Multi-frequency symmetry difference electrical impedance tomography with machine learning for human stroke diagnosis

TSS-ConvNet for electrical impedance tomography image reconstruction

Objective.The objective of this study was to propose a novel data-driven method for solving ill-posed inverse problems, particularly in certain conditions such as time-difference electrical impedance tomography for detecting the location and size of bubbles inside a pipe.Approach.We introduced a new layer architecture composed of three paths: spatial, spectral, and truncated spectral paths. The spatial path processes information locally, whereas the spectral and truncated spectral paths provide the network with a global receptive field. This unique architecture helps eliminate the ill-posedness and nonlinearity inherent in the inverse problem. The three paths were designed to be interconnected, allowing for an exchange of information on different receptive fields with varied learning abilities. Our network has a bottleneck architecture that enables it to recover signal information from noisy redundant measurements. We named our proposed model truncated spatial-spectral convolutional neural network (TSS-ConvNet).Main results.Our model demonstrated superior accuracy with relatively high resolution on both simulation and experimental data. This indicates that our approach offers significant potential for addressing ill-posed inverse problems in complex conditions effectively and accurately.Significance.The TSS-ConvNet overcomes the receptive field limitation found in most existing models that only utilize local information in Euclidean space. We trained the network on a large dataset covering various configurations with random parameters to ensure generalization over the training samples.

Analysis of electrode arrangements for brain stroke diagnosis via electrical impedance tomography through numerical computational models

Objective.Rapid stroke-type classification is crucial for improved prognosis. However, current methods for classification are time-consuming, require expensive equipment, and can only be used in the hospital. One method that has demonstrated promise in a rapid, low-cost, non-invasive approach to stroke diagnosis is electrical impedance tomography (EIT). While EIT for stroke diagnosis has been the topic of several studies in recent years, to date, the impact of electrode placements and arrangements has rarely been analyzed or tested and only in limited scenarios. Optimizing the location and choice of electrodes can have the potential to improve performance and reduce hardware cost and complexity and, most importantly, diagnosis time.Approach.In this study, we analyzed the impact of electrodes in realistic numerical models by (1) investigating the effect of individual electrodes on the resulting simulated EIT boundary measurements and (2) testing the performance of different electrode arrangements using a machine learning classification model.Main results.We found that, as expected, the electrodes deemed most significant in detecting stroke depend on the location of the electrode relative to the stroke lesion, as well as the role of the electrode. Despite this dependence, there are notable electrodes used in the models that are consistently considered to be the most significant across the various stroke lesion locations and various head models. Moreover, we demonstrate that a reduction in the number of electrodes used for the EIT measurements is possible, given that the electrodes are approximately evenly distributed.Significance.In this way, electrode arrangement and location are important variables to consider when improving stroke diagnosis methods using EIT.

Applied machine learning for stroke differentiation by electrical impedance tomography with realistic numerical models

Electrical impedance tomography (EIT) may have potential to overcome existing limitations in stroke differentiation, enabling low-cost, rapid, and mobile data collection. Combining bioimpedance measurement technologies such as EIT with machine learning classifiers to support decision-making can avoid commonly faced reconstruction challenges due to the nonlinear and ill-posed nature of EIT imaging. Therefore, in this work, we advance this field through a study integrating realistic head models with clinically relevant test scenarios, and a robust architecture consisting of nested cross-validation and principal component analysis. Specifically, realistic head models are designed which incorporate the highly conductive layers of cerebrospinal fluid in the subarachnoid space and ventricles. In total, 135 unique models are created to represent a large patient population, with normal, haemorrhagic, and ischemic brains. Simulated EIT voltage data generated from these models are used to assess the classification performance of support vector machines. Parameters explored include driving frequency, signal-to-noise ratio, kernel function, and composition of binary classes. Classifier accuracy at 60 dB signal-to-noise ratio, reported as mean and standard deviation, are (79.92% ± 10.82%) for lesion differentiation, (74.78% ± 3.79%) for lesion detection, (77.49% ± 15.90%) for bleed detection, and (60.31% ± 3.98%) for ischemia detection (after ruling out bleed). The results for each method were obtained with statistics from 3 independent runs with 17,280 observations, polynomial kernel functions, and feature reduction of 76% by PCA (from 208 to 50 features). While results of this study show promise for stroke differentiation using EIT data, our findings indicate that the achievable accuracy is highly dependent on the classification scenario and application-specific classifiers may be necessary to achieve acceptable accuracy.

MMV-Net: A Multiple Measurement Vector Network for Multifrequency Electrical Impedance Tomography

Multifrequency electrical impedance tomography (mfEIT) is an emerging biomedical imaging modality to reveal frequency-dependent conductivity distributions in biomedical applications. Conventional model-based image reconstruction methods suffer from low spatial resolution, unconstrained frequency correlation, and high computational cost. Deep learning has been extensively applied in solving the EIT inverse problem in biomedical and industrial process imaging. However, most existing learning-based approaches deal with the single-frequency setup, which is inefficient and ineffective when extended to the multifrequency setup. This article presents a multiple measurement vector (MMV) model-based learning algorithm named MMV-Net to solve the mfEIT image reconstruction problem. MMV-Net considers the correlations between mfEIT images and unfolds the update steps of the Alternating Direction Method of Multipliers for the MMV problem (MMV-ADMM). The nonlinear shrinkage operator associated with the weighted l2,1 regularization term of MMV-ADMM is generalized in MMV-Net with a cascade of a Spatial Self-Attention module and a Convolutional Long Short-Term Memory (ConvLSTM) module to better capture intrafrequency and interfrequency dependencies. The proposed MMV-Net was validated on our Edinburgh mfEIT Dataset and a series of comprehensive experiments. The results show superior image quality, convergence performance, noise robustness, and computational efficiency against the conventional MMV-ADMM and the state-of-the-art deep learning methods.

Research Trends and Hotspots of Medical Electrical Impedance Tomography Algorithms: A Bibliometric Analysis From 1987 to 2021

Electrical impedance tomography (EIT) is a gradually maturing medical imaging technique that relies on computational algorithms for reconstructing and visualizing internal conductivity distributions within the human body. To provide a comprehensive and objective understanding of the current state and trends in the EIT algorithm research, we conducted bibliometric analysis on a 25-year EIT algorithm research dataset sourced from Web of Science Core Collections. We visualized publication characteristics, collaboration patterns, keywords, and co-cited references. The results indicate a steady increase in annual publications over recent decades. The United States, United Kingdom, China, and South Korea contributed 60% of the articles collaboratively. Keyword analysis unveiled three distinct stages in the evolution of EIT algorithm research: the establishment of fundamental algorithm frameworks, optimization for improved imaging performance, and the development of algorithms for clinical applications. Additionally, there has been a shift in research focus from traditional theories to the incorporation of new methods, such as artificial intelligence. Co-cited references suggest that integrating EIT with other established imaging techniques may emerge as a new trend in EIT algorithm research. In summary, EIT algorithms have been a consistent research focus, with current efforts centered on optimizing algorithms to enhance imaging performance. The emerging research trend involves utilizing more diverse and intersecting algorithms.

Towards continuous EIT monitoring for hemorrhagic stroke patients

The practical implementation of continuous monitoring of stroke patients by Electrical Impedance Tomography (EIT) is addressed. In a previous paper, we have demonstrated EIT sensitivity to cerebral hemodynamics, using scalp-mounted electrodes, very low-noise measurements, and a novel image reconstruction method. In the present paper, we investigate the potential to adapt that system for clinical application, by using 50% fewer electrodes and by incorporating into the measurement protocol an additional high-frequency measurement to provide an effective reference. Previously published image reconstruction methods for multi-frequency EIT are substantially improved by exploiting the forward calculations enabled by the detailed head model, particularly to make the referencing method more robust and to attempt to remove the effects of modelling error. Images are presented from simulation of a typical hemorrhagic stroke and its growth. These results are encouraging for exploration of the potential clinical benefit of the methodology in long-term monitoring of hemorrhagic stroke.

Robust electrical impedance tomography for biological application: A mini review

Electrical impedance tomography (EIT) has been used by researchers across several areas because of its low-cost and no-radiation properties. Researchers use complex conductivity in bioimpedance experiments to evaluate changes in various indicators within the image target. The diverse volumes and edges of biological tissues and the large impedance range impose dedicated demands on hardware design. The EIT hardware with a high signal-to-noise ratio (SNR), fast scanning and suitable for the impedance range of the image target is a fundamental foundation that EIT research needs to be equipped with. Understanding the characteristics of this technique and state-of-the-art design will accelerate the development of the robust system and provide a guidance for the superior performance of next-generation EIT. This review explores the hardware strategies for EIT proposed in the literature.

Evaluation of Blood Biomarkers and Parameters for the Prediction of Stroke Survivors' Functional Outcome upon Discharge Utilizing Explainable Machine Learning

Despite therapeutic advancements, stroke remains a leading cause of death and long-term disability. The quality of current stroke prognostic models varies considerably, whereas prediction models of post-stroke disability and mortality are restricted by the sample size, the range of clinical and risk factors and the clinical applicability in general. Accurate prognostication can ease post-stroke discharge planning and help healthcare practitioners individualize aggressive treatment or palliative care, based on projected life expectancy and clinical course. In this study, we aimed to develop an explainable machine learning methodology to predict functional outcomes of stroke patients at discharge, using the Modified Rankin Scale (mRS) as a binary classification problem. We identified 35 parameters from the admission, the first 72 h, as well as the medical history of stroke patients, and used them to train the model. We divided the patients into two classes in two approaches: "Independent" vs. "Non-Independent" and "Non-Disability" vs. "Disability". Using various classifiers, we found that the best models in both approaches had an upward trend, with respect to the selected biomarkers, and achieved a maximum accuracy of 88.57% and 89.29%, respectively. The common features in both approaches included: age, hemispheric stroke localization, stroke localization based on blood supply, development of respiratory infection, National Institutes of Health Stroke Scale (NIHSS) upon admission and systolic blood pressure levels upon admission. Intubation and C-reactive protein (CRP) levels upon admission are additional features for the first approach and Erythrocyte Sedimentation Rate (ESR) levels upon admission for the second. Our results suggest that the said factors may be important predictors of functional outcomes in stroke patients.

Fast Iterative Shrinkage-Thresholding Algorithm with Continuation for Brain Injury Monitoring Imaging Based on Electrical Impedance Tomography

Electrical impedance tomography (EIT) is low-cost and noninvasive and has the potential for real-time imaging and bedside monitoring of brain injury. However, brain injury monitoring by EIT imaging suffers from image noise (IN) and resolution problems, causing blurred reconstructions. To address these problems, a least absolute shrinkage and selection operator model is built, and a fast iterative shrinkage-thresholding algorithm with continuation (FISTA-C) is proposed. Results of numerical simulations and head phantom experiments indicate that FISTA-C reduces IN by 63.2%, 47.2%, and 29.9% and 54.4%, 44.7%, and 22.7%, respectively, when compared with the damped least-squares algorithm, the split Bergman, and the FISTA algorithms. When the signal-to-noise ratio of the measurements is 80-50 dB, FISTA-C can reduce IN by 83.3%, 72.3%, and 68.7% on average when compared with the three algorithms, respectively. Both simulation and phantom experiments suggest that FISTA-C produces the best image resolution and can identify the two closest targets. Moreover, FISTA-C is more practical for clinical application because it does not require excessive parameter adjustments. This technology can provide better reconstruction performance and significantly outperforms the traditional algorithms in terms of IN and resolution and is expected to offer a general algorithm for brain injury monitoring imaging via EIT.

Advances of deep learning in electrical impedance tomography image reconstruction

Electrical impedance tomography (EIT) has been widely used in biomedical research because of its advantages of real-time imaging and nature of being non-invasive and radiation-free. Additionally, it can reconstruct the distribution or changes in electrical properties in the sensing area. Recently, with the significant advancements in the use of deep learning in intelligent medical imaging, EIT image reconstruction based on deep learning has received considerable attention. This study introduces the basic principles of EIT and summarizes the application progress of deep learning in EIT image reconstruction with regards to three aspects: a single network reconstruction, deep learning combined with traditional algorithm reconstruction, and multiple network hybrid reconstruction. In future, optimizing the datasets may be the main challenge in applying deep learning for EIT image reconstruction. Adopting a better network structure, focusing on the joint reconstruction of EIT and traditional algorithms, and using multimodal deep learning-based EIT may be the solution to existing problems. In general, deep learning offers a fresh approach for improving the performance of EIT image reconstruction and could be the foundation for building an intelligent integrated EIT diagnostic system in the future.

An Explainable Machine Learning Pipeline for Stroke Prediction on Imbalanced Data

Stroke is an acute neurological dysfunction attributed to a focal injury of the central nervous system due to reduced blood flow to the brain. Nowadays, stroke is a global threat associated with premature death and huge economic consequences. Hence, there is an urgency to model the effect of several risk factors on stroke occurrence, and artificial intelligence (AI) seems to be the appropriate tool. In the present study, we aimed to (i) develop reliable machine learning (ML) prediction models for stroke disease; (ii) cope with a typical severe class imbalance problem, which is posed due to the stroke patients’ class being significantly smaller than the healthy class; and (iii) interpret the model output for understanding the decision-making mechanism. The effectiveness of the proposed ML approach was investigated in a comparative analysis with six well-known classifiers with respect to metrics that are related to both generalization capability and prediction accuracy. The best overall false-negative rate was achieved by the Multi-Layer Perceptron (MLP) classifier (18.60%). Shapley Additive Explanations (SHAP) were employed to investigate the impact of the risk factors on the prediction output. The proposed AI method could lead to the creation of advanced and effective risk stratification strategies for each stroke patient, which would allow for timely diagnosis and the right treatments.

Real-time monitoring hypoxia at high altitudes using electrical bioimpedance technique: an animal experiment

Hypoxia poses a serious threat to pilots. The aim of this study was to examine the efficacy of electrical bioimpedance (EBI) in detecting the onset of hypoxia in real time in a rabbit hypoxia model. Thirty-two New Zealand rabbits were divided equally into four groups (control group and three hypoxia groups, i.e., mild, moderate, and severe). Hypoxia was induced by simulating various altitudes in the hypobaric oxygen chamber (3,000 m, 5,000 m, and 8,000 m). Both cerebral impedance and blood oxygen (Sp_O2) were monitored continuously. Results showed that the cerebral impedance increased immediately during the period of increasing altitude and decreased quickly to the initial baseline at the phase of descending altitude. Moreover, the change of cerebral impedance in the mild hypoxia group (3,000 m) was significantly smaller than those in the other two groups (5,000 m and 8,000 m, P < 0.05). The changes in cerebral impedance and Sp_O2 were significantly correlated based on the total of measurement data (r² = 0.628, P < 0.001). Furthermore, the agreement analysis performed with Bland-Altman and standardized residual plots exhibited high concordance between cerebral impedance and Sp_O2. Receiver operator characteristic analysis manifested that the sensitivity, specificity, and area under the curve using cerebral impedance for changes in Sp_O2 >10% were 0.735, 0.826, and 0.845, respectively. These findings demonstrated that EBI could sensitively and accurately monitor changes of cerebral impedance induced by hypoxia, which might provide a potential tool for the real-time and noninvasive monitoring of hypoxic condition of pilots in flight for early identification of hypoxia.NEW & NOTEWORTHY This study is the first to examine the efficacy of electrical bioimpedance (EBI) in detecting the onset of high-altitude hypoxia in real time. The novelty of this research includes three aspects. First, the cerebral impedance of rabbits increased immediately during the rising of altitude and decreased quickly to the initial baseline at the phase of descending altitude. Second, there was a significant correlation and high concordance between cerebral impedance and Sp_O2. Third, cerebral impedance could determine the change of Sp_O2 resulting from hypoxia.

Self-Abrading Servo Electrode Helmet for Electrical Impedance Tomography

Electrical Impedance Tomography (EIT) is a medical imaging technique which has the potential to reduce time to treatment in acute stroke by rapidly differentiating between ischaemic and haemorrhagic stroke. The potential of these methods has been demonstrated in simulation and phantoms, it has not yet successfully translated to clinical studies, due to high sensitivity to errors in scalp electrode mislocation and poor electrode-skin contact. To overcome these limitations, a novel electrode helmet was designed, bearing 32 independently controlled self-abrading electrodes. The contact impedance was reduced through rotation on an abrasive electrode on the scalp using a combined impedance, rotation and position feedback loop. Potentiometers within each unit measure the electrode tip displacement within 0.1 mm from the rigid helmet body. Characterisation experiments on a large-scale test rig demonstrated that approximately 20 kPa applied pressure and 5 rotations was necessary to achieve the target 5 kΩ contact impedance at 20 Hz. This performance was then replicated in a simplified self-contained unit where spring loaded electrodes are rotated by servo motors. Finally, a 32-channel helmet and controller which sequentially minimised contact impedance and simultaneously located each electrode was built which reduced the electrode application and localisation time to less than five minutes. The results demonstrated the potential of this approach to rapidly apply electrodes in an acute setting, removing a significant barrier for imaging acute stroke with EIT.