Impedance-based tissue discrimination for needle guidance

Peripheral nerve stimulation in regional anesthesia

Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. In light of this evolving utility of nerve stimulation, this is an appropriate time to review the basic concepts and knowledge base of this historically important tool. Electrical nerve stimulation facilitates nerve localization, using threshold current as a surrogate for needle-to-nerve distance. Preferential activation of motor nerves is possible because motor nerve fibers are more readily activated with a shorter duration of current compared with sensory nerves. The association between current and needle-to-nerve distance predicts that less current is needed to evoke a motor response as the needle moves closer to the nerve. Thus, an elicited motor response at or below 0.5 mA is considered a common end point for successful neural blockade. However, current magnitude is neither 100% sensitive nor specific. Independent of technical ability, both the biological environment and the equipment used impact the current-distance relationship. Thus, successful electrical nerve stimulation is dependent on an anesthesiologist with a solid foundation in anatomy and a thorough understanding of electrophysiology.

Tissue characterization using electrical impedance spectroscopy data: a linear algebra approach

In this study, we use a new linear algebra manipulation on electrical impedance spectroscopy measurements to provide real-time information regarding the nature of the tissue surrounding the needle in minimal invasive procedures. Using a Comsol Multiphysics three-dimensional model, a phantom based on ex vivo animal tissue and in vivo animal data, we demonstrate how tissue inhomogeneity can be characterized without any previous knowledge of the electrical properties of the different tissues, except that they should not be linearly dependent on a certain frequency range. This method may have applications in needle biopsies, radiation seeds, or minimally invasive surgery and can reduce the number of computer tomography or magnetic resonance imaging images. We conclude by demonstrating how this mathematical approach can be useful in other applications.

New method for separation of electrode polarization impedance from measured tissue impedance

In this paper we have shown that electrode polarization impedance (EPI) can be separated from measured tissue impedance as long as the characteristic frequencies of EPI and tissue are not too close, so that the EPI is largely displayed as a separate dispersion. In 2-electrode measurements the EPI and sample are physically connected in series, and commonly modelled by equivalent components in series. We have calculated the parallel equivalent elements and converted the series connected EPI and sample to a parallel admittance model. By curve fitting on the converted model we have shown that this provides a new method for estimating the EPI with enhanced accuracy compared to similar techniques used on the impedance model.

A finite element model of needle electrode spatial sensitivity

We used the finite element (FE) method to estimate the spatial sensitivity of a needle electrode for bioimpedance measurements. This current conducting needle with an insulated shaft was inserted in a saline solution and the current was measured at the neutral electrode. Model resistance and reactance were calculated and successfully compared with measurements on a laboratory model. The sensitivity field was described graphically based on these FE simulations.

Invasive electrical impedance tomography for blood vessel detection

We present a novel method for localization of large blood vessels using a bioimpedance based needle positioning system on an array of ten monopolar needle electrodes. The purpose of the study is to develop a portable, low cost tool for rapid vascular access for cooling and controlled reperfusion of cardiac arrest patients. Preliminary results show that localization of blood vessels is feasible with this method, but larger studies are necessary to improve the technology.

Electrical impedance of stainless steel needle electrodes

We present experimental findings regarding variability and stability of the electrical impedance properties of medical grade stainless steel needle electrodes in vitro. Monopolar impedance spectra (1 Hz to 1 MHz) were measured and scanning electron microscope images were obtained for five needle types with active electrode area from 0.28 to 0.7 mm(2). A saline tank (0.9% NaCl) was used as tissue model. Measurements were done before and after electrolytic treatment with anodic and cathodic DC currents of 1 muA. With active electrode areas below 1 mm(2), high influence from electrode polarization impedance (EPI) was expected at low frequencies (LF). For higher frequencies (HF) the EPI decreases and the impedance of the surrounding tissue is more pronounced. The hypothesis tested was that the EPI at LF would depend upon contact area, alloy composition, surface structure, and treatment of the active electrode, and at HF upon the electrode area geometry, and the specific resistivity of saline. Our results show large differences in electrical properties between needle types. After electrolytic treatment the EPI decreased. After 5-48 h of saline exposure the EPI increased, both for treated and untreated needles. Cathodic treatment gave lower impedance and drift than anodic or no treatment.

Real-time cannula navigation in biological tissue with high temporal and spatial resolution based on impedance spectroscopy

In many medical applications a well-directed positioning of a cannula in body tissue is mandatory. Especially the accurate placing of the cannula tip in the tissue is important for efficient drug delivery or for accessing blood vessels and nerves. This paper presents a new approach for a universal cannula navigation system based on tissue classification on the cannula tip by impedance spectroscopy. The cannula serves as coaxial, open ended waveguide which is connected to remote measurement equipment. Objective of the new system is to reach a high spatial and temporal resolution for dynamic cannula guidance. Therefore the proposed coaxial cannula design has been analyzed by Finite Element Simulation to investigate the sensitivity of the cannula tip. For fast tissue impedance spectrum measurement the Time-Domain-Reflectometry method is used in order to achieve a high temporal resolution. Measurement data derived in the laboratory is analyzed and interpreted using the general Cole-Cole model for tissue. Based on the results we propose to use a chirp signal for impedance measurement in order to improve the sensitivity of the system towards specific tissue properties.