Bioimpedance tomography (electrical impedance tomography)

Exploratory study on the methodology of fast imaging of unilateral stroke lesions by electrical impedance asymmetry in human heads

Stroke has a high mortality and disability rate and should be rapidly diagnosed to improve prognosis. Diagnosing stroke is not a problem for hospitals with CT, MRI, and other imaging devices but is difficult for community hospitals without these devices. Based on the mechanism that the electrical impedance of the two hemispheres of a normal human head is basically symmetrical and a stroke can alter this symmetry, a fast electrical impedance imaging method called symmetrical electrical impedance tomography (SEIT) is proposed. In this technique, electrical impedance tomography (EIT) data measured from the undamaged craniocerebral hemisphere (CCH) is regarded as reference data for the remaining EIT data measured from the other CCH for difference imaging to identify the differences in resistivity distribution between the two CCHs. The results of SEIT imaging based on simulation data from the 2D human head finite element model and that from the physical phantom of human head verified this method in detection of unilateral stroke.

Transrectal electrical impedance tomography of the prostate: spatially coregistered pathological findings for prostate cancer detection

PURPOSE

Prostate cancer ranks as one of the most common malignancies and currently represents the second leading cancer-specific cause of death in men. The current use of single modality transrectal ultrasound (TRUS) for biopsy guidance has a limited sensitivity and specificity for accurately identifying cancerous lesions within the prostate. This study introduces a novel prostate cancer imaging method that combines TRUS with electrical impedance tomography (EIT) and reports on initial clinical findings based on in vivo measurements.

METHODS

The ultrasound system provides anatomic information, which guides EIT image reconstruction. EIT reconstructions are correlated with semiquantitative pathological findings. Thin plate spline warping transformations are employed to overlay electrical impedance images and pathological maps describing the spatial distribution of prostate cancer, with the latter used as reference for data analysis. Clinical data were recorded from a total of 50 men prior to them undergoing radical prostatectomy for prostate cancer treatment. Student's t-tests were employed to statistically examine the electrical property difference between cancerous tissue and benign tissue as defined through histological assessment of the excised gland.

RESULTS

Example EIT reconstructions are presented along with a statistical analysis comparing EIT and pathology. An average transformation error of 1.67% is found when 381 spatially coregistered pathological images are compared with their target EIT reconstructed counterparts. At EIT signal frequencies of 0.4, 3.2, and 25.6 kHz, paired-testing demonstrated that the conductivity of cancerous regions is significantly greater than that of benign regions ( p < 0.0304).

CONCLUSIONS

These preliminary clinical findings suggest the potential benefits electrical impedance measurements might have for prostate cancer detection.

Clinical review: Lung imaging in acute respiratory distress syndrome patients--an update

Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective.

Electrical property sensing biopsy needle for prostate cancer detection

BACKGROUND

Significant electrical property differences have been demonstrated to exist between malignant and benign prostate tissues. We evaluated how well a custom designed clinically deployable electrical property sensing biopsy needle is able to discriminate between these tissue types in an ex vivo prostate model.

METHODS

An electrical impedance spectroscopy (EIS) sensing biopsy (Bx) needle was developed to record resistive (ρR) and reactive (ρX) components of electrical impedance from 100 Hz to 1 MHz. Standard twelve-core biopsy protocols were followed, in which the EIS-Bx device was used to gauge electrical properties prior to extracting tissue cores through biopsy needle firing from 36 ex vivo human prostates. Histopathological assessment of the cores was statistically compared to the impedance spectrum gauged from each core.

RESULTS

The magnitudes of the mean resistive and reactive components were significantly higher in cancer tissues (P < 0.05). ROC curves showed that ρR at 63.09 kHz was optimal for discriminating cancer from benign tissues; this parameter had 75.4% specificity, 76.1% sensitivity, and ROC AUC of 0.779. Similarly, 251.1 kHz was optimal when using ρX to discriminate cancer from benign tissues; this parameter had a 77.9% specificity, 71.4% sensitivity, and ROC AUC of 0.79.

CONCLUSION

Significant electrical property differences noted between benign and malignant prostate tissues suggest the potential efficacy an EIS-Bx device would provide for cancer detection in a clinical setting. By sensing a greater fraction of the prostate's volume in real-time, the EIS-Bx device has the potential to improve the accuracy of cancer grading and volume estimation made with current biopsy procedures.

Review of electromagnetic techniques for breast cancer detection

Breast cancer is anticipated to be responsible for almost 40,000 deaths in the USA in 2011. The current clinical detection techniques suffer from limitations which motivated researchers to investigate alternative modalities for the early detection of breast cancer. This paper focuses on reviewing the main electromagnetic techniques for breast cancer detection. More specifically, this work reviews the cutting edge research in microwave imaging, electrical impedance tomography, diffuse optical tomography, microwave radiometry, biomagnetic detection, biopotential detection, and magnetic resonance imaging (MRI). The goal of this paper is to provide biomedical researchers with an in-depth review that includes all main electromagnetic techniques in the literature and the latest progress in each of these techniques.

Advancements in transmitters and sensors for biological tissue imaging in magnetic induction tomography

Magnetic Induction Tomography (MIT), which is also known as Electromagnetic Tomography (EMT) or Mutual Inductance Tomography, is among the imaging modalities of interest to many researchers around the world. This noninvasive modality applies an electromagnetic field and is sensitive to all three passive electromagnetic properties of a material that are conductivity, permittivity and permeability. MIT is categorized under the passive imaging family with an electrodeless technique through the use of excitation coils to induce an electromagnetic field in the material, which is then measured at the receiving side by sensors. The aim of this review is to discuss the challenges of the MIT technique and summarize the recent advancements in the transmitters and sensors, with a focus on applications in biological tissue imaging. It is hoped that this review will provide some valuable information on the MIT for those who have interest in this modality. The need of this knowledge may speed up the process of adopted of MIT as a medical imaging technology.

BREAST IMAGING SYSTEMS: A REVIEW AND COMPARATIVE STUDY

Due to the successful union between computational technologies and basic laws of physics and biological sciences, many biomedical imaging systems now find significant presence in clinical settings, aiding physicians in diagnosing most forms of human illness with more confidence. In the case of breast imaging, apart from the basic diagnosis, these imaging systems also help in locating the abnormal tissues for biopsy, identifying the exact margins of the lesion for good lumpectomy results, staging and restaging the cancer, detecting locations of metastases, and planning and following up treatment protocols. It is well known that early detection of cancer is the only way to increase the survival rate of the patient. Without such imaging systems, it would be hard and almost impossible for the physicians to determine the nature and extent of the disease by merely simple physical examinations and biopsies. This article presents a description of most of these invaluable breast-imaging systems. Moreover, a comparison of these modalities and a review of a few of the developments these devices have come across over the years are also given.

A four-shell diffusion phantom of the head for electrical impedance tomography

A four-shell head phantom has been built and characterized. Its structure is similar to that of nonhomogeneous concentric shell domains used by numerical solvers that better approximate current distribution than phantoms currently used to validate electrical impedance tomography systems. Each shell represents a head tissue, namely, skin, skull, cerebrospinal fluid, and brain. A novel technique, which employs a volume conductive impermeable film, has been implemented to prevent ion diffusion between different agar regions without affecting current distribution inside the phantom. Comparisons between simulations and phantom measurements performed over four days are given to prove both the adherence to the model in the frequency range between 10 kHz and 1 MHz and its long-term stability.

Regional ventilation distribution determined by electrical impedance tomography: reproducibility and effects of posture and chest plane

BACKGROUND AND OBJECTIVE

Reliable assessment of regional lung ventilation and good reproducibility of electrical impedance tomography (EIT) data are the prerequisites for the future application of EIT in a clinical setting. The aims of our study were to determine (i) the reproducibility of repeated EIT measurements and (ii) the effect of the studied transverse chest plane on ventilation distribution in different postures.

METHODS

Ten healthy adult subjects were studied in three postures on two separate days. EIT and spirometric data were obtained during tidal breathing and slow vital capacity (VC) manoeuvres. EIT data were acquired in two chest planes at 13 scans/s. Reproducibility of EIT findings was assessed by Bland-Altman analysis and Pearson correlation in 16 regions of interest in each plane. Regional ventilation distribution during tidal breathing and deep expiration was determined as fractional ventilation in four quadrants of the studied chest cross-sections.

RESULTS

Our study showed a good reproducibility of EIT measurements repeated after an average time interval of 8 days. Global tidal volumes and VCs determined by spirometry on separate days were not significantly different. Regional ventilation in chest quadrants assessed by EIT was also unaffected. Posture exerted a significant effect on ventilation distribution among the chest quadrants during spontaneous breathing and deep expiration in both planes. The spatial distribution patterns in the two planes were not identical.

CONCLUSIONS

We conclude that regional EIT ventilation findings are reproducible and recommend that the EIT examination location on the chest is carefully chosen especially during repeated measurements and follow-up.

Frequency-division multiplexing for electrical impedance tomography in biomedical applications

Electrical impedance tomography (EIT) produces an image of the electrical impedance distribution of tissues in the body, using electrodes that are placed on the periphery of the imaged area. These electrodes inject currents and measure voltages and from these data, the impedance can be computed. Traditional EIT systems usually inject current patterns in a serial manner which means that the impedance is computed from data collected at slightly different times. It is usually also a time-consuming process. In this paper, we propose a method for collecting data concurrently from all of the current patterns in biomedical applications of EIT. This is achieved by injecting current through all of the current injecting electrodes simultaneously, and measuring all of the resulting voltages at once. The signals from various current injecting electrodes are separated by injecting different frequencies through each electrode. This is called frequency-division multiplexing (FDM). At the voltage measurement electrodes, the voltage related to each current injecting electrode is isolated by using Fourier decomposition. In biomedical applications, using different frequencies has important implications due to dispersions as the tissue's electrical properties change with frequency. Another significant issue arises when we are recording data in a dynamic environment where the properties change very fast. This method allows simultaneous measurements of all the current patterns, which may be important in applications where the tissue changes occur in the same time scale as the measurement. We discuss the FDM EIT method from the biomedical point of view and show results obtained with a simple experimental system.

Performance evaluation of five types of Ag/AgCl bio-electrodes for cerebral electrical impedance tomography

Electrical impedance tomography (EIT) is an emerging medical imaging technique, which has already been investigated in several clinical applications due to its low-cost, non-invasiveness, non-radioactivity, high temporal resolution, and great sensitivity to impedance changes. One potential use of EIT is to perform long-term continuous imaging monitoring of brain for patients who suffer from severe cerebral diseases. However, this application requires a demanding performance of electrodes because of the characteristics of cerebral EIT measurements. Although Ag/AgCl bio-electrodes are widely used for clinical practices or EIT research at the moment, influences of different types of Ag/AgCl electrodes on cerebral EIT measurements have not been investigated. In this study, five common types of Ag/AgCl bio-electrodes were put into comparison by measuring the forearm and the brain of 10 healthy adult volunteers and evaluating those data in frequency or time domain in terms of contact impedance, uniformity, signal-to-noise ratio, and stability. Results show that Ag/AgCl powder electrode has an overall best performance with as low contact impedance as commercial ECG electrodes (p > 0.05), high SNR (60.3 ± 4.5 dB), better uniformity (coefficient of correlation 0.95 ± 0.03), and greater stability (slope 0.68 ± 0.03). After further improvement in design and instrumentation, Ag/AgCl powder electrode is likely to become the optimal choice for cerebral EIT measurements and provide feasible technical support for further research or application in cerebral EIT.

Analysis of the willow root system by electrical impedance spectroscopy

Information on plant roots is increasingly needed for understanding and managing plants under various environmental conditions, including climate change. Several methods have been developed to study fine roots but they are either destructive or cumbersome, or may not be suitable for studies of fine root functionality. Electrical impedance, resistance, and capacitance have been proposed as possible non-destructive measures for studying roots. Their use is limited by a lack of knowledge concerning the electrical circuit of the system. Electrical impedance spectroscopy (EIS) was used for hydroponically raised willows (Salix schwerinii) to estimate the root system size. The impedance spectra were investigated in three experimental set-ups and the corresponding appropriate lumped models were formulated. The fit of the proposed lumped models with the measured impedance spectra data was good. The model parameters were correlated with the contact area of the roots and/or stems raised in the hydroponic solution. The EIS method proved a useful non-destructive method for assessing root surface area. This work may be considered to be a new methodological contribution to understanding root systems and their functions in a non-destructive manner.

Design of a complex bioimpedance spectrometer using DFT and undersampling for neural networks diagnostics

Electrical impedance spectroscopy offers many applications in the medical field due the fast response, non-invasiveness and low cost. One promising area is the use of this method for diagnostics. This paper describes the design and experimental evaluation of a multifrequencial complex bioimpedance analyzer. Impedance amplitude and phase were calculated using Discrete Fourier Transform (DFT) and high frequency signals were measured with undersampling. The prototype was able to measure values from 1 Ω to 50 kΩ (frequency range from 50 Hz to 500 kHz). The accuracy of the technique was compared with a commercial equipment. The analysis of passive components resulted in a mean error of 2.9% for the magnitude and 0.69 degrees for the phase. Besides, an initial study for head and neck cancer detection through neural networks is shown. One used bioimpedance values as well as gender, age and body mass index as inputs. The network used 120 training and 40 validation data and was able to simulate 77.5% of the two types of diagnostic correctly.

A fisher information matrix interpretation of the NOSER algorithm in electrical impedance tomography

In this paper, we employ the concept of the Fisher information matrix (FIM) to reformulate and improve on the "Newton's One-Step Error Reconstructor" (NOSER) algorithm. FIM is a systematic approach for incorporating statistical properties of noise, modeling errors and multi-frequency data. The method is discussed in a maximum likelihood estimator (MLE) setting. The ill-posedness of the inverse problem is mitigated by means of a nonlinear regularization strategy. It is shown that the overall approach reduces to the maximum a posteriori estimator (MAP) with the prior (conductivity vector) described by a multivariate normal distribution. The covariance matrix of the prior is a diagonal matrix and is computed directly from the Fisher information matrix. An eigenvalue analysis is presented, revealing the advantages of using this prior to a Gaussian smoothness prior (Laplace). Reconstructions are shown using measured data obtained from a shallow breathing of an adult human subject. The reconstructions show that the FIM approach clearly improves on the original NOSER algorithm.

Reconstruction convergence and speed enhancement in electrical impedance tomography for domains with known internal boundaries

An improved approach for electrical impedance tomography (EIT) image reconstruction, based on modifying the forward and inverse solutions, is proposed. In this approach, the EIT forward problem is solved via the finite element method (FEM) using two types of elements. The inverse problem is solved by the modified Newton-Raphson method, whereas the condition number of the Hessian matrix is being monitored. At the early stage of the reconstruction, first-order elements are used, and if the condition number exceeds the allowable limit, the algorithm restarts. Otherwise, if the reconstruction error becomes lower than a predefined threshold, second-order elements are employed in the forward solution in order to preserve the precision of the final results. The latter stage converges in very few iterations. Since the solution speed with the first-order FEM is considerably higher than the second-order FEM, the reconstruction speed improves considerably by this approach, whereas the accuracy of the results is guaranteed by the well-conditioned Hessian matrix. Numerical simulations and experiments are followed by comparisons with other reconstruction methods which demonstrate the reliability and high solution speed of this approach. According to the results, the convergence of the proposed method is significantly improved, and its speed is 2-200 times higher than the previously developed methods with the same level of precision.

Current devices for high-performance whole-body hyperthermia therapy

For late-stage cancer, whole-body hyperthermia (WBH) is highly regarded by physicians as a promising alternative to conventional therapies. Although WBH is still under scrutiny due to potential toxicity, its benefits are incomparable, as diversified devices and very promising treatment protocols in this area are advanced into Phase II and III clinical trials. Following the introduction of the WBH principle, this paper comprehensively reviews the state-of-art high-performance WBH devices based on the heat induction mechanisms - radiation, convection and conduction. Through analyzing each category's physical principle and heat-induction property, the advantages and disadvantages of the devices are evaluated. Technical strategies and critical scientific issues are summarized. For future developments, research directions worth pursuing are presented in this article.

Absolute electrical impedance tomography (aEIT) guided ventilation therapy in critical care patients: simulations and future trends

Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients.

Electrical impedance tomography reconstruction using a monotonicity approach based on a priori knowledge

Electrical Impedance Tomography(EIT) has been proposed as an alternative modality for breast imaging. Current EIT reconstruction algorithms are based in optimization procedures that aim to minimize the difference between the recorded data and a set of candidate scenarios. However, these methods produce images with diffused edges, as sharp structures are penalized by current regularization techniques. In this paper, a novel edge preserving EIT reconstruction method is proposed. This technique uses a priori information obtained from Breast Microwave Radar images to estimate the location of the dense breast regions. Then, the monotonicity of the impedance matrix of the collected data is used to reconstruct a profile of the tissue distribution in the breast region. The proposed method yielded promising results when applied to numeric phantoms generated from Magnetic Resonance Imaging datasets.

Single cell electric impedance topography: mapping membrane capacitance

Single-cell electric impedance topography (sceTopo), a technique introduced here, maps the spatial distribution of capacitance (i.e. displacement current) associated with the membranes of isolated, living cells. Cells were positioned in the center of a circular recording chamber surrounded by eight electrodes. Electrodes were evenly distributed on the periphery of the recording chamber. Electric impedance measured between adjacent electrode pairs (10 kHz-5 MHz) was used to construct topographical maps of the spatial distribution of membrane capacitance. Xenopus Oocytes were used as a model cell to develop sceTopo because these cells consist of two visually distinguishable hemispheres, each with distinct membrane composition and structure. Results showed significant differences in the imaginary component of the impedance between the two oocyte hemispheres. In addition, the same circumferential array was used to map the size of the extracellular electrical shunt path around the cell, providing a means to estimate the location and shape of the cell in the recording chamber.

Code-division-multiplexed electrical impedance tomography spectroscopy

Electrical impedance tomography uses multiple impedance measurements to image the internal conductivity of an object, such as the human body. Code-division multiplexing is proposed as a new method that can provide simultaneous impedance measurements of the multiple channels. Code division provides clear advantages of a wide frequency range at reduced cost and reduced complexity of sources. A potential drawback is the lack of perfectly orthogonal code sets. This caused an increase of 0.62% in root-mean-square spectral error when two codes were used to record two impedance channels simultaneously on a low-pass filter network. The method described provides images and spectra which are equivalent to the conventional time-multiplexed method, with increases in frequency resolution and measurement speed which may be of benefit in some applications of electrical impedance tomography spectroscopy.

Comparison of a new integrated current source with the modified Howland circuit for EIT applications

Multi-frequency electrical impedance tomography (MF-EIT) systems require current sources that are accurate over a wide frequency range (1 MHz) and with large load impedance variations. The most commonly employed current source design in EIT systems is the modified Howland circuit (MHC). The MHC requires tight matching of resistors to achieve high output impedance and may suffer from instability over a wide frequency range in an integrated solution. In this paper, we introduce a new integrated current source design in CMOS technology and compare its performance with the MHC. The new integrated design has advantages over the MHC in terms of power consumption and area. The output current and the output impedance of both circuits were determined through simulations and measurements over the frequency range of 10 kHz to 1 MHz. For frequencies up to 1 MHz, the measured maximum variation of the output current for the integrated current source is 0.8% whereas for the MHC the corresponding value is 1.5%. Although the integrated current source has an output impedance greater than 1 MOmega up to 1 MHz in simulations, in practice, the impedance is greater than 160 kOmega up to 1 MHz due to the presence of stray capacitance.

Visualization of multidimensional and multimodal tomographic medical imaging data, a case study

Multidimensional tomographic datasets contain physical properties defined over four-dimensional (e.g. spatial-temporal, spatial-spectral), five-dimensional (e.g. spatial-temporal-spectral) or even higher-dimensional domains. Multimodal tomographic datasets contain physical properties obtained with different imaging modalities. In medicine, four-dimensional data are widely used, five-dimensional data are emerging, and multimodal data are being used more often every day. Visualization is vital for medical diagnosis and surgical planning to interpret the information included in imaging data. Visualization of multidimensional and multimodal tomographic imaging data is still a challenging task. As a case study, our work focuses on the visualization of five-dimensional (spatial-temporal-spectral) brain electrical impedance tomography (EIT) data. In this paper, a task-based subset definition scheme is proposed: a task model named Cubic Task Explorer (CTE) is derived to support the visualization task exploration for medical imaging data, and a structured method for visualization system development called Task-based Multi-Dimensional Visualization (TMDV) is proposed. A prototype system named EIT5DVis is developed using the CTE model and TMDV method to visualize five-dimensional brain EIT data.

The use of skin surface electropotentials for breast cancer detection--preliminary clinical trial results obtained using the biofield diagnostic system

The purpose of this study is to evaluate the efficiency of the Biofield Diagnostic System (BDS) as an adjunct to established diagnostic techniques such as mammography and ultrasound in differentiating benign and malignant breast lesions. The clinical trial was conducted at the Tan Tock Seng hospital, Singapore. 103 women scheduled for mammography and/or ultrasound tests participated in the study. The BDS test recorded a sensitivity of 100%, specificity of 97.6%, and an accuracy of 98.1%. The area under the ROC curve was 0.988 which was slightly lower than that of ultrasound (0.994) and slightly higher than that of mammography (0.951). The BDS test has demonstrated high sensitivity and specificity values in the studied population. The accuracy is also comparable to that of diagnostic techniques like mammography and ultrasound. Thus, it is evident that BDS can be a fast and reliable adjunct tool for getting a secondary opinion on lesions with indeterminate mammographic and sonographic results.

Linear superposition electrical impedance tomography imaging with multiple electrical/biopsy probes

In medical diagnostics, tissue is often examined with multiple discrete biopsies taken under ultrasound placement. In a previous theoretical study, we have suggested that the linear nature of the equations used in electrical impedance tomography (EIT) can be employed with the conventional practice of biopsy sampling to produce an image of the tissue between the biopsy samplings. Specifically, the biopsy probes can be used to record EIT-type electrical data during the discrete tissue sampling. The location of the discrete biopsy needle insertions available from the ultrasound placement of the probes can be combined with the electrical measurement data and used with linear superposition to produce a complete EIT image of the tissue between the sampled sites. In this study, we explore the concept experimentally using gel phantoms to simulate tissue and heterogeneities in the tissue. The experiments are performed in 2-D and 3-D configurations, and data are taken discretely, one at a time, through single electrical probe insertions. In the 2-D configuration, we were able to produce images of reasonable quality for heterogeneities with a diameter larger than 3 mm (conductivity ratio 1:5) and with relative conductivity differences above 50% (diameter 5 mm).

A study of composite electrode-tissue impedance

Electrical impedance tomography has been used in the medical environment for many years. Recently it has been used for brain function imaging. This type of technology uses a large number of electrodes on the scalp, examples in the literature ranging from 8 to 64. In this paper, the composite impedance of the electrode in contact with tissue is investigated. An experimental method has been developed to enable the use of a commercial impedance analyzer in compliance with medical safety standards. The magnitude and long-term stability of the composite impedance of the electrode-tissue system is found to be greatly dependent on the type of electrodes used.

The Use of Tissue Electrical Characteristics for Breast Cancer Detection: A Perspective Review

Breast cancer is the most frequently occurring malignancy in women. It is characterized by a high mortality rate. For the purpose of detecting this life threatening disease, research efforts are being made worldwide to exploit new technologies, to improve the detection accuracy of current devices and to develop new detection devices, comprehensive diagnostic procedures, and protocols. One such technology that is gaining popular attention over the recent years is the usage of electrical characteristics of the breast tissue to differentiate normal and cancerous tissues. Most of the devices using this technology are currently being used as adjunct diagnostic tools to improve the detection accuracy of established techniques like mammography and ultrasound. Also, early detection of breast cancer can help save many thousands of lives every year and can also reduce unnecessary healthcare expenditure caused by advanced stage treatment options. Hence, more research is also being done to adapt these devices into screening tools for early detection of breast cancer.

The main objective of this review is to highlight the features of the currently available commercial devices that use this technology for breast cancer detection. The electrical behavior of normal and cancerous breast tissues is first presented. The various commercial devices that utilize electrical impedance or electropotentials for breast cancer detection are then described. Finally, conclusions and potential areas of research are highlighted.

Imaging and cancer: a review

Multiple biomedical imaging techniques are used in all phases of cancer management. Imaging forms an essential part of cancer clinical protocols and is able to furnish morphological, structural, metabolic and functional information. Integration with other diagnostic tools such as in vitro tissue and fluids analysis assists in clinical decision-making. Hybrid imaging techniques are able to supply complementary information for improved staging and therapy planning. Image guided and targeted minimally invasive therapy has the promise to improve outcome and reduce collateral effects. Early detection of cancer through screening based on imaging is probably the major contributor to a reduction in mortality for certain cancers. Targeted imaging of receptors, gene therapy expression and cancer stem cells are research activities that will translate into clinical use in the next decade. Technological developments will increase imaging speed to match that of physiological processes. Targeted imaging and therapeutic agents will be developed in tandem through close collaboration between academia and biotechnology, information technology and pharmaceutical industries.

Imaging cryosurgery with EIT: tracking the ice front and post-thaw tissue viability

Cryosurgery employs freezing for targeted destruction of undesirable tissues such as cancer. Ice front imaging has made controlled treatment of deep body tumors possible. One promising method, recently explored for this task, is EIT, which recovers images of electrical impedance from measurements made at boundary electrodes. However, since frozen tissue near the ice front survives, ice front imaging is insufficient. Monitoring treatment effect would enable iterative cryosurgery, where extents of ablation and need for further treatment are assessed upon thawing. Since lipid bilayers are strong barriers to low frequency electrical current and cell destruction implies impaired membranes, EIT should be able to detect the desired effect of cryosurgery: cell death. Previous work has tested EIT for ice front imaging with tank studies while others have simulated EIT in detecting cryoablation, but in vivo tests have not been reported in either case. To address this, we report 3D images of differential conductivity throughout the freeze-thaw cycle in a rat liver model in vivo with histological validation, first testing our system for ice front imaging in a gel and for viability imaging post-thaw in a raw potato slice.

Image reconstruction incorporated with the skull inhomogeneity for electrical impedance tomography

The structural similarity of the head model affects the accuracy of forward solution to electrical impedance tomography (EIT). Generally, the four-concentric circle model (FCCM) is used as the head model, which ignores the inhomogeneous distribution of the conductivity of real skull. In order to decrease the errors caused by using FCCM, a more accurate head model named inhomogeneous skull model (ISM) has been proposed and a reconstruction algorithm incorporated with ISM has been developed for brain EIT. Simulation results have shown improvement in image quality and localization accuracy when using ISM. It is also suggested that the reconstructed image could be more sensitive to the location of bony sutures than to the variation of skull thickness. In conclusion, incorporating skull inhomogeneity into image reconstruction is an effective way to improve image quality and localization accuracy for brain EIT.

A new concept for medical imaging centered on cellular phone technology

According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a) a data acquisition device (DAD) at a remote patient site that is simple, with limited controls and no image display capability and b) an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site). The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

Video rate electrical impedance tomography of vascular changes: preclinical development

Peripheral vasculature disease is strongly correlated with cardiovascular-associated mortality. Monitoring circulation health, especially in the peripheral limbs, is vital to detecting clinically significant disease at a stage when it can still be addressed through medical intervention. Electrical impedance tomography (EIT) maps the electrical properties of tissues within the body and has been used to image dynamically varying physiology, including blood flow. Here, we suggest that peripheral vasculature health can be monitored with EIT by imaging the hemodynamics of peripheral vessels and the surrounding tissues during reactive hyperemia testing. An analysis based on distinguishability theory is presented that indicates that an EIT system capable of making measurements with a precision of 50 microV may be able to detect small changes in vessel size associated with variations in blood flow. An EIT system with these precision capabilities is presented that is able to collect data at frame rates exceeding 30 fps over a broad frequency range up to 10 MHz. The system's high speed imaging performance is verified through high contrast phantom experiments and through physiological imaging of induced ischemia with a human forearm. Region of interest analysis of the induced ischemia images shows a marked decrease in conductivity over time, changing at a rate of approximately -3 x 10(-7) S m(-1) s(-1), which is the same order of magnitude as reported in the literature. The distinguishability analysis suggests that a system such as the one developed here may provide a means to characterize the hemodynamics associated with blood flow through the peripheral vasculature.

Multiple biopsy probe sampling enabled minimally invasive electrical impedance tomography

Biopsies are a reliable method for examining tissues and organs inside the body, in particular for detection of tumors. However, a single biopsy produces only limited information on the site from which it is taken. Therefore, tumor detection now employs multiple biopsy samplings to examine larger volumes of tissue. Nevertheless, even with multiple biopsies, the information remains discrete, while the costs of biopsy increase. Here we propose and evaluate the feasibility of using minimally invasive medical imaging as a means to overcome the limitations of discrete biopsy sampling. The minimally invasive medical imaging technique employs the biopsy probe as electrodes for measurements of electrical impedance tomography relevant data during each biopsy sampling. The data from multiple samplings are combined and used to produce an EIT image of the tissue. Two- and three-dimensional mathematical simulations confirm that the minimally invasive medical imaging technique can produce electrical impedance tomography images of the tissues between the biopsy probe insertion sites. We show that these images can detect tumors that would be missed with multiple biopsy samplings only, and that the technique may facilitate the detection of tumors with fewer biopsies, thereby reducing the cost of cancer detection.

Methods of optimization of electrical impedance tomography for imaging tissue electroporation

Tissue electroporation is a medical technique in which electrical pulses of microsecond to millisecond length are applied to a tissue in order to permeabilize the membrane of targeted cells, either temporarily or permanently, for the purpose of drug delivery and gene therapy or tissue ablation, respectively. Electrical impedance tomography (EIT) has been suggested as an effective means of imaging the treated area and thereby providing control of electroporation. In this simulation based study we introduce methods for optimizing the use of EIT under the special conditions of electroporation. First, we address the issue of the rapid changes in tissue conductivity, during and after the application of pulses. We propose a solution through a method of simultaneously collecting data from all the electrodes, essentially capturing the state of the tissue at a single instant. This method, which employs several distinct frequencies, one for each electrode, allows a speedy and continuous collection of data, a vital part of real-time electroporation monitoring. The second issue is taking advantage of the presence of electroporation electrodes for the EIT process. We show how the electroporation electrodes that are normally found inside the tissue may help improve the reconstruction compared to data collected only from the body's boundary. This mathematical study employs recently collected in vivo data of rat liver electroporation to obtain a model which represents, as closely as possible, the reality of electroporation procedures.

A review of errors in multi-frequency EIT instrumentation

Multi-frequency electrical impedance tomography (MFEIT) was proposed over 10 years ago as a potential spectroscopic impedance imaging method. At least seven systems have been developed for imaging the lung, heart, breast and brain, yet none has yet achieved clinical acceptance. While the absolute impedance varies considerably between different tissues, the changes in the spectrum due to physiological changes are expected to be quite small, especially when measured through a volume. This places substantial requirements on the MFEIT instrumentation to maintain a flat system frequency response over a broad frequency range (dc-MHz). In this work, the EIT measurement problem is described from a multi-frequency perspective. Solutions to the common problems are considered from recent MFEIT systems, and the debate over four-terminal or two-terminal (multiple source) architecture is revisited. An analysis of the sources of MFEIT errors identifies the major sources of error as stray capacitance and common-mode voltages which lead to a load dependence in the frequency response of MFEIT systems. A system that employs active electrodes appears to be the most able to cope with these errors (Li et al 1996). A distributed system with digitization at the electrode is suggested as a next step in MFEIT system development.