in the medical environments where patient monitoring takes place, contributing to approximately 87% of all such incidents. Studies have also shown that good cognitively ergonomic design of monitoring equipment for use in these environments should reduce the human factors errors associated with the information they provide. The purpose of this review is to consider the current state of knowledge concerning human factors engineering in its application to patient monitoring. It considers the prevalence of human factors error, principles of good human factors design, the effect of specific design features and the problem of the measurement of the effectiveness of designs in reducing human factors error. The conclusion of the review is that whilst the focus of human factors studies has, in recent years, moved from instrument design to organizational issues, patient monitor designers still have an important contribution to make to improving the safety of the monitored patient. Further, whilst better psychological understanding of the causes of human factors errors will in future guide better human factors engineering, in this area there are still many practical avenues of research that need exploring from the current base of understanding.

Assessment of dynamic cerebral autoregulation based on spontaneous fluctuations in arterial blood pressure and intracranial pressure.

Abstract: Assessments of dynamic cerebral autoregulation usually measure the cerebral blood flow velocity (CBFV) response to changes in arterial blood pressure (ABP). We studied the effect of substituting ABP by cerebral perfusion pressure (CPP), expressed as the difference between ABP and intracranial pressure (ICP), in estimates of dynamic autoregulation obtained by transfer function analysis. CBFV, ABP and ICP were recorded during periods of physiological stability in 30 patients with severe head injury. Transfer function analysis was performed using the following combinations of input–output variables: ABP–CBFV, CPP–CBFV and CBFV–ICP. Frequency and time-domain (step response) functions were averaged for recordings with mean ICP = 20 mmHg (group B). The ABP–CBFV transfer function parameters and step response for group A were similar to previous studies in normal subjects, but group B showed deterioration of dynamic autoregulation. Radically different step responses were obtained from both groups for the CPP–CBFV transfer function and the coherence was not significantly improved. The CBFV–ICP transfer function had the highest values of coherence and indicates that changes in CBFV are the cause of spontaneous fluctuations in ICP. Furthermore, the ICP step response plateau was significantly higher for group B than for group A. An alternative calculation of the CBFV step response to changes in CPP resembled the corresponding responses for the ABP input. For spontaneous fluctuations in ABP, ICP and CBFV, it is not possible to calculate the CPP–CBFV transfer function directly due to the high positive correlation between ICP and CBFV, but an alternative estimate can be obtained by using the CBFV–ICP transfer function. The latter could also be useful as a method to assess intracranial compliance in head injury patients.

The number of electrodes and basis functions in EIT image reconstruction

Abstract: In electrical impedance tomography, many factors affect the image reconstruction results. Among them are the number of electrodes (NOE) and the number of conductivity basis functions (NOCBF) for image reconstruction. The NOCBF generally reflects the density of the mesh with which images are reconstructed. How and to what extent do these factors affect the image reconstruction and corresponding images? In this area detailed analysis is still lacking. This study aims to address the above question. In this study, image reconstruction and its ill-posed condition were analysed by singular value decomposition (SVD) and spectral expansion theory with different configurations of NOE and NOCBF. The results in this study indicate that for a circular 2D plane object with electrodes evenly located around the boundary: (1) Under certain conditions, increasing the NOE enables us to improve the ill-posed condition in image reconstruction and hence improve the image quality. Generally more improvement is expected near the image periphery than in the image centre. (2) Increasing the NOCBF generally worsens the ill-posed condition. But it enables the solution to be sought in a finer subspace and may be able to improve the image quality on the periphery, while generally the result in image centre depends more on the prior information incorporated in the regularization.

Sensitivity maps for low-contrast perturbations within conducting background in magnetic induction tomography.

Abstract: Magnetic induction tomography (MIT) is a contactless method for mapping the electrical conductivity of tissue by measuring the perturbation of an alternating magnetic field with appropriate receiver coils. Reconstruction algorithms so far suggested for biomedical applications are based on weighted backprojection, hence requiring tube-shaped zones of sensitivity between excitation coils and receiving coils, the sensitivity being essentially zero outside this 'projection beam'. This condition is met for conducting perturbations in empty space and for some special configurations of insulators in saline. In biological structures, however, perturbations with low conductivity contrast are embedded into a bulk conductor. The respective sensitivity distribution was investigated and quantified theoretically and experimentally by displacing a conducting (agar, 8 S m−1) and an insulating sphere within a saline tank (4 S m−1). In contrast to the case in the empty space the sensitivity is not confined to a tube but even increases outside the 'projection beam'. The difference can be explained by the interaction of bulk currents with the perturbing object. This effect invalidates backprojection and hence the solution of the complete inverse eddy-current problem is suggested.

True colour imaging of the fundus using a scanning laser ophthalmoscope.

Abstract: Currently retinal imaging is performed with the fundus camera. This has a number of limitations, in particular the high level of illuminations required for imaging. The scanning laser ophthalmoscope (SLO) has been proposed as an alternative imaging device but to date one of its main limitations has been that it gives only monochromatic images. In this paper we describe an SLO which uses low power red, green and blue lasers to image the human fundus. Using three lasers simultaneously to produce a colour image will increase the fundus exposure by a factor of three. To overcome this problem, a technique has been developed for multiplexing the lasers so that each point on the retina is imaged by the three lasers pulsed rapidly in sequence. The total exposure is thus kept to the same level as for a single laser and total imaging time is not increased. An example is shown of the image from a patient with diabetic retinopathy.

Modelled current distribution in cervical squamous tissue

Abstract: The electrical properties of cervical squamous epithelium have been modelled in the frequency range 100 Hz to 10 MHz. The hierarchical modelling process comprises a cellular level stage, which includes detailed models of cells typical of different depths within the epithelium and a tissue model, which utilizes electrical properties obtained from the cellular models. The fit between the modelled and measured impedance spectra and the distribution of current with depth depends on the macroscopic model structure. Both the properties of the basement membrane and the presence of a surface mucus layer are shown to have a significant effect. The best fit with measured data is obtained when a 10 ?m thick, high-conductivity surface layer is included in the tissue model.

A comparison of methods for measurement of spatial resolution in two-dimensional circular EIT images.

Abstract: The literature concerning measurement of spatial resolution in electrical impedance tomography (EIT) is vague. Different groups often use their own method or a modified version of a better known method, thus hindering a generalized resolution measurement which could be useful for gauging the performance of one system against another. Measurement of spatial resolution in EIT is further complicated by its spatial variant nature and hence cannot be expressed simply with a single parameter as it can be in other imaging modalities (such as nuclear medicine or MRI for example). If the performance of each acquisition and image reconstruction system in EIT is to be compared objectively then there needs to be a common standard. In this paper the results of different methods for calculating spatial resolution are compared and an improved method is proposed which aims to fulfil this role.

The repeatability of cerebral autoregulation assessment using sinusoidal lower body negative pressure.

Abstract: A forced periodic variation in blood pressure produces a similar variation in cerebral blood velocity. The amplitudes and phases of the pressure and velocity waveforms are indicative of the dynamic response of the cerebral autoregulation. The phase of the velocity leads the pressure; the greater the phase difference the faster the autoregulation response. Various techniques have been employed to oscillate arterial blood pressure but measurement reproducibility has been poor. The purpose of this study was to assess the reproducibility of phase measurements when sinusoidal lower body negative pressure is used to vary blood pressure. Five healthy volunteers were assessed at two vacuum levels on each of eight visits. For each measurement a 12 s sinusoidal cycle was maintained for 5 min. The Fourier components of blood pressure and the middle cerebral artery velocity were determined at the oscillation frequency. The phase of velocity consistently led the pressure. The mean phase difference was 42 ± 13° for the stronger vacuum and 36 ± 42° for the weaker vacuum. The variation given is the within-subjects standard deviation estimated from a one-way analysis of variance. Sinusoidal lower body negative pressure is a useful stimulus for investigating autoregulation; it has advantages over other methods. High vacuums show good reproducibility but are too uncomfortable for patient use.

Use of electrical impedance tomography (EIT) for the assessment of unilateral pulmonary function

Abstract: We describe a fully automatable quantification process for the assessment of unilateral pulmonary function (UPF) by means of EIT and propose a measurement protocol for its clinical implementation. Measurements were performed at the fourth and sixth intercostal levels on a first group of ten healthy subjects (5M, 5F, ages 26–48 years) to define the proper protocol by evaluating the most common postures and ventilation modes. Several off-line processing tools were also evaluated, including the use of digital filters to extract the respiratory components from EIT time series. Comparative measures were then carried out on a second group consisting of five pre-operatory patients with lung cancer (4M, 1F, ages 25–77 years) scheduled for radionuclide scanning. Results show that measurements were best performed with the subject sitting down, holding his arms up and breathing spontaneously. As regards data processing, it is best to extract Fourier respiratory components. The mean of the healthy subject group leads to a left–right division of lung ventilation consistent with literature values (47% left lung, 53% right lung). The comparative study indicates a good correlation (r = 0.96) between the two techniques, with a mean difference of (−0.4 ± 5.4)%, suggesting that the elimination of cardiac components from the thoracic transimpedance signal leads to a better estimation of UPF.

How can we measure substrate, metabolite and neurotransmitter concentrations in the human brain?

Abstract: Cerebral injury and disease is associated with fundamental derangements in metabolism, with changes in the concentration of important substrates (e.g. glucose), metabolites (e.g. lactate) and neurotransmitters (e.g. glutamate and γ-aminobutyric acid) in addition to changes in oxygen utilization. The ability to measure these substances in the human brain is increasing our understanding of the pathophysiology of trauma, stroke, epilepsy and tumours. There are several techniques in clinical practice already in use and new methods are under evaluation. Such techniques include the use of cerebral probes (e.g. microdialysis, voltammetry and spectrophotometry) and functional imaging (e.g. positron emission tomography and magnetic resonance spectroscopy). This review describes these techniques in terms of their principles and clinical applications.

A multi-shell algorithm to reconstruct EIT images of brain function

Abstract: Electrical impedance tomography (EIT) may be used to image brain function, but an important consideration is the effect of the highly resistive skull and other extracerebral layers on the flow of injected current. We describe a new reconstruction algorithm, based on a forward solution which models the head as four concentric, spherical shells, with conductivities of the brain, cerebrospinal fluid, skull and scalp. The model predicted that the mean current travelling in the brain in the diametric plane for current injection from polar electrodes was 5.6 times less than if the head was modelled as a homogeneous sphere; this suggests that an algorithm based on this should be more accurate than one based on a homogeneous sphere model. In images reconstructed from computer-simulated data or data from a realistic saline-filled tank containing a real skull, a Perspex rod was localized to within 17% or 20% of the tank diameter of its true position, respectively. Contrary to expectation, the tank images were less accurate than those obtained with a reconstruction algorithm based on a homogeneous sphere. It is not yet clear if the theoretical advantages of this algorithm will yield practical advantages for head EIT imaging; it may be necessary to proceed to more complex algorithms based on numerical models which incorporate realistic head geometry. If so, this analytical forward model and algorithm may be used to validate numerical solutions.

Preliminary static EIT images of the thorax in health and disease.

Abstract: The results of a preliminary clinical evaluation of a one-frequency electrical impedance tomography (EIT) system enabling static in vivo imaging are presented. The design of the measuring system and image reconstruction software are described. Thirty-one subjects were examined and divided into four clinical groups. The first group consisted of 22 patients with clinical diagnosis of lung cancer with tumour localization in one lung. The second group consisted of seven healthy subjects. A patient after a one-sided pneumectomy and another with one-sided emphysema diagnosis were also examined. Static EIT images of a healthy human chest and a chest with various abnormalities are given and discussed. The evaluated system distinguishably visualizes various states of lungs and thorax including lung cancer. The average static conductivity of an affected lung in the first clinical group statistically differs from the average conductivity of a healthy lung. In spite of low spatial resolution, according to preliminary results, the method can be sensitive to cancer and other lung diseases in screening investigations.

Optimal imaging with adaptive mesh refinement in electrical impedance tomography.

Abstract: In non-linear electrical impedance tomography the goodness of fit of the trial images is assessed by the well-established statistical ?2 criterion applied to the measured and predicted datasets. Further selection from the range of images that fit the data is effected by imposing an explicit constraint on the form of the image, such as the minimization of the image gradients. In particular, the logarithm of the image gradients is chosen so that conductive and resistive deviations are treated in the same way. In this paper we introduce the idea of adaptive mesh refinement to the 2D problem so that the local scale of the mesh is always matched to the scale of the image structures. This improves the reconstruction resolution so that the image constraint adopted dominates and is not perturbed by the mesh discretization. The avoidance of unnecessary mesh elements optimizes the speed of reconstruction without degrading the resulting images. Starting with a mesh scale length of the order of the electrode separation it is shown that, for data obtained at presently achievable signal-to-noise ratios of 60 to 80 dB, one or two refinement stages are sufficient to generate high quality images.