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Liu C, Liu H, Li Y, Xiao Z, Wang Y, Guo H, Luo J. Establishing a 4D-CT lung function related volumetric dose model to reduce radiation pneumonia. Sci Rep 2024; 14:12589. [PMID: 38824238 PMCID: PMC11144207 DOI: 10.1038/s41598-024-63251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
In order to study how to use pulmonary functional imaging obtained through 4D-CT fusion for radiotherapy planning, and transform traditional dose volume parameters into functional dose volume parameters, a functional dose volume parameter model that may reduce level 2 and above radiation pneumonia was obtained. 41 pulmonary tumor patients who underwent 4D-CT in our department from 2020 to 2023 were included. MIM Software (MIM 7.0.7; MIM Software Inc., Cleveland, OH, USA) was used to register adjacent phase CT images in the 4D-CT series. The three-dimensional displacement vector of CT pixels was obtained when changing from one respiratory state to another respiratory state, and this three-dimensional vector was quantitatively analyzed. Thus, a color schematic diagram reflecting the degree of changes in lung CT pixels during the breathing process, namely the distribution of ventilation function strength, is obtained. Finally, this diagram is fused with the localization CT image. Select areas with Jacobi > 1.2 as high lung function areas and outline them as fLung. Import the patient's DVH image again, fuse the lung ventilation image with the localization CT image, and obtain the volume of fLung different doses (V60, V55, V50, V45, V40, V35, V30, V25, V20, V15, V10, V5). Analyze the functional dose volume parameters related to the risk of level 2 and above radiation pneumonia using R language and create a predictive model. By using stepwise regression and optimal subset method to screen for independent variables V35, V30, V25, V20, V15, and V10, the prediction formula was obtained as follows: Risk = 0.23656-0.13784 * V35 + 0.37445 * V30-0.38317 * V25 + 0.21341 * V20-0.10209 * V15 + 0.03815 * V10. These six independent variables were analyzed using a column chart, and a calibration curve was drawn using the calibrate function. It was found that the Bias corrected line and the Apparent line were very close to the Ideal line, The consistency between the predicted value and the actual value is very good. By using the ROC function to plot the ROC curve and calculating the area under the curve: 0.8475, 95% CI 0.7237-0.9713, it can also be determined that the accuracy of the model is very high. In addition, we also used Lasso method and random forest method to filter out independent variables with different results, but the calibration curve drawn by the calibration function confirmed poor prediction performance. The function dose volume parameters V35, V30, V25, V20, V15, and V10 obtained through 4D-CT are key factors affecting radiation pneumonia. Establishing a predictive model can provide more accurate lung restriction basis for clinical radiotherapy planning.
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Affiliation(s)
- Chunmei Liu
- Department of Radiation Oncology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Huizhi Liu
- Department of Radiation Oncology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Yange Li
- Department of Radiation Oncology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Zhiqing Xiao
- Department of Radiation Oncology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Yanqiang Wang
- Department of Radiation Oncology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Han Guo
- Department of Radiation Oncology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Jianmin Luo
- Department of Hematology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, China.
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Reza MS, Jin L, Jeong YJ, Oh TI, Kim H, Kim KJ. Electrospun Rubber Nanofiber Web-Based Dry Electrodes for Biopotential Monitoring. SENSORS (BASEL, SWITZERLAND) 2023; 23:7377. [PMID: 37687833 PMCID: PMC10490276 DOI: 10.3390/s23177377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
This study aims to find base materials for dry electrode fabrication with high accuracy and without reducing electrode performance for long-term bioelectric potential monitoring after electroless silver plating. Most applications of dry electrodes that have been developed in the past few decades are restricted by low accuracy compared to commercial Ag/AgCl gel electrodes, as in our previous study of PVDF-based dry electrodes. In a recent study, however, nanoweb-based chlorinated polyisoprene (CPI) and poly(styrene-b-butadiene-b-styrene) (SBS) rubber were selected as promising candidates due to their excellent elastic properties, as well as their nanofibril nature, which may improve electrode durability and skin contact. The electroless silver plating technique was employed to coat the nanofiber web with silver, and silver nanoweb(AgNW)-based dry electrodes were fabricated. The key electrode properties (contact impedance, step response, and noise characteristics) for AgNW dry electrodes were investigated thoroughly using agar phantoms. The dry electrodes were subsequently tested on human subjects to establish their realistic performance in terms of ECG, EMG monitoring, and electrical impedance tomography (EIT) measurements. The experimental results demonstrated that the AgNW dry electrodes, particularly the SBS-AgNW dry electrodes, performed similarly to commercial Ag/AgCl gel electrodes and were outperformed in terms of long-term stability.
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Affiliation(s)
- Mohammad Shamim Reza
- Department of Advanced Materials Engineering for Information & Electronics, Kyung Hee University, Yongin 17104, Gyeonggi-do, Republic of Korea; (M.S.R.); (L.J.)
| | - Lu Jin
- Department of Advanced Materials Engineering for Information & Electronics, Kyung Hee University, Yongin 17104, Gyeonggi-do, Republic of Korea; (M.S.R.); (L.J.)
| | - You Jeong Jeong
- Department of Biomedical Engineering, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (Y.J.J.); (T.I.O.)
| | - Tong In Oh
- Department of Biomedical Engineering, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (Y.J.J.); (T.I.O.)
| | - Hongdoo Kim
- Department of Advanced Materials Engineering for Information & Electronics, Kyung Hee University, Yongin 17104, Gyeonggi-do, Republic of Korea; (M.S.R.); (L.J.)
| | - Kap Jin Kim
- Department of Advanced Materials Engineering for Information & Electronics, Kyung Hee University, Yongin 17104, Gyeonggi-do, Republic of Korea; (M.S.R.); (L.J.)
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Brabant O, Loroesch S, Adler A, Waldmann AD, Raisis A, Mosing M. Performance evaluation of electrode design and material for a large animal electrical impedance tomography belt. Vet Rec 2022; 191:e2184. [PMID: 36197754 DOI: 10.1002/vetr.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/14/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Electrical impedance tomography (EIT) produces lung ventilation images via a thoracic electrode belt. Robust electrode design and material, providing low electrode skin contact impedance (SCI), is needed in veterinary medicine. The aim of this study was to compare three EIT electrode designs and materials. METHODS Simulations of cylindrical, rectangular and spiked electrode designs were used to evaluate electrode SCI as a function of electrode size, where skin contact was uneven. Gold-plated washers (EGW ), zinc-plated rivets (EZR ) and zinc-galvanised spikes (EZS ) were assigned randomly on two interconnected EIT belts. Gel was applied to the cranial or caudal belt and placed on 17 standing cattle. SCI was recorded at baseline and 3, 5, 7, 9 and 11 minutes later. RESULTS Simulations that involved electrodes with a greater skin contact area had lower and more uniform SCI. In cattle, SCI decreased with all electrodes over time (p < 0.01). Without gel, no difference was found between EGW and EZS , while SCI was higher for EZR (p < 0.03). With gel, SCI was lower in EGW and EZR (p < 0.026), with the SCI in EGW being the lowest (p < 0.01). LIMITATIONS Low numbers of animals and static electrode position may affect SCI. CONCLUSIONS Electrode design is important for EIT measurement, with larger electrode designs able to compensate for the use of less conductive materials. Gel is not necessary to achieve acceptable SCI in large animals.
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Affiliation(s)
- Olivia Brabant
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Sarah Loroesch
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Andreas D Waldmann
- Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Anthea Raisis
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Martina Mosing
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
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Thoracic weighting of restrained subjects during exhaustion recovery causes loss of lung reserve volume in a model of police arrest. Sci Rep 2021; 11:15166. [PMID: 34385477 PMCID: PMC8361138 DOI: 10.1038/s41598-021-94157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/30/2021] [Indexed: 11/25/2022] Open
Abstract
Restraint asphyxia has been proposed as a mechanism for some arrest-related deaths that occur during or shortly after a suspect is taken into custody. Our analysis of the literature found that prone positioning, weight applied to the back, recovery after simulated pursuit, and restraint position have led to restrictive, but non life-threatening respiratory changes when tested in subsets. However, the combined effects of all four parameters have not been tested together in a single study. We hypothesized that a complete protocol with high-sensitivity instrumentation could improve our understanding of breathing physiology during weighted restraint. We designed an electrical impedance tomography (EIT)-based protocol for this purpose and measured the 3D distribution of ventilation within the thorax. Here, we present the results from a study on 17 human subjects that revealed FRC declines during weighted restrained recovery from exercise for subjects in the restraint postures, but not the control posture. These prolonged FRC declines were consistent with abdominal muscle recruitment to assist the inspiratory muscles, suggesting that subjects in restraint postures have increased work of breathing compared to controls. Upon removal of the weighted load, lung reserve volumes gradually increased for the hands-behind-the-head restraint posture but continued to decrease for subjects in the hands-behind-the-back restraint posture. We discuss the possible role this increased work of breathing may play in restraint asphyxia.
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Strodthoff N, Strodthoff C, Becher T, Weiler N, Frerichs I. Inferring Respiratory and Circulatory Parameters from Electrical Impedance Tomography With Deep Recurrent Models. IEEE J Biomed Health Inform 2021; 25:3105-3111. [PMID: 33577463 DOI: 10.1109/jbhi.2021.3059016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical impedance tomography (EIT) is a noninvasive imaging modality that allows a continuous assessment of changes in regional bioimpedance of different organs. One of its most common biomedical applications is monitoring regional ventilation distribution in critically ill patients treated in intensive care units. In this work, we put forward a proof-of-principle study that demonstrates how one can reconstruct synchronously measured respiratory or circulatory parameters from the EIT image sequence using a deep learning model trained in an end-to-end fashion. For this purpose, we devise an architecture with a convolutional feature extractor whose output is processed by a recurrent neural network. We demonstrate that one can accurately infer absolute volume, absolute flow, normalized airway pressure and within certain limitations even the normalized arterial blood pressure from the EIT signal alone, in a way that generalizes to unseen patients without prior calibration. As an outlook with direct clinical relevance, we furthermore demonstrate the feasibility of reconstructing the absolute transpulmonary pressure from a combination of EIT and absolute airway pressure, as a way to potentially replace the invasive measurement of esophageal pressure. With these results, we hope to stimulate further studies building on the framework put forward in this work.
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Thürk F, Elenkov M, Waldmann AD, Böhme S, Braun C, Adler A, Kaniusas E. Influence of reconstruction settings in electrical impedance tomography on figures of merit and physiological parameters. Physiol Meas 2019; 40:094003. [DOI: 10.1088/1361-6579/ab248e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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de Castro Martins T, Sato AK, de Moura FS, de Camargo EDLB, Silva OL, Santos TBR, Zhao Z, Möeller K, Amato MBP, Mueller JL, Lima RG, de Sales Guerra Tsuzuki M. A Review of Electrical Impedance Tomography in Lung Applications: Theory and Algorithms for Absolute Images. ANNUAL REVIEWS IN CONTROL 2019; 48:442-471. [PMID: 31983885 PMCID: PMC6980523 DOI: 10.1016/j.arcontrol.2019.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Electrical Impedance Tomography (EIT) is under fast development, the present paper is a review of some procedures that are contributing to improve spatial resolution and material properties accuracy, admitivitty or impeditivity accuracy. A review of EIT medical applications is presented and they were classified into three broad categories: ARDS patients, obstructive lung diseases and perioperative patients. The use of absolute EIT image may enable the assessment of absolute lung volume, which may significantly improve the clinical acceptance of EIT. The Control Theory, the State Observers more specifically, have a developed theory that can be used for the design and operation of EIT devices. Electrode placement, current injection strategy and electrode electric potential measurements strategy should maximize the number of observable and controllable directions of the state vector space. A non-linear stochastic state observer, the Unscented Kalman Filter, is used directly for the reconstruction of absolute EIT images. Historically, difference images were explored first since they are more stable in the presence of modelling errors. Absolute images require more detailed models of contact impedance, stray capacitance and properly refined finite element mesh where the electric potential gradient is high. Parallelization of the forward program computation is necessary since the solution of the inverse problem often requires frequent solutions of the forward problem. Several reconstruction algorithms benefit by the Bayesian inverse problem approach and the concept of prior information. Anatomic and physiologic information are used to form the prior information. An already tested methodology is presented to build the prior probability density function using an ensemble of CT scans and in vivo impedance measurements. Eight absolute EIT image algorithms are presented.
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Affiliation(s)
| | - André Kubagawa Sato
- Computational Geometry Laboratory, Escola Politécnica da Universidade de São Paulo, Brazil
| | - Fernando Silva de Moura
- Universidade Federal do ABC, Center of Engineering, Modeling and Applied Social Sciences, Brazil
| | | | - Olavo Luppi Silva
- Universidade Federal do ABC, Center of Engineering, Modeling and Applied Social Sciences, Brazil
| | | | - Zhanqi Zhao
- Institute of Technical Medicine, Furtwangen University, Germany
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Knut Möeller
- Institute of Technical Medicine, Furtwangen University, Germany
| | - Marcelo Brito Passos Amato
- Respiratory Intensive Care Unit, Pulmonary Division, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Jennifer L Mueller
- Department of Mathematics, and School of Biomedical Engineering, Colorado State University, United States of America
| | - Raul Gonzalez Lima
- Department of Mechanical Engineering, Escola Politécnica da Universidade de São Paulo, Brazil
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8
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Zhao Z, Yun PJ, Kuo YL, Fu F, Dai M, Frerichs I, Möller K. Comparison of different functional EIT approaches to quantify tidal ventilation distribution. Physiol Meas 2018; 39:01NT01. [DOI: 10.1088/1361-6579/aa9eb4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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Thürk F, Boehme S, Mudrak D, Kampusch S, Wielandner A, Prosch H, Braun C, Toemboel FPR, Hofmanninger J, Kaniusas E. Effects of individualized electrical impedance tomography and image reconstruction settings upon the assessment of regional ventilation distribution: Comparison to 4-dimensional computed tomography in a porcine model. PLoS One 2017; 12:e0182215. [PMID: 28763474 PMCID: PMC5538699 DOI: 10.1371/journal.pone.0182215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/16/2017] [Indexed: 01/17/2023] Open
Abstract
Electrical impedance tomography (EIT) is a promising imaging technique for bedside monitoring of lung function. It is easily applicable, cheap and requires no ionizing radiation, but clinical interpretation of EIT-images is still not standardized. One of the reasons for this is the ill-posed nature of EIT, allowing a range of possible images to be produced–rather than a single explicit solution. Thus, to further advance the EIT technology for clinical application, thorough examinations of EIT-image reconstruction settings–i.e., mathematical parameters and addition of a priori (e.g., anatomical) information–is essential. In the present work, regional ventilation distribution profiles derived from different EIT finite-element reconstruction models and settings (for GREIT and Gauss Newton) were compared to regional aeration profiles assessed by the gold-standard of 4-dimensional computed tomography (4DCT) by calculating the root mean squared error (RMSE). Specifically, non-individualized reconstruction models (based on circular and averaged thoracic contours) and individualized reconstruction models (based on true thoracic contours) were compared. Our results suggest that GREIT with noise figure of 0.15 and non-uniform background works best for the assessment of regional ventilation distribution by EIT, as verified versus 4DCT. Furthermore, the RMSE of anteroposterior ventilation profiles decreased from 2.53±0.62% to 1.67±0.49% while correlation increased from 0.77 to 0.89 after embedding anatomical information into the reconstruction models. In conclusion, the present work reveals that anatomically enhanced EIT-image reconstruction is superior to non-individualized reconstruction models, but further investigations in humans, so as to standardize reconstruction settings, is warranted.
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Affiliation(s)
- Florian Thürk
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
| | - Stefan Boehme
- Department of Anesthesia, Pain Management and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Mudrak
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
| | - Stefan Kampusch
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
| | - Alice Wielandner
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christina Braun
- Anesthesiology & Perioperative Intensive Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Frédéric P R Toemboel
- Department of Anesthesia, Pain Management and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Hofmanninger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
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11
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Yang L, Dai M, Xu C, Zhang G, Li W, Fu F, Shi X, Dong X. The Frequency Spectral Properties of Electrode-Skin Contact Impedance on Human Head and Its Frequency-Dependent Effects on Frequency-Difference EIT in Stroke Detection from 10Hz to 1MHz. PLoS One 2017; 12:e0170563. [PMID: 28107524 PMCID: PMC5249181 DOI: 10.1371/journal.pone.0170563] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/08/2017] [Indexed: 11/18/2022] Open
Abstract
Frequency-difference electrical impedance tomography (fdEIT) reconstructs frequency-dependent changes of a complex impedance distribution. It has a potential application in acute stroke detection because there are significant differences in impedance spectra between stroke lesions and normal brain tissues. However, fdEIT suffers from the influences of electrode-skin contact impedance since contact impedance varies greatly with frequency. When using fdEIT to detect stroke, it is critical to know the degree of measurement errors or image artifacts caused by contact impedance. To our knowledge, no study has systematically investigated the frequency spectral properties of electrode-skin contact impedance on human head and its frequency-dependent effects on fdEIT used in stroke detection within a wide frequency band (10 Hz-1 MHz). In this study, we first measured and analyzed the frequency spectral properties of electrode-skin contact impedance on 47 human subjects’ heads within 10 Hz-1 MHz. Then, we quantified the frequency-dependent effects of contact impedance on fdEIT in stroke detection in terms of the current distribution beneath the electrodes and the contact impedance imbalance between two measuring electrodes. The results showed that the contact impedance at high frequencies (>100 kHz) significantly changed the current distribution beneath the electrode, leading to nonnegligible errors in boundary voltages and artifacts in reconstructed images. The contact impedance imbalance at low frequencies (<1 kHz) also caused significant measurement errors. We conclude that the contact impedance has critical frequency-dependent influences on fdEIT and further studies on reducing such influences are necessary to improve the application of fdEIT in stroke detection.
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Affiliation(s)
- Lin Yang
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Meng Dai
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Canhua Xu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Ge Zhang
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Weichen Li
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xuetao Shi
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xiuzhen Dong
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
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12
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Frerichs I, Amato MBP, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, Bodenstein M, Gagnon H, Böhm SH, Teschner E, Stenqvist O, Mauri T, Torsani V, Camporota L, Schibler A, Wolf GK, Gommers D, Leonhardt S, Adler A. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax 2016; 72:83-93. [PMID: 27596161 PMCID: PMC5329047 DOI: 10.1136/thoraxjnl-2016-208357] [Citation(s) in RCA: 474] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/12/2016] [Accepted: 07/16/2016] [Indexed: 11/04/2022]
Abstract
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology.
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Affiliation(s)
- Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marcelo B P Amato
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - David G Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Zhanqi Zhao
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Bartłomiej Grychtol
- Fraunhofer Project Group for Automation in Medicine and Biotechnology PAMB, Mannheim, Germany
| | - Marc Bodenstein
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Hervé Gagnon
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | | | | | - Ola Stenqvist
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vinicius Torsani
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Australia
| | - Gerhard K Wolf
- Children's Hospital Traunstein, Ludwig Maximilian's University, Munich, Germany
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Steffen Leonhardt
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
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13
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Jin L, Kim KJ, Song EH, Ahn YJ, Jeong YJ, Oh TI, Woo EJ. Highly precise nanofiber web-based dry electrodes for vital signal monitoring. RSC Adv 2016. [DOI: 10.1039/c6ra00079g] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Dry electrodes have been prepared through silver-plating elastic TPU and SBS electrospun nanofiber webs to improve electrode accuracy. The results revealed that the new dry electrodes can exhibit performance comparable to Ag/AgCl gel electrode.
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Affiliation(s)
- L. Jin
- Department of Advanced Materials Engineering for Information & Electronics
- Kyung Hee University
- Yongin-si
- Korea
| | - K. J. Kim
- Department of Advanced Materials Engineering for Information & Electronics
- Kyung Hee University
- Yongin-si
- Korea
| | - E. H. Song
- Department of Advanced Materials Engineering for Information & Electronics
- Kyung Hee University
- Yongin-si
- Korea
| | - Y. J. Ahn
- Department of Advanced Materials Engineering for Information & Electronics
- Kyung Hee University
- Yongin-si
- Korea
| | - Y. J. Jeong
- Department of Biomedical Engineering
- School of Medicine
- Kyung Hee University
- Seoul
- Korea
| | - T. I. Oh
- Department of Biomedical Engineering
- School of Medicine
- Kyung Hee University
- Seoul
- Korea
| | - E. J. Woo
- Department of Biomedical Engineering
- School of Medicine
- Kyung Hee University
- Seoul
- Korea
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Becher T, Kott M, Schädler D, Vogt B, Meinel T, Weiler N, Frerichs I. Influence of tidal volume on ventilation inhomogeneity assessed by electrical impedance tomography during controlled mechanical ventilation. Physiol Meas 2015; 36:1137-46. [PMID: 26007294 DOI: 10.1088/0967-3334/36/6/1137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The global inhomogeneity (GI) index is a parameter of ventilation inhomogeneity that can be calculated from images of tidal ventilation distribution obtained by electrical impedance tomography (EIT). It has been suggested that the GI index may be useful for individual adjustment of positive end-expiratory pressure (PEEP) and for guidance of ventilator therapy. The aim of the present work was to assess the influence of tidal volume (VT) on the GI index values. EIT data from 9 patients with acute respiratory distress syndrome ventilated with a low and a high VT of 5 ± 1 (mean ± SD) and 9 ± 1 ml kg(-1) predicted body weight at a high and a low level of PEEP (PEEPhigh, PEEPlow) were analyzed. PEEPhigh and PEEPlow were set 2 cmH2O above and 5 cmH2O below the lower inflection point of a quasi-static pressure volume loop, respectively. The lower inflection point was identified at 8.1 ± 1.4 (mean ± SD) cmH2O, resulting in a PEEPhigh of 10.1 ± 1.4 and a PEEPlow of 3.1 ± 1.4 cmH2O. At PEEPhigh, we found no significant trend in GI index with low VT when compared to high VT (0.49 ± 0.15 versus 0.44 ± 0.09, p = 0.13). At PEEPlow, we found a significantly higher GI index with low VT compared to high VT (0.66 ± 0.19 versus 0.59 ± 0.17, p = 0.01). When comparing the PEEP levels, we found a significantly lower GI index at PEEPhigh both for high and low VT. We conclude that high VT may lead to a lower GI index, especially at low PEEP settings. This should be taken into account when using the GI index for individual adjustment of ventilator settings.
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Affiliation(s)
- T Becher
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, 24118 Kiel, Germany
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