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Sethi AK, Muddaloor P, Anvekar P, Agarwal J, Mohan A, Singh M, Gopalakrishnan K, Yadav A, Adhikari A, Damani D, Kulkarni K, Aakre CA, Ryu AJ, Iyer VN, Arunachalam SP. Digital Pulmonology Practice with Phonopulmography Leveraging Artificial Intelligence: Future Perspectives Using Dual Microwave Acoustic Sensing and Imaging. SENSORS (BASEL, SWITZERLAND) 2023; 23:5514. [PMID: 37420680 DOI: 10.3390/s23125514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Respiratory disorders, being one of the leading causes of disability worldwide, account for constant evolution in management technologies, resulting in the incorporation of artificial intelligence (AI) in the recording and analysis of lung sounds to aid diagnosis in clinical pulmonology practice. Although lung sound auscultation is a common clinical practice, its use in diagnosis is limited due to its high variability and subjectivity. We review the origin of lung sounds, various auscultation and processing methods over the years and their clinical applications to understand the potential for a lung sound auscultation and analysis device. Respiratory sounds result from the intra-pulmonary collision of molecules contained in the air, leading to turbulent flow and subsequent sound production. These sounds have been recorded via an electronic stethoscope and analyzed using back-propagation neural networks, wavelet transform models, Gaussian mixture models and recently with machine learning and deep learning models with possible use in asthma, COVID-19, asbestosis and interstitial lung disease. The purpose of this review was to summarize lung sound physiology, recording technologies and diagnostics methods using AI for digital pulmonology practice. Future research and development in recording and analyzing respiratory sounds in real time could revolutionize clinical practice for both the patients and the healthcare personnel.
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Affiliation(s)
- Arshia K Sethi
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pratyusha Muddaloor
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Joshika Agarwal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Anmol Mohan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Keerthy Gopalakrishnan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology & Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ashima Yadav
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Aakriti Adhikari
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Devanshi Damani
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79995, USA
| | - Kanchan Kulkarni
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, U1045, F-33000 Bordeaux, France
- IHU Liryc, Heart Rhythm Disease Institute, Fondation Bordeaux Université, F-33600 Pessac, France
| | | | - Alexander J Ryu
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Shivaram P Arunachalam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology & Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Herrero-Cortina B, Oliveira A, Polverino E, Gómez-Trullén EM, Torres A, Marques A. Feasibility of computerized adventitious respiratory sounds to assess the effects of airway clearance techniques in patients with bronchiectasis. Physiother Theory Pract 2019; 36:1245-1255. [PMID: 30669914 DOI: 10.1080/09593985.2019.1566945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To examine the feasibility of adventitious respiratory sound (ARS) as an outcome measure to assess the effects of airway clearance techniques (ACTs) in outpatients with bronchiectasis. Methods: ARS were registered pre/post four ACTs sessions. Clinical outcomes included: number of crackles (coarse and fine), number of wheezes (monophonic and polyphonic), wheezes occupation rate (%) and sputum quantity. Feasibility outcomes of ARS included: reasons for exclusion, suitability, safety, equipment and time required, magnitude of change after intervention and sample size estimation. Results: Seven patients (49.7 ± 20.5 years; FEV1 69.3 ± 15.8% predicted) were included. Recordings from four patients were excluded due to excessive environment noise. All ARS measurements were completed without any adverse events. An electronic stethoscope was acquired and the time spent to complete each assessment was 6 ± 3.5 min. The largest changes were observed for number of expiratory coarse crackles [effect size (95%CI) ES = 0.40 (0.01-0.79)], which correlated moderately with sputum quantity (r = 0.56), and inspiratory monophonic wheezes [ES = 0.61 (0.22-1.00)]. The estimated sample size for a full crossover trial was 46. Conclusions: ARS is feasible to assess the effects of ACTs in patients with bronchiectasis. Expiratory coarse crackles seem to be the most appropriate ARS parameter, but this finding needs to be confirmed in an adequately powered trial.
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Affiliation(s)
- Beatriz Herrero-Cortina
- Health Sciences Faculty, Universidad San Jorge, Campus Universitario Villanueva de Gállego , Villanueva de Gállego, Spain
| | - Ana Oliveira
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago , Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Campus Universitário de Santiago , Aveiro, Portugal
| | - Eva Polverino
- Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron (HUVH), CIBERES , Barcelona, Spain.,Servei de Pneumologia, Hospital Clinic de Barcelona, Universitat de Barcelona, IDIBAPS, CIBERES , Barcelona, Spain
| | - Eva María Gómez-Trullén
- Faculty of Health and Sport Sciences, Department of Physiatry and Nursing, University of Zaragoza , Huesca, Spain
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic de Barcelona, Universitat de Barcelona, IDIBAPS, CIBERES , Barcelona, Spain
| | - Alda Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago , Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Campus Universitário de Santiago , Aveiro, Portugal
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Oliveira A, Machado A, Marques A. Minimal Important and Detectable Differences of Respiratory Measures in Outpatients with AECOPD †. COPD 2018; 15:479-488. [PMID: 30512981 DOI: 10.1080/15412555.2018.1537366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interpreting clinical changes during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is challenging due to the absence of established minimal detectable (MDD) and important (MID) differences for most respiratory measures. This study established MDD and MID for respiratory measures in outpatients with AECOPD following pharmacological treatment. COPD assessment test (CAT), modified Borg scale (MBS), modified British Medical Research Council (mMRC) questionnaire, peripheral oxygen saturation (SpO2), computerised respiratory sounds and forced expiratory volume in one second (FEV1) were collected within 24-48 hour of an AECOPD and after 45 days of pharmacological treatment. MID and MDD were calculated using anchor- (receiver operating characteristic and linear regression analysis) and distribution-based methods (effect size, SEM, 0.5*SD and MDC95) and pooled using Meta XL. Forty-four outpatients with AECOPD (31♂; 68.2 ± 9.1 years; FEV1 51.1 ± 20.3%predicted) participated. Significant correlations with CAT were found for the MBS (r = 0.34), mMRC (r = 0.39) and FEV1 (r = 0.33), resulting in MIDs of 0.8, 0.5-0.6 and 0.03L, respectively. MDD of 0.5-1.4 (MBS), 0.4-1.2 (mMRC), 0.10-0.28L (FEV1), 3.6-10.1% (FEV1%predicted), 0.9-2.4% (SpO2), 0.7-1.9 (number of inspiratory crackles), 1.1-4.5 (number of expiratory crackles), 7.1-25.8% (inspiratory wheeze rate) and 11.8-63.0% (expiratory wheeze rate) were found. Pooled data of MID/MDD showed that improvements of 0.9 for the MBS, 0.6 for the mMRC, 0.15L for the FEV1, 7.6% for the FEV1%predicted, 1.5% for the SpO2, 1.1 for the inspiratory and 2.4 for the number of expiratory number of crackles, 14.1% for the inspiratory and 32.5% for the expiratory wheeze rate are meaningful following an AECOPD managed with pharmacological treatment on an outpatient basis.
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Affiliation(s)
- Ana Oliveira
- a Faculty of Sports , University of Porto , Porto , Portugal.,b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| | - Ana Machado
- b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| | - Alda Marques
- b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
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Oliveira A, Lage S, Rodrigues J, Marques A. Reliability, validity and minimal detectable change of computerized respiratory sounds in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 12:1838-1848. [PMID: 29148182 DOI: 10.1111/crj.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/17/2017] [Accepted: 11/14/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Computerized respiratory sounds (CRS) are closely related to the movement of air within the tracheobronchial tree and are promising outcome measures in patients with chronic obstructive pulmonary disease (COPD). However, CRS measurement properties have been poorly tested. OBJECTIVE The aim of this study was to assess the reliability, validity and the minimal detectable changes (MDC) of CRS in patients with stable COPD. METHODS Fifty patients (36♂, 67.26 ± 9.31y, FEV1 49.52 ± 19.67%predicted) were enrolled. CRS were recorded simultaneously at seven anatomic locations (trachea; right and left anterior, lateral and posterior chest). The number of crackles, wheeze occupation rate, median frequency (F50) and maximum intensity (Imax) were processed using validated algorithms. Within-day and between-days reliability, criterion and construct validity, validity to predict exacerbations and MDC were established. RESULTS CRS presented moderate-to-excellent within-day reliability (ICC1,3 ≥ 0.51; P < .05) and moderate-to-good between-days reliability (ICC1,2 ≥ 0.47; P < .05) for most locations. Negligible-to-moderate correlations with FEV1 %predicted were found (-0.53 < rs < -0.28; P < .05), and the inspiratory number of crackles were the best discriminator between mild-to-moderate and severe-to-very severe airflow limitations (area under the curve >0.78). CRS correlated poorly with patient-reported outcomes (rs < 0.48; P < .05) and did not predict exacerbations. Inspiratory number of crackles at posterior right chest, inspiratory F50 at trachea and anterior left chest and expiratory Imax at anterior right chest were simultaneously reliable and valid, and their MDC were 2.41, 55.27, 29.55 and 3.98, respectively. CONCLUSION CRS are reliable and valid. Their use, integrated with other clinical and patient-reported measures, may fill the gap of assessing small airways and contribute toward a patient's comprehensive evaluation.
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Affiliation(s)
- Ana Oliveira
- Faculty of Sports, University of Porto, Porto, Portugal.,Lab 3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.,Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Susan Lage
- Rehabilitation Sciences Program, School of Physical Education, Physiotherapy and Occupational Therapy (EEFFTO), Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - João Rodrigues
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Alda Marques
- Lab 3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.,Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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