Stroke volume estimation in heart failure patients using bioimpedance: a realistic simulation of the forward problem

Surface Potential Simulation for Robust Electrode Placement by MRI Based Human Phantom with FEM Based Quasi-Static Solver for Bioimpedance Measurement

Estimating cardiac output (CO) and thoracic fluid content (TFC) by non-invasive measurement of thoracic electrical bioimpedance (TEB) is on the rise of becoming clinically established. Dynamic fluid management and detecting and trending excess quasi-static thoracic fluids are of particular interest to benefit the critically ill patient. While the advantages such as easy application and non-invasive assessment are intriguing, there are some challenges. In addition to artifacts due to the patient's movement, instability of the electrode-skin interfaces, the accuracy of the applied current and varying cable capacity because of motion, exact placement of electrodes - or lack thereof - must be considered. In particular the robustness of the electrode placement, i.e., the insensitivity to inaccuracy of electrode placement (actual sensor from the nominal). We propose a new technique for evaluation of electrode placement by simulation with MRI based human phantoms with FEM based quasi-static solver for bioimpedance measurement. Results: We identified alternative electrode positions which lead to an increase in robustness of bioimpedance measurements of up to 9.5 times compared to the standard electrode placement. Simulations suggested an improvement in ECG signal quality which was confirmed by a subject measurement.

Evaluation of Electrode Setups by MRI Based Human Phantom with FEM Based Quasi-Static Solver for Bioimpedance Measurement. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019;2019:3978-3982. [PMID: 31946743 DOI: 10.1109/embc.2019.8856693]

Transthoracic electrical bioimpedance (TEB) measurement for acquiring of hemodynamic parameters e.g. stroke volume (SV) and cardiac output (CO) becomes commonly used. For precise and reliable measurement, a good understanding of the measurement system is needed to provide robust electrode placement, reproducible results, and large signal amplitudes. We propose an evaluation by MRI based human phantom with FEM based quasi-static solver for electrode placement in bioimpedance measurement. Placements according to Osypka, Cheetah and Bernstein et al. were simulated and compared with measurements taken from a (real) human subject. As a parameter for evaluation of signal quality, the percentage of current passing through the descending aorta from the overall injected current is measured. The placement according to Osypka results in 1.46 % of current flow through the descending aorta (Cheetah placement 1.12 %, Bernstein et al. placement 0.877 %) for the male human phantom DUKE. The simulation was compared with a real human subject (with comparable age, height, weight) by calculating the baseline impedance (Z₀). The simulation seems to fit at best with Osypka placement, where the deviation between simulated baseline impedance and real human subject is 19.9 % (deviation for Cheetah 34.1 %, deviation for Bernstein 62.5 %). The simulation with MRI based human phantoms seems to be a very good basis for further investigations of current injection and bioimpedance measurement comprehension.

Evaluation of different stimulation and measurement patterns based on internal electrode: application in cardiac impedance tomography

The conductivity distribution around the thorax is altered during the cardiac cycle due to the blood perfusion, heart contraction and lung inflation. Previous studies showed that these bio-impedance changes are appropriate for non-invasive cardiac function imaging using Electrical Impedance Tomography (EIT) techniques. However, the spatial resolution is presently low. One of the main obstacles in cardiac imaging at the heart location is the large impedance variation of the lungs by respiration and muscles on the dorsal and posterior side of the body. In critical care units there is a potential to insert an internal electrode inside the esophagus directly behind the heart in the same plane of the external electrodes. The aim of the present study is to evaluate different current stimulation and measurement patterns with both external and internal electrodes. Analysis is performed with planar arrangement of 16 electrodes for a simulated 3D cylindrical tank and pig thorax model. In our study we evaluated current injection patterns consisting of adjacent, diagonal, trigonometric, and radial to the internal electrode. The performance of these arrangements was assessed using quantitative methods based on distinguishability, sensitivity and GREIT (Graz consensus Reconstruction algorithm for Electrical Impedance Tomography). Our evaluation shows that an internal electrode configuration based on the trigonometric injection patterns has better performance and improves pixel intensity of the small conductivity changes related to heart near 1.7 times in reconstructed images and also shows more stability with different levels of added noise. For the internal electrode, when we combined radial or adjacent injection with trigonometric injection pattern, we found an improvement in amplitude response. However, the combination of diagonal with trigonometric injection pattern deteriorated the shape deformation (correlation coefficient r=0.344) more than combination of radial and trigonometric injection (correlation coefficient r=0.836) for the perturbations in the area close to the center of the cylinder. We also find that trigonometric stimulation pattern performance is degraded in a realistic thorax model with anatomical asymmetry. For that reason we recommend using internal electrodes only for voltage measurements and as a reference electrode during trigonometric stimulation patterns in practical measurements.

Computational modelling of blood-flow-induced changes in blood electrical conductivity and its contribution to the impedance cardiogram

Studies have shown that blood-flow-induced change in electrical conductivity is of equal importance in assessment of the impedance cardiogram (ICG) as are volumetric changes attributed to the motion of heart, lungs and blood vessels. To better understand the sole effect of time-varying blood conductivity on the spatiotemporal distribution of trans-thoracic electric fields (i.e. ICG), this paper presents a segmented high-resolution (1 mm(3)) thoracic cardiovascular system, in which the time-varying pressures, flows and electrical conductivities of blood in different vessels are evaluated using a set of coupled nonlinear differential equations, red blood cell orientation and cardiac cycle functions. Electric field and voltage simulations are performed using two and four electrode configurations delivering a small alternating electric current to an anatomically realistic and electrically accurate model of modelled human torso. The simulations provide a three-dimensional electric field distribution and show that the time-varying blood conductivity alters the voltage potential difference between the electrodes by a maximum of 0.28% for a cardiac output of about 5 L min(-1). As part of a larger study, it is hoped that this initial model will be useful in providing improved insights into blood-flow-related spatiotemporal electric field variations and assist in the optimal placement of electrodes in impedance cardiography experiments.