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Sharma M, Brown AW, Powell NM, Rajaram N, Tong L, Mourani PM, Schootman M. Racial and skin color mediated disparities in pulse oximetry in infants and young children. Paediatr Respir Rev 2024; 50:62-72. [PMID: 38233229 PMCID: PMC11139570 DOI: 10.1016/j.prrv.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
Race-based and skin pigmentation-related inaccuracies in pulse oximetry have recently been highlighted in several large electronic health record-based retrospective cohort studies across diverse patient populations and healthcare settings. Overestimation of oxygen saturation by pulse oximeters, particularly in hypoxic states, is disparately higher in Black compared to other racial groups. Compared to adult literature, pediatric studies are relatively few and mostly reliant on birth certificates or maternal race-based classification of comparison groups. Neonates, infants, and young children are particularly susceptible to the adverse life-long consequences of hypoxia and hyperoxia. Successful neonatal resuscitation, precise monitoring of preterm and term neonates with predominantly lung pathology, screening for congenital heart defects, and critical decisions on home oxygen, ventilator support and medication therapies, are only a few examples of situations that are highly reliant on the accuracy of pulse oximetry. Undetected hypoxia, especially if systematically different in certain racial groups may delay appropriate therapies and may further perpetuate health care disparities. The role of biological factors that may differ between racial groups, particularly skin pigmentation that may contribute to biased pulse oximeter readings needs further evaluation. Developmental and maturational changes in skin physiology and pigmentation, and its interaction with the operating principles of pulse oximetry need further study. Importantly, clinicians should recognize the limitations of pulse oximetry and use additional objective measures of oxygenation (like co-oximetry measured arterial oxygen saturation) where hypoxia is a concern.
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Affiliation(s)
- Megha Sharma
- Department of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Research Institute, Little Rock, AR, United States.
| | - Andrew W Brown
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Nicholas M Powell
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Narasimhan Rajaram
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States; Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, United States
| | - Lauren Tong
- Clinical Library Services, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Peter M Mourani
- Arkansas Children's Research Institute, Little Rock, AR, United States; Department of Pediatrics, Division of Pediatric Critical Care, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mario Schootman
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Rodriguez AJ, Vasudevan S, Farahmand M, Weininger S, Vogt WC, Scully CG, Ramella-Roman J, Pfefer TJ. Tissue mimicking materials and finger phantom design for pulse oximetry. BIOMEDICAL OPTICS EXPRESS 2024; 15:2308-2327. [PMID: 38633081 PMCID: PMC11019708 DOI: 10.1364/boe.518967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
Pulse oximetry represents a ubiquitous clinical application of optics in modern medicine. Recent studies have raised concerns regarding the potential impact of confounders, such as variable skin pigmentation and perfusion, on blood oxygen saturation measurement accuracy in pulse oximeters. Tissue-mimicking phantom testing offers a low-cost, well-controlled solution for characterizing device performance and studying potential error sources, which may thus reduce the need for costly in vivo trials. The purpose of this study was to develop realistic phantom-based test methods for pulse oximetry. Material optical and mechanical properties were reviewed, selected, and tuned for optimal biological relevance, e.g., oxygenated tissue absorption and scattering, strength, elasticity, hardness, and other parameters representing the human finger's geometry and composition, such as blood vessel size and distribution, and perfusion. Relevant anatomical and physiological properties are summarized and implemented toward the creation of a preliminary finger phantom. To create a preliminary finger phantom, we synthesized a high-compliance silicone matrix with scatterers for embedding flexible tubing and investigated the addition of these scatterers to novel 3D printing resins for optical property control without altering mechanical stability, streamlining the production of phantoms with biologically relevant characteristics. Phantom utility was demonstrated by applying dynamic, pressure waveforms to produce tube volume change and resultant photoplethysmography (PPG) signals. 3D printed phantoms achieved more biologically relevant conditions compared to molded phantoms. These preliminary results indicate that the phantoms show strong potential to be developed into tools for evaluating pulse oximetry performance. Gaps, recommendations, and strategies are presented for continued phantom development.
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Affiliation(s)
- Andres J. Rodriguez
- Department of Biomedical Engineering, Florida International University, Miami. Florida, 33174, USA
| | - Sandhya Vasudevan
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Masoud Farahmand
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Sandy Weininger
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - William C. Vogt
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Christopher G. Scully
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Jessica Ramella-Roman
- Department of Biomedical Engineering, Florida International University, Miami. Florida, 33174, USA
| | - T. Joshua Pfefer
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA
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Ghauri MD, Šušnjar S, Guadagno CN, Bhattacharya S, Thomasson B, Swartling J, Gautam R, Andersson-Engels S, Konugolu Venkata Sekar S. Hybrid heterogeneous phantoms for biomedical applications: a demonstration to dosimetry validation. BIOMEDICAL OPTICS EXPRESS 2024; 15:863-874. [PMID: 38404353 PMCID: PMC10890852 DOI: 10.1364/boe.514994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/27/2024]
Abstract
Phantoms simultaneously mimicking anatomical and optical properties of real tissues can play a pivotal role for improving dosimetry algorithms. The aim of the paper is to design and develop a hybrid phantom model that builds up on the strengths of solid and liquid phantoms for mimicking various anatomical structures for prostate cancer photodynamic therapy (PDT) dosimetry validation. The model comprises of a photosensitizer-embedded gelatin lesion within a liquid Intralipid prostate shape that is surrounded by a solid silicone outer shell. The hybrid phantom was well characterized for optical properties. The final assembled phantom was also evaluated for fluorescence tomographic reconstruction in conjunction with SpectraCure's IDOSE software. The developed model can lead to advancements in dosimetric evaluations. This would improve PDT outlook as a clinical treatment modality and boost phantom based standardization of biophotonic devices globally.
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Affiliation(s)
- M. Daniyal Ghauri
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
- Department of Engineering and Food Sciences, University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - Stefan Šušnjar
- SpectraCure AB, Gasverksgatan 1, SE-222 29 Lund, Sweden
- Department of Physics, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden
| | - Claudia Nunzia Guadagno
- BioPixS Ltd – Biophotonics Standards, IPIC, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
| | - Somdatta Bhattacharya
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
| | | | | | - Rekha Gautam
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
| | - Stefan Andersson-Engels
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
- BioPixS Ltd – Biophotonics Standards, IPIC, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
- Department of Physics, University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - Sanathana Konugolu Venkata Sekar
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
- BioPixS Ltd – Biophotonics Standards, IPIC, Lee Maltings Complex, Dyke Parade, T12R5CP, Cork, Ireland
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