A real-time electrical impedance tomography system for clinical use--design and preliminary results

Electrical Sensor Calibration by Fuzzy Clustering with Mandatory Constraint

Electrical tomography sensors have been widely used for pipeline parameter detection and estimation. Before they can be used in formal applications, the sensors must be calibrated using enough labeled data. However, due to the high complexity of actual measuring environments, the calibrated sensors are inaccurate since the labeling data may be uncertain, inconsistent, incomplete, or even invalid. Alternatively, it is always possible to obtain partial data with accurate labels, which can form mandatory constraints to correct errors in other labeling data. In this paper, a semi-supervised fuzzy clustering algorithm is proposed, and the fuzzy membership degree in the algorithm leads to a set of mandatory constraints to correct these inaccurate labels. Experiments in a dredger validate the proposed algorithm in terms of its accuracy and stability. This new fuzzy clustering algorithm can generally decrease the error of labeling data in any sensor calibration process.

A Review of EMG-, FMG-, and EIT-Based Biosensors and Relevant Human–Machine Interactivities and Biomedical Applications

Wearables developed for human body signal detection receive increasing attention in the current decade. Compared to implantable sensors, wearables are more focused on body motion detection, which can support human–machine interaction (HMI) and biomedical applications. In wearables, electromyography (EMG)-, force myography (FMG)-, and electrical impedance tomography (EIT)-based body information monitoring technologies are broadly presented. In the literature, all of them have been adopted for many similar application scenarios, which easily confuses researchers when they start to explore the area. Hence, in this article, we review the three technologies in detail, from basics including working principles, device architectures, interpretation algorithms, application examples, merits and drawbacks, to state-of-the-art works, challenges remaining to be solved and the outlook of the field. We believe the content in this paper could help readers create a whole image of designing and applying the three technologies in relevant scenarios.

Blood Transfusion for Elderly Patients with Hip Fracture: a Nationwide Cohort Study

BACKGROUND

This nationwide study aimed to investigate the blood transfusion status of elderly hip fracture patients and to examine the effect of packed red blood cell transfusion on all-cause mortality.

METHODS

From the Korean National Health Insurance Service-Senior cohort consisting of 588,147 participants aged over 60 years in 2002, a total of 14,744 new-onset hip fracture patients aged 65-99 years were followed up for 11 years. The adjusted hazard ratios (aHRs), risk ratios, and their 95% confidence intervals were estimated by the Cox proportional hazard model and Poisson regression model.

RESULTS

There were 10,973 patients (74.42%) in the transfusion group and 3,771 (25.58%) patients in the non-transfusion group. The mean volume of blood transfusion was 1,164.51 mL (± 865.25; median, 800 mL; interquartile range, 640-1,440). In the multivariable-adjusted Cox proportional hazard model, the transfusion group had 1.34-fold more risk of all-cause mortality than the non-transfusion group (aHR, 1.34; 95% confidence interval [CI], 1.26-1.42). In the multivariate-adjusted Poisson regression model, hip fracture patients in the transfusion group were 1.43 (adjusted risk ratio [aRR], 1.43; 95% CI, 1.09-1.87; P = 0.009) folds more likely to die within 30 days than those in the non-transfusion group. The mortality risk was highest at 90 days (aRR, 1.64; 95% CI, 1.40-1.93; P < 0.001) and slightly decreased at 180 days (aRR, 1.58; 95% CI, 1.40-1.79; P < 0.001) and 1 year (aRR, 1.43; 95% CI, 1.31-1.58; P < 0.001).

CONCLUSION

In this nationwide representative cohort study, blood transfusion was performed in 75% of hip fracture patients. Even after adjusting for comorbidity and anticoagulant use, the postoperative results (hospitalization, mortality) of the transfusion group did not show significantly worse results than the non-transfusion group. Therefore, adequate patient blood management can only improve the patient's outcome after hip fracture surgery.

Global and regional degree of obstruction determined by electrical impedance tomography in patients with obstructive ventilatory defect

Background

Electrical impedance tomography is a continuous imaging method capable of measuring lung volume changes. The purpose of this study was to examine whether EIT was capable of evaluating the degree of obstructive ventilatory defect (OVD) on the global and regional level.

Methods

41 healthy subjects with no lung diseases and 67 subjects suffering from obstructive lung diseases were examined using EIT and spirometry during forced vital capacity (FVC) maneuver. The subjects were divided into control group (n = 41), early airway obstruction group (n = 26), mild group (n = 17), moderate group (n = 16) and severe group (n = 8) according to the degree of obstruction. Forced expiratory volume in 1 second (FEV₁) and FEV₁/FVC were determined by EIT. The mode index (MI) was proposed to evaluate the degree of global and regional obstruction; the effectiveness of MI was validated by evaluating posture related change of lung emptying capacity in sitting and supine postures; the degree of regional obstruction was determined according to the cut-off values of MI obtained from receiver operating characteristic (ROC) analysis; regional obstruction was located in the four-quadrant region of interest (ROI) and the contour-map ROI with contour lines at the cut-off values of MI.

Results

Significant differences were found between different groups (P<0.05) and the global MI was 0.93±0.03, 0.86±0.05, 0.81±0.09, 0.73±0.09 and 0.60±0.11 (mean ±SD), respectively. The cut-off MI value was 0.90, 0.83, 0.77, and 0.65, respectively.

Conclusion

The results indicated the potential of EIT to evaluate the degree of obstruction in patients with obstructive ventilatory defect on the global and regional level.

Low-cost multifrequency electrical impedance-based system (MFEIBS) for clinical imaging: design and performance evaluation

Electrical impedance tomography (EIT) is an upcoming and capable imaging modality used for clinical imaging. It is non-invasive, non-ionising and an inexpensive technique. This paper explains the designing and the analysis of a low-cost multifrequency electrical impedance-based system (MFEIBS) having a flexible mechanism of interfacing up to 32 electrodes, suitable for 1 kHz-2 MHz. Various indicators to check the performance of the EIT system were evaluated and presented here. The performance of VCO and VCCS was measured up to 2 MHz. SNR was measured with saline phantom and its mean value is 74 dB for the complete bandwidth. Different combinations of resistors and capacitors were used to find the accuracy of the system, and relative error was less than 0.55% for the entire range. CMRR of the system was calculated and it was found to be maximum 85 dB at 1 kHz frequency. A 16-electrode circular plastic phantom having a diameter of 18 cm was established and connected with a simple MFEIBS. Obtained surface potential was applied to the computer used for image formation using NI USB-6259, 16-bit, 1.25 MS/s M Series High-speed DAQ. Images reconstructed using the system presented in this paper was generated from a 16-electrode plastic phantom filled with NaCl up to 1.2 cm height.

A Quantitative Evaluation of Drive Pattern Selection for Optimizing EIT-Based Stretchable Sensors

Electrical Impedance Tomography (EIT) is a medical imaging technique that has been recently used to realize stretchable pressure sensors. In this method, voltage measurements are taken at electrodes placed at the boundary of the sensor and are used to reconstruct an image of the applied touch pressure points. The drawback with EIT-based sensors, however, is their low spatial resolution due to the ill-posed nature of the EIT reconstruction. In this paper, we show our performance evaluation of different EIT drive patterns, specifically strategies for electrode selection when performing current injection and voltage measurements. We compare voltage data with Signal-to-Noise Ratio (SNR) and Boundary Voltage Changes (BVC), and study image quality with Size Error (SE), Position Error (PE) and Ringing (RNG) parameters, in the case of one-point and two-point simultaneous contact locations. The study shows that, in order to improve the performance of EIT based sensors, the electrode selection strategies should dynamically change correspondingly to the location of the input stimuli. In fact, the selection of one drive pattern over another can improve the target size detection and position accuracy up to 4.7% and 18%, respectively.

System Description and First Application of an FPGA-Based Simultaneous Multi-Frequency Electrical Impedance Tomography

A new prototype of a multi-frequency electrical impedance tomography system is presented. The system uses a field-programmable gate array as a main controller and is configured to measure at different frequencies simultaneously through a composite waveform. Both real and imaginary components of the data are computed for each frequency and sent to the personal computer over an ethernet connection, where both time-difference imaging and frequency-difference imaging are reconstructed and visualized. The system has been tested for both time-difference and frequency-difference imaging for diverse sets of frequency pairs in a resistive/capacitive test unit and in self-experiments. To our knowledge, this is the first work that shows preliminary frequency-difference images of in-vivo experiments. Results of time-difference imaging were compared with simulation results and shown that the new prototype performs well at all frequencies in the tested range of 60 kHz-960 kHz. For frequency-difference images, further development of algorithms and an improved normalization process is required to correctly reconstruct and interpreted the resulting images.

FPGA-based voltage and current dual drive system for high frame rate electrical impedance tomography

Electrical impedance tomography (EIT) is used to image the electrical property distribution of a tissue under test. An EIT system comprises complex hardware and software modules, which are typically designed for a specific application. Upgrading these modules is a time-consuming process, and requires rigorous testing to ensure proper functioning of new modules with the existing ones. To this end, we developed a modular and reconfigurable data acquisition (DAQ) system using National Instruments' (NI) hardware and software modules, which offer inherent compatibility over generations of hardware and software revisions. The system can be configured to use up to 32-channels. This EIT system can be used to interchangeably apply current or voltage signal, and measure the tissue response in a semi-parallel fashion. A novel signal averaging algorithm, and 512-point fast Fourier transform (FFT) computation block was implemented on the FPGA. FFT output bins were classified as signal or noise. Signal bins constitute a tissue's response to a pure or mixed tone signal. Signal bins' data can be used for traditional applications, as well as synchronous frequency-difference imaging. Noise bins were used to compute noise power on the FPGA. Noise power represents a metric of signal quality, and can be used to ensure proper tissue-electrode contact. Allocation of these computationally expensive tasks to the FPGA reduced the required bandwidth between PC, and the FPGA for high frame rate EIT. In 16-channel configuration, with a signal-averaging factor of 8, the DAQ frame rate at 100 kHz exceeded 110 frames s (-1), and signal-to-noise ratio exceeded 90 dB across the spectrum. Reciprocity error was found to be for frequencies up to 1 MHz. Static imaging experiments were performed on a high-conductivity inclusion placed in a saline filled tank; the inclusion was clearly localized in the reconstructions obtained for both absolute current and voltage mode data.

Multi-GPU Jacobian accelerated computing for soft-field tomography

Image reconstruction in soft-field tomography is based on an inverse problem formulation, where a forward model is fitted to the data. In medical applications, where the anatomy presents complex shapes, it is common to use finite element models (FEMs) to represent the volume of interest and solve a partial differential equation that models the physics of the system. Over the last decade, there has been a shifting interest from 2D modeling to 3D modeling, as the underlying physics of most problems are 3D. Although the increased computational power of modern computers allows working with much larger FEM models, the computational time required to reconstruct 3D images on a fine 3D FEM model can be significant, on the order of hours. For example, in electrical impedance tomography (EIT) applications using a dense 3D FEM mesh with half a million elements, a single reconstruction iteration takes approximately 15-20 min with optimized routines running on a modern multi-core PC. It is desirable to accelerate image reconstruction to enable researchers to more easily and rapidly explore data and reconstruction parameters. Furthermore, providing high-speed reconstructions is essential for some promising clinical application of EIT. For 3D problems, 70% of the computing time is spent building the Jacobian matrix, and 25% of the time in forward solving. In this work, we focus on accelerating the Jacobian computation by using single and multiple GPUs. First, we discuss an optimized implementation on a modern multi-core PC architecture and show how computing time is bounded by the CPU-to-memory bandwidth; this factor limits the rate at which data can be fetched by the CPU. Gains associated with the use of multiple CPU cores are minimal, since data operands cannot be fetched fast enough to saturate the processing power of even a single CPU core. GPUs have much faster memory bandwidths compared to CPUs and better parallelism. We are able to obtain acceleration factors of 20 times on a single NVIDIA S1070 GPU, and of 50 times on four GPUs, bringing the Jacobian computing time for a fine 3D mesh from 12 min to 14 s. We regard this as an important step toward gaining interactive reconstruction times in 3D imaging, particularly when coupled in the future with acceleration of the forward problem. While we demonstrate results for EIT, these results apply to any soft-field imaging modality where the Jacobian matrix is computed with the adjoint method.

Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse

The assessment of the regional match between alveolar ventilation and perfusion in critically ill patients requires simultaneous measurements of both parameters. Ideally, assessment of lung perfusion should be performed in real-time with an imaging technology that provides, through fast acquisition of sequential images, information about the regional dynamics or regional kinetics of an appropriate tracer. We present a novel electrical impedance tomography (EIT)-based method that quantitatively estimates regional lung perfusion based on first-pass kinetics of a bolus of hypertonic saline contrast. Pulmonary blood flow was measured in six piglets during control and unilateral or bilateral lung collapse conditions. The first-pass kinetics method showed good agreement with the estimates obtained by single-photon-emission computerized tomography (SPECT). The mean difference (SPECT minus EIT) between fractional blood flow to lung areas suffering atelectasis was -0.6%, with a SD of 2.9%. This method outperformed the estimates of lung perfusion based on impedance pulsatility. In conclusion, we describe a novel method based on EIT for estimating regional lung perfusion at the bedside. In both healthy and injured lung conditions, the distribution of pulmonary blood flow as assessed by EIT agreed well with the one obtained by SPECT. The method proposed in this study has the potential to contribute to a better understanding of the behavior of regional perfusion under different lung and therapeutic conditions.

A quantitative method based on total relative change for dynamic electrical impedance tomography

We proposed a new method based on total relative change (TRC) from measured boundary voltages to quantify the volume changes of fluid during electrical impedance tomography (EIT) monitoring. The results showed that TRC linearly correlated with the volume of infused saline solution into a phantom, and the slope of TRC changes was approximately linear with the infusion speed. A inserted copper tube at different positions did not affect TRC significantly. The linear relationship between TRC and volume change indicates that TRC could be a good quantitative index for dynamic EIT.

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.

Application of conformal transformation to elliptic geometry for electric impedance tomography

Electrical impedance tomography (EIT) is a medical imaging modality that is used to compute the conductivity distribution through measurements on the cross-section of a body part. An elliptic geometry model, which defines a more general frame, ensures more accurate results in reconstruction and assessment of inhomogeneities inside. This study provides a link between the analytical solutions defined in circular and elliptical geometries on the basis of the computation of conformal mapping. The results defined as voltage distributions for the homogeneous case in elliptic and circular geometries have been compared with those obtained by the use of conformal transformation between elliptical and well-known circular geometry. The study also includes the results of the finite element method (FEM) as another approach for more complex geometries for the comparison of performance in other complex scenarios for eccentric inhomogeneities. The study emphasizes that for the elliptic case the analytical solution with conformal transformation is a reliable and useful tool for developing insight into more complex forms including eccentric inhomogeneities.

An image monitoring system for intraperitoneal bleeding using electrical impedance tomography and its preliminary results in vivo

An image monitoring system using electrical impedance tomography (EIT) for intraperitoneal bleeding was designed (FMMU V3.5). It consists of a constant current driving source with frequency of 50 KHz, a high accuracy measurement module, a driving and measuring mode program-controlled circuits, a data acquisition card, an optoelectronic isolated digital I/O board, and a custom-specified linear power supply units. The system applied equal-potential back projection algorithm to reconstruct dynamic images. The relative accuracy of the system is 0.1%, the RTI noise is 11.1 mu V (bandwidth 100 Hz). Based on physical phantom, images reconstructed by the system showed that it can image dynamically to the infused saline solution, and by infusing more solution the gray changed area of the image also enlarged accordingly. For stomach filling model in vivo, the dynamic imaging processes showed that the system can clearly and sensitively monitoring the saline solution drinking into the stomach for 50 ml each time, and by drinking more saline solution the conductivity changed area of the dynamic image also enlarged accordingly.

Assessment of the Pulmonary Volume Pulse in Idiopathic Pulmonary Arterial Hypertension by Means of Electrical Impedance Tomography

BACKGROUND

Electrical impedance tomography (EIT) is a non-invasive imaging technique which can be used to measure the blood volume changes in the pulmonary vascular bed during the cardiac cycle.

STUDY OBJECTIVES

This study was performed to evaluate the differences in the EIT signal of the pulmonary vascular bed between healthy subjects and patients with idiopathic pulmonary arterial hypertension (IPAH), who are known to have a remodelled pulmonary vascular bed.

PATIENTS AND METHODS

Twenty-one patients (17 females, 4 males) with IPAH and 30 healthy controls (5 females, 25 males) were measured. EIT measurements were performed in duplicate, on the same day as right heart catheterization to obtain haemodynamic data. The maximal impedance change during systole (Delta Z(sys)) was used as a measure of the pulmonary volume pulse and expressed in arbitrary units (AU). Total lung capacity, spirometric values and diffusion capacity for carbon monoxide were measured as well.

RESULTS

Mean Delta Z(sys) was 215 +/- 58 x 10(-2) AU (95% CI 193 x 10(-2) to 236 x 10(-2)) in the healthy subjects and 78 +/- 27 x 10(-2) AU (95% CI 66 x 10(-2) to 91 x 10(-2)) in the IPAH patient group (p < 0.0001). No significant correlation was found between Delta Z(sys) and any of the haemodynamic or lung function data.

CONCLUSION

The impedance pulsation of the pulmonary vascular bed is reduced in IPAH in comparison with controls, indicating a reduced volume pulse. This might represent the reduced cross section area, as well as the reduced compliance and number of the pulmonary vessels in these patients.

Detection of emboli in vessels using electrical impedance measurements--phantom and electrodes

A phantom was constructed to simulate the electrical properties of the neck. A range of possible electrode configurations was then examined in order to improve the sensitivity of the impedance measurement method for the in vivo detection of air emboli. The neck phantom consisted of simulated skin, fat and muscle layers made of agar and a conductive rubber tube mimicking the common carotid artery. The ring-shaped electrodes with a guard electrode showed the highest sensitivity to emboli at short distances.

Dynamic electrical impedance imaging with the interacting multiple model scheme

In this paper, an effective dynamical EIT imaging scheme is presented for on-line monitoring of the abruptly changing resistivity distribution inside the object, based on the interacting multiple model (IMM) algorithm. The inverse problem is treated as a stochastic nonlinear state estimation problem with the time-varying resistivity (state) being estimated on-line with the aid of the IMM algorithm. In the design of the IMM algorithm multiple models with different process noise covariance are incorporated to reduce the modeling uncertainty. Simulations and phantom experiments are provided to illustrate the proposed algorithm.

Determinants of pulmonary perfusion measured by electrical impedance tomography

Electrical impedance tomography (EIT) is a non-invasive imaging technique for detecting blood volume changes that can visualize pulmonary perfusion. The two studies reported here tested the hypothesis that the size of the pulmonary microvascular bed, rather than stroke volume (SV), determines the EIT signal. In the first study, the impedance changes relating to the maximal pulmonary pulsatile blood volume during systole (Delta Z(sys)) were measured in ten healthy subjects, ten patients diagnosed with chronic obstructive pulmonary disease, who were considered to have a reduced pulmonary vascular bed, and ten heart failure patients with an assumed low cardiac output but with a normal lung parenchyma. Mean Delta Z(sys) (SD) in these groups was 261 (34)x10(-5), 196 (39)x10(-5) ( P<0.001) and 233 (61)x10(-5) arbitrary units (AU) (P=NS), respectively. In the second study, including seven healthy volunteers, Delta Z(sys) was measured at rest and during exercise on a recumbent bicycle while SV was measured by means of magnetic resonance imaging. The Delta Z(sys) at rest was 352 (53)x10(-5 ) and 345 (112)x10(-5 )AU during exercise (P=NS), whereas SV increased from 83 (21) to 105 (34) ml (P<0.05). The EIT signal likely reflects the size of the pulmonary microvascular bed, since neither a low cardiac output nor a change in SV of the heart appear to influence EIT.

Pulmonary vascular responses to hypoxia and hyperoxia in healthy volunteers and COPD patients measured by electrical impedance tomography

BACKGROUND

Electrical impedance tomography (EIT) is a noninvasive imaging technique using impedance to visualize and measure blood volume changes.

STUDY OBJECTIVE

To examine the validity of EIT in the measurement of hypoxic pulmonary vasoconstriction (HPV) and hyperoxic pulmonary vasodilation in healthy volunteers and COPD patients.

PARTICIPANTS

Group 1 consisted of seven healthy volunteers (mean age, 46 years; age range, 36 to 53 years). Group 2 comprised six clinically stable COPD patients (mean age, 65 years; age range, 50 to 74 years).

INTERVENTIONS

EIT measurements were performed in healthy subjects while they were breathing room air, 14% oxygen (ie, hypoxia), and 100% oxygen (ie, hyperoxia) through a mouthpiece. Maximal impedance change during systole (DeltaZsys) was used as a measure of pulmonary perfusion-related impedance changes. Stroke volume (SV) was measured by means of MRI. In the COPD group, EIT and SV also were determined, but only in room air and under hyperoxic conditions.

RESULTS

The data were statistically compared to data for the room air baseline condition. In the volunteers, the mean (+/- SD) DeltaZsys for the group was 352 +/- 53 arbitrary units (AU) while breathing room air, 309 +/- 75 AU in hypoxia (p < 0.05), and 341 +/- 69 AU in hyperoxia (not significant [NS]). The mean MRI-measured SV was 83 +/- 21 mL while breathing room air, 90 +/- 29) mL in hypoxia (NS), and 94 +/- 19 mL in hyperoxia (p < 0.05). In the COPD patients, the mean DeltaZsys for this group was 222 +/- 84 AU while breathing room air and 255 +/- 83 AU in hyperoxia (p < 0.05). In this group, the SV was 59 +/- 16 mL while breathing room air and 61 +/- 13 mL in hyperoxia (NS). Thus, the volunteer EIT response to hypoxia is not caused by decreased SV, because SV did not show a significant decrease. Similarly, in COPD patients the EIT response to hyperoxia is not caused by increased SV, because SV showed only a minor change.

CONCLUSION

EIT can detect blood volume changes due to HPV noninvasively in healthy subjects and hyperoxic vasodilation in COPD patients.

Electrical impedance tomography to measure pulmonary perfusion: is the reproducibility high enough for clinical practice?

A possible clinical application of electrical impedance tomography (EIT) might be to monitor changes in the pulmonary circulation, provided the reproducibility of the EIT measurement is adequate. The purpose of this study was threefold: the intra- and inter-investigator variability of repeated measurements was investigated. Three different regions of interest (ROI) were analysed to assess the optimal ROI. Twenty-four healthy subjects and six patients were included. The Sheffield applied potential tomograph (DAS-01P, IBEES, Sheffield, UK) was used. Electrodes were attached by investigator A, and duplicate EIT measurements were performed. After detachment and 45 min of rest, the protocol was repeated by another investigator B, and afterwards by the initial investigator A. Three ROIs were analysed: whole circle, 'inner half circle' and contour. The mean difference in impedance changes between observers is presented in arbitrary units (AU) +/- SD. Finally, the influence of age, body composition and sex on the EIT result was examined. For the contour ROI, the mean difference for the intra-investigator situation was -1.44 x 10(-2) +/- 18.45 x 10(-2) AU (-0.7 +/- 9.0%), and was 5.46 x 10(-2) +/- 21.66 x 10(-2) AU (2.7 +/- 10.8%) for the inter-investigator situation. The coefficient of reproducibility of the intra- and inter-investigator reproducibility varied between 0.89 and 0.97 for all ROIs (P < 0.0001). There is a relation between impedance change and age (correlation coefficient r = -0.63, P < 0.01 for contour ROI), and between impedance change and body mass index (BMI) (r = -0.53, P < 0.05). We found a significant difference in mean impedance change between groups of males and females. In conclusion, EIT results are highly reproducible when performed by the same investigator as well as by two different investigators.

Propagation of measurement noise through backprojection reconstruction in electrical impedance tomography

A framework to analyze the propagation of measurement noise through backprojection reconstruction algorithms in electrical impedance tomography (EIT) is presented. Two measurement noise sources were considered: noise in the current drivers and in the voltage detectors. The influence of the acquisition system architecture (serial/semi-parallel) is also discussed. Three variants of backprojection reconstruction are studied: basic (unweighted), weighted and exponential backprojection. The results of error propagation theory have been compared with those obtained from simulated and experimental data. This comparison shows that the approach provides a good estimate of the reconstruction error variance. It is argued that the reconstruction error in EIT images obtained via backprojection can be approximately modeled as a spatially nonstationary Gaussian distribution. This methodology allows us to develop a spatial characterization of the reconstruction error in EIT images.

Monitoring of recruitment and derecruitment by electrical impedance tomography in a model of acute lung injury

OBJECTIVE

To evaluate a noninvasive system for obtaining information about alveolar recruitment and derecruitment in a model of acute lung injury.

DESIGN

Prospective experimental study.

SETTING

Animal research laboratory.

SUBJECTS

Nine anesthetized pigs.

INTERVENTIONS

Electrical impedance tomography measurements were performed. Electrical impedance tomography is an imaging technique that can register the ventilation-induced impedance changes in different parts of the lung. In nine anesthetized pigs, repeated lung lavages were performed until a PaO2 of <80 mm Hg was reached. Thereafter, the lungs were recruited according to two different recruitment protocols: the open lung approach and the open lung concept. Five time points for measurements were chosen: healthy (reference), lavage (atelectasis), recruitment, derecruitment, and maintain recruited (final).

MEASUREMENTS AND MAIN RESULTS

After lavage, there was a significant increase in the impedance ratio, defined as the ventilation-induced impedance changes of the anterior part of the lung divided by that of the posterior part (from 1.75 +/- 0.63 to 4.51 +/- 2.22; p < .05). The impedance ratio decreased significantly after performing the recruitment protocol (from 4.51 +/- 2.22 to 1.18 +/- 0.51). During both recruitment procedures, a steep increase in baseline impedance change was seen. Furthermore, during derecruitment, a decrease in the slope in baseline impedance change was seen in the posterior part of the lung, whereas the anterior part showed no change.

CONCLUSION

Electrical impedance tomography is a technique that can show impedance changes resembling recruitment and derecruitment of alveoli in the anterior and posterior parts of the lung. Therefore, electrical impedance tomography may help in determining the optimal mechanical ventilation in a patient with acute lung injury.

Movement artefact rejection in impedance pneumography using six strategically placed electrodes

In this paper, we have proposed a technique for reducing movement artefacts in impedance pneumography by placing six electrodes at appropriate locations and suitably combining the measurements obtained. The strategy for electrode placement was based on the observation that the electrodes appeared to slide over the rib cage along with the skin, during movement. A volume conductor model of the thoracic cavity was developed and movement artefacts were simulated by shifting the electrodes to a different location on the surface. The impedance changes due to movement in one of the measurements of a 'symmetrical pair' were 180 degrees out of phase with respect to those observed in the other measurement of that pair. However, the impedance changes due to breathing were in phase in both these measurements. Thus, it was possible to reduce movement artefacts by taking a mean of these measurements without affecting the breathing related changes. The six electrodes could be configured into two such symmetrical pairs. The same observation was made in experimental data recorded from human subjects. This indicated that movement artefacts were caused by sliding of electrodes along with the skin and could be reduced by using the six-electrode configuration.

A real-time volumetric visualization system for electrical impedance tomography

Three dimensional (3D) electrical impedance tomography (EIT) presents many additional challenges over and above those associated with two dimensional EIT systems. With present two dimensional (2D) systems, tomographs can be reconstructed and displayed on a PC with a standard computer monitor. In addition, using appropriate data acquisition hardware and simple image reconstruction algorithms, it is possible to collect, reconstruct and display volumetric EIT images in real time using parallel processing architectures. The advantages of this 'real-time' capability are many and include the ability to immediately assess the correct functioning of the system and the ability to track patient events and the effect of procedures in real time. Whilst 3D EIT boundary datasets can be collected in real time, their real-time image reconstruction and display presents some computational challenges. This explains why, to date, no real-time solutions have been presented. In addition the use of a standard computer monitor to display 3D volumes is unsatisfactory since not all depth cues are preserved when using this type of 2D display device. We present a system which is capable of displaying 3D EIT datasets in real time and allows interactive modification of the user's viewpoint. This allows the user to fly around (and through) the EIT volumetric dataset.

Regional pressure volume curves by electrical impedance tomography in a model of acute lung injury

OBJECTIVE

A new noninvasive method, electrical impedance tomography (EIT), was used to make pressure-impedance (PI) curves in a lung lavage model of acute lung injury in pigs. The lower inflection point (LIP) and the upper deflection point (UDP) were determined from these curves and from the traditional pressure-volume (PV) curves to determine whether the PI curves resemble the traditional PV curves. Furthermore, regional differences in the mentioned determinants were investigated.

DESIGN

Prospective, experimental study.

SETTING

Animal research laboratory.

INTERVENTIONS

In nine anesthetized pigs, repeated lung lavage was performed until a Pao2 <80 torr was reached. Thereafter, an inspiratory PV curve was made using a constant flow of oxygen. During the intervention, EIT measurements were performed.

MEASUREMENTS AND MAIN RESULTS

In this study, the LIP(EIT) was within 2 cm H2O of the LIP(PV). Furthermore, it was possible to visualize regional PI curves by EIT. No significant difference was found between the LIP(PV) (21.3+/-3.0 cm H2O) and the LIP(EIT) of the total lung (21.5+/-3.0 cm H2O) or the anterior parts of the lung (21.5+/-2.9 cm H2O). A significantly higher LIP (29.5+/-4.9 cm H2O) was found in the posterior parts of the lung. A UDP(PV) could be found in three animals only, whereas in all animals a UDP(EIT) could be determined from the anterior part of the lung.

CONCLUSIONS

Using EIT, determination of LIP and UDP from the regional PI curves is possible. The obtained information from the regional PI curves may help in understanding alveolar recruitment. The use of this new bedside technique for clinical decision making remains to be examined.

A multichannel continuously selectable multifrequency electrical impedance spectroscopy measurement system

There is increasing evidence that alterations in the electrical property spectrum of tissues below 10 MHz is diagnostic for tissue pathology and/or pathophysiology. Yet, the complexity associated with constructing a high-fidelity multichannel, multifrequency data acquisition instrument has limited widespread development of spectroscopic electrical impedance imaging concepts. To contribute to the relatively sparse experience with multichannel spectroscopy systems this paper reports on the design, realization and evaluation of a prototype 32-channel instrument. The salient features of the system include a continuously selectable driving frequency up to 1 MHz, either voltage or current source modes of operation and simultaneous measurement of both voltage and current on each channel in either of these driving configurations. Comparisons of performance with recently reported fixed-frequency systems is favorable. Volts dc (VDC) signal-to-noise ratios of 75-80 dB are achieved and the noise floor for ac signals is near 100 dB below the signal strength of interest at 10 kHz and 60 dB down at 1 MHz. The added benefit of being able to record multispectral information on source and sense signal amplitudes and phases has also been realized. Phase-sensitive detection schemes and multiperiod undersampling techniques have been deployed to ensure measurement fidelity over the full bandwidth of system operation.

Electrical impedance tomography in the assessment of extravascular lung water in noncardiogenic acute respiratory failure

STUDY OBJECTIVES

To establish the value of electrical impedance tomography (EIT) in assessing pulmonary edema in noncardiogenic acute respiratory failure (ARF), as compared to the thermal dye double indicator dilution technique (TDD).

DESIGN

Prospective clinical study.

SETTING

ICU of a general hospital.

PATIENTS

Fourteen ARF patients.

INTERVENTIONS

In order to use the TDD to determine the amount of extravascular lung water (EVLW), a fiberoptic catheter was placed in the femoral artery.

MEASUREMENTS AND MAIN RESULTS

Fourteen consecutive ARF patients receiving mechanical ventilation were measured by EIT and TDD. EIT visualizes the impedance changes caused by the ventilation in two-dimensional image planes. An impedance ratio (IR) of the ventilation-induced impedance changes of a posterior and an anterior part of the lungs was used to indicate the amount of EVLW. For the 29 measurements in 14 patients, a significant correlation between EIT and TDD (r = 0. 85; p < 0.001) was found. The EIT reproducibility was good. The diagnostic value of the method was tested by receiver operator characteristic analysis, with 10 mL/kg of EVLW considered as the upper limit of normal. At a cutoff level of the IR of 0.64, the IR had a sensitivity of 93%, a specificity of 87%, and a positive predictive value of 87% for a supranormal amount of EVLW. Follow-up measurements were performed in 11 patients. A significant correlation was found between the changes in EVLW measured with EIT and TDD (r = 0.85; p < 0.005).

CONCLUSION

We conclude that EIT is a noninvasive technique for reasonably estimating the amount of EVLW in noncardiogenic ARF.

Influence of electrode impedance changes on the common-mode rejection ratio in bioimpedance measurements

Bioelectrical impedance in vivo measurements suffer from many potential sources of error due to the patient-instrument interface. The total common-mode rejection ratio (CMRR(T)) was investigated experimentally for three measurement channel circuit versions, including electrode-skin impedance imbalance. The first version was of the 'classical' type. The second one makes use of a differential filter at the input of the instrumentation amplifier. The third circuit was a frequency-converting structure, where the signal was demodulated before being amplified. The differential demodulator was based on synchronous sampling using floating capacitors. The experiments were accomplished with simulated imbalance of the real and imaginary parts of electrode-skin impedances. To reduce unwanted common-mode voltage, a differential accurately balanced current source was used. Considering an application in impedance cardiography, the experiments were carried out at a single frequency of 40 kHz. The results showed the advantage of the circuits using frequency conversion and differential input filter, rendering at least 15 dB higher CMRR(T). The most significant reduction of CMRR(T) resulted from imbalance of the capacitance component of voltage-sensing electrode impedances. The third circuit showed an unexpected behaviour of CMRR(T) improvement with higher imbalance of the electrode-skin impedance resistance component.

Electrical conductivity imaging via contactless measurements

A new imaging modality is introduced to image electrical conductivity of biological tissues via contactless measurements. This modality uses magnetic excitation to induce currents inside the body and measures the magnetic fields of the induced currents. In this study, the mathematical basis of the methodology is analyzed and numerical models are developed to simulate the imaging system. The induced currents are expressed using the A-phi formulation of the electric field where A is the magnetic vector potential and phi is the scalar potential function. It is assumed that A describes the primary magnetic vector potential that exists in the absence of the body. This assumption considerably simplifies the solution of the secondary magnetic fields caused by induced currents. In order to solve phi for objects of arbitrary conductivity distribution a three-dimensional (3-D) finite-element method (FEM) formulation is employed. A specific 7 x 7-coil system is assumed nearby the upper surface of a 10 x 10 x 5-cm conductive body. A sensitivity matrix, which relates the perturbation in measurements to the conductivity perturbations, is calculated. Singular-value decomposition of the sensitivity matrix shows various characteristics of the imaging system. Images are reconstructed using 500 voxels in the image domain, with truncated pseudoinverse. The noise level is assumed to produce a representative signal-to-noise ratio (SNR) of 80 dB. It is observed that it is possible to identify voxel perturbations (of volume 1 cm3) at 2 cm depth. However, resolution gradually decreases for deeper conductivity perturbations.

Cerebral blood-flow monitor for use in neonatal intensive care units

The implementation of a real-time multichannel system for monitoring cerebral blood-flow is described. The instrument relies on a completely modular architecture and is based on the principle of measuring the electrical impedance between a number of periodically sensed electrode pairs positioned around the subject's head. The whole setup is controlled by a host computer that performs several functions, such as real-time acquisition, analysis, display and data logging. Two operating options can be chosen by the user: a normal mode that allows continuous monitoring and a triggered mode in which the measurement cycle is automatically started by the occurrence of a preset condition in some other circulatory signal, e.g. the permanently available ECG signal. The design is considerably user-friendly and embodies a number of special safety precautions to take account of the peculiar condition of patients, usually newborn infants hospitalized in intensive care units.

Evaluation of electrical impedance tomography in the measurement of PEEP-induced changes in lung volume

STUDY OBJECTIVES

A new noninvasive practical technique called electrical impedance tomography (EIT) was examined for the measurement of alveolar recruitment.

DESIGN

Prospective clinical study.

SETTING

ICU of a general hospital.

PATIENTS

Acute respiratory failure (ARF) patients.

MEASUREMENTS

The ventilation-induced impedance changes (VICs) of the nondependent and the dependent part of the lung were determined by EIT as a measure of tidal volume distribution. By the use of an impedance ratio (IR), defined as the VIC of the nondependent part of the lung divided by the VIC of the dependent part of the lung, the ventilation performances in both parts of the lung were compared to each other.

RESULTS

Between patients, the VIC of the nondependent part of the lung was significantly lower in the patients with a level of positive end-expiratory pressure (PEEP) of > 10 cm H2O than in patients with a PEEP of < 5 cm H2O (p < 0.05). A significantly lower IR (-/+ SD) was found in the group with PEEP of > 10 cm H2O than in the group with PEEP between 0 and 5 cm H2O (1.28+/-0.58 vs 2.99+/-1.24, respectively; p < 0.01). In individual patients, the VIC of the whole lung increased when the PEEP level was increased. The VICs of the nondependent part of the lung and of the dependent part of the lung showed significant increases at a PEEP of 10 cm H2O compared to a PEEP of 0 cm H2O (p < 0.05). Also the IR decreased in individual patients when the PEEP was increased; a significant decrease was found at 10 cm H2O compared to 0 cm H2O (1.67+/-1.24 vs 2.23+/-1.47, respectively; p < 0.05).

CONCLUSIONS

The decrease in IR indicates an increase in VIC in the dependent part of the lung above the nondependent part of the lung. The increase in VIC can be regarded as an increase in lung volume, implying alveolar recruitment in the dependent part of the lung. The same results also have been shown in earlier reports by CT scan. Since EIT is far more practical than CT scanning and also is a bedside method, EIT might help in the adjustment of ventilator settings in ARF patients.

Ventilation and perfusion imaging by electrical impedance tomography: a comparison with radionuclide scanning

Electrical impedance tomography (EIT) is a technique that makes it possible to measure ventilation and pulmonary perfusion in a volume that approximates to a 2D plane. The possibility of using EIT for measuring the left-right division of ventilation and perfusion was compared with that of radionuclide imaging. Following routine ventilation (81mKr) and perfusion scanning (99mTc-MAA), EIT measurements were performed at the third and the sixth intercostal level in 14 patients with lung cancer. A correlation (r = 0.98, p < 0.005) between the left-right division for the ventilation measured with EIT and that with 81mKr was found. For the left-right division of pulmonary perfusion a correlation of 0.95 (p < 0.005) was found between the two methods. The reliability coefficient (RC) was calculated for estimating the left-right division with EIT. The RC for the ventilation measurements was 94% and 96% for the perfusion measurements. The correlation analysis for reproducibility of the EIT measurements was 0.95 (p < 0.001) for the ventilation and 0.93 (p < 0.001) for the perfusion measurements. In conclusion, EIT can be regarded as a promising technique to estimate the left-right division of pulmonary perfusion and ventilation.

Pulmonary perfusion measured by means of electrical impedance tomography

Electrical impedance tomography (EIT) is a recent imaging technique based on electrical impedance, offering the possibility of measuring pulmonary perfusion. In the present study the influence of several pulmonary haemodynamical parameters on the EIT signal were investigated. First, the influence on the systolic wave of the EIT signal (delta Zsys) of stroke volume, large pulmonary artery distensibility (both assessed by means of MRI) and the extent of the pulmonary peripheral vascular bed in 11 emphysematous patients (reduced peripheral vascular bed) and 9 controls (normal peripheral vascular bed) was investigated. Second, the influence of hypoxic pulmonary vasoconstriction on delta Zsys was examined in 14 healthy subjects. Finally, the origin of the diastolic wave was examined in three patients with atrioventricular dissociation. Multiple regression analysis showed that delta Zsys was only dependent on the variable emphysema (p < 0.02), but not dependent on stroke volume (p < 0.3) or pulmonary artery distensibility (p > 0.9). The mean value of delta Zsys for emphysematous patients (131 +/- 32 arbitrary units (AU)) was significantly lower (p < 0.001) than in the control group (200 +/- 39). In the group of healthy subjects delta Zsys decreased significantly (p < 0.001) during hypoxia (193 +/- 38 AU) compared with rest measurements (260 +/- 62 AU). The absence of the diastolic wave in the cardiological patients suggests the influence of reverse venous blood flow on the EIT signal. It is concluded that volume changes in the small pulmonary vessels contribute significantly to the EIT signal. Moreover, the hypoxia induced decrease in delta Zsys indicates the potential of EIT for measuring pulmonary vascular responses to external stimuli.

Influences of lung parenchyma density and thoracic fluid on ventilatory EIT measurements

Ventilatory impedance changes can be measured by electrical impedance tomography (EIT). Several studies have pointed out that the ventilatory-induced impedance change measured over the lungs shows a linear relationship with tidal volume. However, EIT measures the ventilatory impedance changes relative to a reference. Therefore, changes in the reference due to lung parenchyma destruction (increase of thoracic impedance) or lung water (decrease of thoracic impedance) might influence ventilatory EIT measurements. A study was designed to evaluate the influence of the density of lung parenchyma and the thoracic fluid content on ventilatory EIT measurements. Eleven emphysema patients with a variable degree of lung parenchyma destruction, nine haemodialysis patients with general fluid overload and ten healthy subjects were measured. The impedance changes were measured with the subject in the supine position breathing a constant tidal volume of 1 litre starting at the maximum end-expiratory level. In the emphysema group a significantly lower impedance change between ins- and expiration was found in comparison with the healthy subjects (11.6 +/- 6.4 AU l-1 versus 18.6 +/- 4.2 AU l-1, p < 0.05), whereas the haemodialysis group showed a significantly larger impedance change between ins- and expiration before haemodialysis (30.5 +/- 13.1 AU l-1, p < 0.05). A significant decrease in ventilation-induced impedance change during dialysis was found (30.5 +/- 13.1 AU l-1 versus 21.4 +/- 8.6 AU l-1, p < 0.01). Furthermore, a significant correlation between lung function parameters, which indicate the severity of lung parenchyma destruction, and the measured impedance change was found in emphysema patients. From these results it can be concluded that the density of lung parenchyma and the thoracic fluid content have a serious impact on the ventilation-induced impedance change.

Electrical impedance tomography of complex conductivity distributions with noncircular boundary

Electrical impedance tomography (EIT) uses low-frequency current and voltage measurements made on the boundary of a body to compute the conductivity distribution within the body. Since the permittivity distribution inside the body also contributes significantly to the measured voltages, the present reconstruction algorithm images complex conductivity distributions. A finite element model (FEM) is used to solve the forward problem, using a 6017-node mesh for a piecewise-linear potential distribution. The finite element solution using this mesh is compared with the analytical solution for a homogeneous field and a maximum error of 0.05% is observed in the voltage distribution. The boundary element method (BEM) is also used to generate the voltage data for inhomogeneous conductivity distributions inside regions with noncircular boundaries. An iterative reconstruction algorithm is described for approximating both the conductivity and permittivity distributions from this data. The results for an off-centered inhomogeneity showed a 35% improvement in contrast from that seen with only one iteration, for both the conductivity and the permittivity values. It is also shown that a significant improvement in images results from accurately modeling a noncircular boundary. Both static and difference images are distorted by assuming a circular boundary and the amount of distortion increases significantly as the boundary shape becomes more elliptical. For a homogeneous field in an elliptical body with axis ratio of 0.73, an image reconstructed assuming the boundary to be circular has an artifact at the center of the image with an error of 20%. This error increased to 37% when the axis ratio was 0.64. A reconstruction algorithm which used a mesh with the same axis ratio as the elliptical boundary reduced the error in the conductivity values to within 0.5% of the actual values.

Noninvasive assessment of right ventricular diastolic function by electrical impedance tomography

STUDY OBJECTIVES

Electrical impedance tomography (EIT) offers the possibility to study blood volume changes within the right atrium during the cardiac cycle. The aim of this study was to determine the applicability of EIT in the assessment of right ventricular diastolic function in COPD.

DESIGN

By means of region of interest analysis, impedance changes within the right atrium during the cardiac cycle were plotted as a function of time. As a diastolic index of the right ventricle, the right atrium emptying volume (RAEV), defined as the ratio between the volume change during the rapid filling phase relative to the total ventricular filling volume, was calculated. In a first study, the validity of the EIT method was assessed by comparison of the RAEV measured by EIT and MRI in a group of eight patients with severe COPD and seven control subjects. A second study was undertaken to assess the relation between RAEV and pulmonary artery pressure in a group of 27 patients measured by right-sided heart catheterization.

RESULTS

The correlation coefficient between RAEV measured with MRI and EIT was 0.78. The difference between RAEV measured by MRI and EIT was 8.3 +/- 15.7% (mean +/- SD) for the control subjects and 3.5 +/- 10.9% for the COPD patients. RAEV values measured by EIT and MRI were larger in the control group (47.1 +/- 7.6%) compared with the patient group (38.1 +/- 10.4%). There was a clear nonlinear relationship between RAEV and the pulmonary artery pressure (y = 315 x-0.64, r = 0.83, p < 0.001).

CONCLUSION

Our results indicate that RAEV measured by EIT is a useful noninvasive and inexpensive method for assessing right ventricular diastolic function in COPD patients.

Fast EIT data acquisition system with active electrodes and its application to cardiac imaging

A wide-band high-speed data acquisition system for electrical impedance tomography (EIT) is described. 32 active electrodes are used in the system, half of them as receive electrodes and the other half as drive electrodes. A buffer is mounted on the back of each receive electrode and a current source on each drive electrode. A multielectrode system with active electrodes was built to make it convenient to attach all the electrodes on the human thorax. The system is suitable for both dynamic imaging and multifrequency electrical impedance tomography (MFEIT). Its operating frequency can be chosen between 24 kHz and 400 kHz. Current is injected sequentially into 16 adjacent current electrode pairs and the 16 voltages between adjacent receive electrodes are measured for each current injection. ECG is collected to determine the relationship between the reconstructed images and cardiac activity. The collection of one frame of data is completed within 25 ms. The system has been successfully used for imaging the variation of conductivity distribution of the human thorax. The beat-by-beat cardiac-related change of conductivity distribution has been imaged by our system. The quasi-periodic variation of the impedance distribution can be seen from the image sequence with breath-holding.

Improvement of cardiac imaging in electrical impedance tomography by means of a new electrode configuration

Until now, electrical impedance tomography (EIT) has been used for cardiac imaging with the electrodes attached transversally at the level of the fourth intercostal space at the anterior side. However, the results obtained with this electrode configuration have been disappointing. The aim of the present study was to improve the measurement design of EIT for cardiac imaging. Therefore, magnetic resonance imaging (MRI) scans were analysed in two healthy subjects to determine the optimum anatomical plane in which atria and ventricles are clearly visually separated. From these findings, we proposed a new oblique plane at the level of the ictus cordis anteriorly and 10 cm higher posteriorly. EIT pictures obtained in the oblique plane revealed a better visual separation between the ventricles and atria than with the electrodes attached in the transverse plane. Comparison between volume changes measured by means of MRI and impedance changes in different regions of interest measured with EIT were performed with the electrodes in the proposed oblique plane. Ventricular and atrial volume changes measured by MRI show the same pattern as do impedance changes measured by EIT. Furthermore, we assessed the reproducibility and validity of the oblique electrode configuration in ten healthy mate volunteers during rest and during exercise compared with the currently used transverse electrode configuration. The reproducibility coefficient assessed from repeated measurements with the electrodes attached in the oblique plane was 0.98 at rest and 0.85 during exercise. For the transverse plane the reproducibility coefficient was 0.96 at rest and 0.66 during exercise. The well-known increase in stroke volume during exercise is 40% in healthy subjects. The increase in impedance change during exercise compared with rest was 34 +/- 13% (20-59%) for the oblique plane and 68 +/- 57% (13-140%) for the transverse plane. From these results we infer that the stroke volume is assessed more accurately by using the oblique plane. From these findings, we conclude that the oblique plane improved the cardiac measurements, because (i) a better spatial separation of the heart compartments is obtained, (ii) the results are more reliable and (iii) measurements during exercise are more accurate with the electrodes attached in an oblique plane.