Noninvasive Optical, Electrical, and Acoustic Methods of Total Hemoglobin Determination

Towards an Innovative Sensor in Smart Capsule for Aerial Drones for Blood and Blood Component Delivery

Aerial drone technology is currently being investigated worldwide for the delivery of blood components. Although it has been demonstrated to be safe, the delivered medical substances still need to be analyzed at the end of the flight mission to assess the level of haemolysis and pH prior to the use in a patient. This process can last up to 30 min and prevent the time saved using drone delivery. Our study aims to integrating an innovative sensor for the haemolysis and pH detection into the Smart Capsule, an already demonstrated technology capable of managing transfusion transport through drones. In the proposed scenario, the haemolysis is evaluated optically by a minilysis device using LED-photodetector combination. The preliminary validation has been demonstrated for both the thermal stability of the Smart Capsule and the haemolysis detection of the minilysis device prototype. Firstly, the onboard temperature test has shown that the delivery system is capable of maintaining proper temperature, even though the samples have been manipulated to reach a higher temperature before inserting into the Smart Capsule. Then, in the laboratory haemolysis test, the trend of linear regression between the outputs from the spectrophotometer and the minilysis prototype confirmed the concept design of the minilysis device.

Progressive evaluation in spectroscopic sensors for non-invasive blood haemoglobin analysis - a review

Frequent monitoring of haemoglobin concentration is highly recommended by physicians to diagnose anaemia and polycythemia Vera. Moreover, Some other conditions also demand assessment of haemoglobin, and these conditions are blood loss, before blood donation, during pregnancy, preoperative, perioperative and postoperative conditions. Cyanmethaemoglobin/haemiglobincyanide method, portable haemoglobinometers and haematology analyzers are few standard methods to diagnose mentioned ailments. However, discomfort, delay and risk of infection are typical limitations of traditional measuring solutions. These limitations create the necessity to develop a non-invasive haemoglobin monitoring technique for a better lifestyle. Various methods and products are already developed and popular due to their non-invasiveness; however, invasive solutions are still considered as the reference standard method. Therefore, this review summarizes the attributes of existing non-invasive solutions. These attributes are finalized as brief details, accuracy, optimal benefits, and research challenges for exploring potential gaps, advancements and possibilities to consider as futuristic alternative methodologies. Non-invasive total haemoglobin assessing techniques are mainly based on optical spectroscopy (reflectance/transmittance) or digital photography or spectroscopic imaging in spot check/continuous monitoring mode. In all these techniques, we have noticed that there is a need to consider different light conditions, motion artefacts, melanocytes, other blood constituents, smoking and precise fixing of the sensor from the sensing spot for exact formulation. Moreover, based on careful and critical analysis of outcomes, none of these techniques or products is used independently or intended to replace invasive laboratory testing. Therefore there is a requirement for a more accurate technique that can eliminate the requirement of blood samples and likely end up as a reference standard method.

Emerging point-of-care technologies for anemia detection

Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.

Optical density based quantification of total haemoglobin concentrations with spectroscopic optical coherence tomography

Spectroscopic optical coherence tomography (sOCT) has emerged as a new possibility for non-invasive quantification of total haemoglobin concentrations [tHb]. Recently, we demonstrated that [tHb] measured in ex-vivo human whole-blood with a conventional sOCT system achieves a precision of 9.10 g/dL with a bias of 1.50 g/dL. This precision improved by acquiring data with a combination of focus tracking and zero-delay acquisition (FZA) that compensated for experimental limitations, increasing to 3.80 g/dL with a bias of 1.50 g/dL. Nevertheless, sOCT precision should improve at least to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim 2$$\end{document}∼2 g/dL to be clinically relevant. Therefore, sOCT-based [tHb] determinations require the development of new analysis methods that reduce the variability of [tHb] estimations. In this work, we aim to increase sOCT precision by retrieving the [tHb] content from a numerical optimisation of the optical density (OD), while considering the blood absorption flattening effect. The OD-based approach simplifies previous two-step Lambert–Beer fitting approaches to a single step, thereby reducing errors during the fitting procedure. We validated our model with ex-vivo [tHb] measurements on flowing whole-blood samples in the clinical range (7–23 g/dL). Our results show that, with the new model, conventional sOCT can determine [tHb] with a precision of 3.09 g/dL and a bias of 0.86 g/dL compared to a commercial blood analyser. We present further precision improvement by combining the OD methodology with FZA, leading to a precision of 2.08 g/dL with a bias of 0.46 g/dL.

Smartphone-Enabled Paper-Based Hemoglobin Sensor for Extreme Point-of-Care Diagnostics

We report a simple, affordable (∼0.02 US $/test), rapid (within 5 min), and quantitative paper-based sensor integrated with smartphone application for on-spot detection of hemoglobin (Hgb) concentration using approximately 10 μL of finger-pricked blood. Quantitative analytical colorimetry is achieved via an Android-based application (Sens-Hb), integrating key operational steps of image acquisition, real-time analysis, and result dissemination. Further, feedback from the machine learning algorithm for adaptation of calibration data offers consistent dynamic improvement for precise predictions of the test results. Our study reveals a successful deployment of the extreme point-of-care test in rural settings where no infrastructural facilities for diagnostics are available. The Hgb test device is validated both in the controlled laboratory environment (n = 200) and on the field experiments (n = 142) executed in four different Indian villages. Validation results are well correlated with the pathological gold standard results (r = 0.9583) with high sensitivity and specificity for the healthy (n = 136) (>11 g/dL) (specificity: 97.2%), mildly anemic (n = 55) (<11 g/dL) (sensitivity: 87.5%, specificity: 100%), and severely anemic (n = 9) (<7 g/dL) (sensitivity: 100%, specificity: 100%) samples. Results from field trials reveal that only below 5% cases of the results are interpreted erroneously by classifying mildly anemic patients as healthy ones. On-field deployment has unveiled the test kit to be extremely user friendly that can be handled by minimally trained frontline workers for catering the needs of the underserved communities.

Acquiring photoacoustic signature of hematocrit variation from plexus layer of in-silico human skin phantom

Optical penetration inside human skin is constrained by the wavelength dependent scattering and absorption losses by tissue microstructure and chromophores. This computational study investigates whether the signature of hematocrit variation from plexus i.e., the first skin layer having very small blood volume percentage distributed in capillary vessels, is retained by the detected photoacoustic response. Thein-silicoskin phantom is irradiated by a light source equivalent to a small footprint and low power (below 5 W) continuous wave LASER diode. As the low fluence can be compensated by exploiting strong absorption by targeted chromophores (hemoglobin molecules), an irradiation of wavelength 405 nm has been used to generate detectable pressure from capillary blood vessels of plexus. Optical energy deposition inside the tissue has been modelled using Monte Carlo technique and the pressure wave is computed using k-wave. It is found that with the increase in hematocrit from 10% to 50%, photoacoustic amplitude monotonically increases and gets almost doubled. The increment is about 30% in the range of hematocrit of physiological interest (from 30% to 50%).The variation follows a quadratic relationship for the entire hematocrit range. This photoacoustic signature of hematocrit variation has further been validated against minimum detectable pressure (800 Pa). This numerical model is expected to be an important basis to realize the idea of low cost small footprintin-vivophotoacoustic hematocrit measurement device.

Noninvasive Blood and Tissue Analysis: Raman Spectroscopy, One Perspective for Monitoring of Glucose and Beyond

Noninvasive in vivo blood and tissue analysis remains a challenge to medical technology epitomized by the ongoing quest to replace fingerstick self-monitoring of blood glucose. Recent developments warrant comment on near-term prospects for using Raman spectroscopy to meet that challenge. These developments combined with 20 years of experimentation with noninvasive blood and tissue analysis suggest that it may be possible and practical to perform noninvasive in vivo glucose analysis with improvements in (1) the enabling technologies for making Raman measurements and (2) an underlying anatomical-physiological model of how in vivo spectroscopic measurements are made and interpreted. We review the substantial progress made toward meeting the challenge and the personal, public health, and economic implications of these ongoing efforts.

An Optimizing Dynamic Spectrum Differential Extraction Method for Noninvasive Blood Component Analysis

Dynamic spectra (DS) can greatly reduce the influence of individual differences and the measurement environment by extracting the absorbance of pulsating blood at multiple wavelengths, and it is expected to achieve noninvasive detection of blood components. Extracting high-quality DS is the prerequisite for improving detection accuracy. This paper proposed an optimizing differential extraction method in view of the deficiency of existing extraction methods. In the proposed method, the sub-dynamic spectrum (sDS) is composed by sequentially extracting the absolute differences of two sample points corresponding to the height of the half peak on the two sides of the lowest point in each period of the logarithm photoplethysmography signal. The study was based on clinical trial data from 231 volunteers. Single-trial extraction method, original differential extraction method, and optimizing differential extraction method were used to extract DS from the volunteers' experimental data. Partial least squares regression (PLSR) and radial basis function (RBF) neural network were used for modeling. According to the effect of PLSR modeling, by extracting DS using the proposed method, the correlation coefficient of prediction set (R_p) has been improved by 17.33% and the root mean square error of prediction set has been reduced by 7.10% compared with the original differential extraction method. Compared with the single-trial extraction method, the correlation coefficient of calibration set (R_c) has increased from 0.747659 to 0.8244, with an increase of 10.26%, while the correlation coefficient of prediction set (R_p) decreased slightly by 3.22%, much lower than the increase of correction set. The result of the RBF neural network modeling also shows that the accuracy of the optimizing differential method is better than the other two methods both in calibration set and prediction set. In general, the optimizing differential extraction method improves the data utilization and credibility compared with the existing extraction methods, and the modeling effect is better than the other two methods.

Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation

BACKGROUND

Calculation of cardiovascular magnetic resonance (CMR) extracellular volume (ECV) requires input of hematocrit, which may not be readily available. The purpose of this study was to evaluate the diagnostic accuracy of ECV calculated using various noninvasive measures of hematocrit compared to ECV calculated with input of laboratory hematocrit as the reference standard.

METHODS

One hundred twenty three subjects (47.7 ± 14.1 years; 42% male) were prospectively recruited for CMR T1 mapping between August 2016 and April 2017. Laboratory hematocrit was assessed by venipuncture. Noninvasive hematocrit was assessed with a point-of-care (POC) device (Pronto-7® Pulse CO-Oximeter®, Masimo Personal Health, Irvine, California, USA) and by synthetic derivation based on the relationship with blood pool T1 values. Left ventricular ECV was calculated with input of laboratory hematocrit (Lab-ECV), POC hematocrit (POC-ECV), and synthetic hematocrit (synthetic-ECV), respectively. Statistical analysis included Wilcoxon signed-rank test, Bland-Altman analysis, receiver-operating curve analysis and intra-class correlation (ICC).

RESULTS

There was no significant difference between Lab-ECV and POC-ECV (27.1 ± 4.7% vs. 27.3 ± 4.8%, p = 0.106), with minimal bias and modest precision (bias - 0.18%, 95%CI [- 2.85, 2.49]). There was no significant difference between Lab-ECV and synthetic-ECV (26.7 ± 4.4% vs. 26.5 ± 4.3%, p = 0.084) in subjects imaged at 1.5 T, although bias was slightly higher and limits of agreement were wider (bias 0.23%, 95%CI [- 2.82, 3.27]). For discrimination of abnormal Lab-ECV ≥30%, POC-ECV had good diagnostic performance (sensitivity 85%, specificity 96%, accuracy 94%, and AUC 0.902) and synthetic-ECV had moderate diagnostic performance (sensitivity 71%, specificity 98%, accuracy 93%, and AUC 0.849). POC-ECV had excellent test-retest (ICC 0.994, 95%CI[0.987, 0.997]) and inter-observer agreement (ICC 0.974, 95%CI[0.929, 0.991]).

CONCLUSIONS

Myocardial ECV can be accurately and reproducibly calculated with input of hematocrit measured using a noninvasive POC device, potentially overcoming an important barrier to implementation of ECV. Further evaluation of synthetic ECV is required prior to clinical implementation.

Noninvasive hemoglobin measurement using dynamic spectrum

Spectroscopy methods for noninvasive hemoglobin (Hgb) measurement are interfered by individual difference and particular weak signal. In order to address these problems, we have put forward a series of improvement methods based on dynamic spectrum (DS), including instrument design, spectrum extraction algorithm, and modeling approach. The instrument adopts light sources composed of eight laser diodes with the wavelength range from 600 nm to 1100 nm and records photoplethysmography signals at eight wavelengths synchronously. In order to simplify the optical design, we modulate the light sources with orthogonal square waves and design the corresponding demodulation algorithm, instead of adopting a beam-splitting system. A newly designed algorithm named difference accumulation has been proved to be effective in improving the accuracy of dynamic spectrum extraction. 220 subjects are involved in the clinical experiment. An extreme learning machine calibration model between the DS data and the Hgb levels is established. Correlation coefficient and root-mean-square error of prediction sets are 0.8645 and 8.48 g/l, respectively. The results indicate that the Hgb level can be derived by this approach noninvasively with acceptable precision and accuracy. It is expected to achieve a clinic application in the future.

A systematic review of human and veterinary applications of noninvasive tissue oxygen monitoring

OBJECTIVE

To describe the methodology for and utilization of tissue oxygen monitoring by near infrared spectroscopy, and to review the current literature on the use of this monitoring modality in human and veterinary settings.

DATA SOURCES

Scientific reviews and original research found using the PubMed and CAB Abstract search engines with the following keywords: "tissue oxygen monitoring," "near-infrared tissue spectroscopy," and "tissue oxygen saturation (StO2 )."

HUMAN DATA SYNTHESIS

Tissue oxygen monitors have been evaluated in a wide variety of human clinical applications including trauma and triage, surgery, sepsis, and septic shock, and early goal-directed therapy. StO2 more rapidly identifies occult shock in human patients compared to traditional methods, which can lead to earlier intervention in these patients.

VETERINARY DATA SYNTHESIS

Veterinary studies involving tissue oxygen monitoring are limited, but the technology may have utility for identification of hemorrhagic shock earlier than changes in base excess, blood lactate concentration, or other traditional perfusion parameters.

CONCLUSION

Tissue oxygen monitoring is most commonly performed utilizing a noninvasive, portable monitor, which provides real-time, continuous, repeatable StO2 measurements. A decline in StO2 is an early indicator of shock in both human and veterinary patients. Low StO2 values in human patients are associated with increased morbidity, mortality, and length of hospitalization, as well as the development of multiple organ system dysfunction and surgical site infections.

Fluorescent probes concentration estimation in vitro and ex vivo as a model for early detection of Alzheimer's disease

The pathogenic process of Alzheimer's disease (AD) begins years before clinical diagnosis. Here, we suggest a method that may detect AD several years earlier than current exams. The method is based on previous reports that relate the concentration ratio of biomarkers (amyloid-beta and tau) in the cerebrospinal fluid (CSF) to the development of AD. Our method replaces the lumbar puncture process required for CSF drawing by using fluorescence measurements. The system uses an optical fiber coupled to a laser source and a detector. The laser radiation excites two fluorescent probes which may bond to the CSF biomarkers. Their concentration ratio is extracted from the fluorescence intensities and can be used for future AD detection. First, we present a theoretical model for fluorescence concentration ratio estimation. The method's feasibility was validated using Monte Carlo simulations. Its accuracy was then tested using multilayered tissue phantoms simulating the epidural fat, CSF, and bone. These phantoms have various optical properties, thicknesses, and fluorescence concentrations in order to simulate human anatomy variations and different fiber locations. The method was further tested using ex vivo chicken tissue. The average errors of the estimated concentration ratios were low both in vitro (4.4%) and ex vivo (10.9%), demonstrating high accuracy.

Disposable platform provides visual and color-based point-of-care anemia self-testing

BACKGROUND

Anemia, or low blood hemoglobin (Hgb) levels, afflicts 2 billion people worldwide. Currently, Hgb levels are typically measured from blood samples using hematology analyzers, which are housed in hospitals, clinics, or commercial laboratories and require skilled technicians to operate. A reliable, inexpensive point-of-care (POC) Hgb test would enable cost-effective anemia screening and chronically anemic patients to self-monitor their disease. We present a rapid, stand-alone, and disposable POC anemia test that, via a single drop of blood, outputs color-based visual results that correlate with Hgb levels.

METHODS

We tested blood from 238 pediatric and adult patients with anemia of varying degrees and etiologies and compared hematology analyzer Hgb levels with POC Hgb levels, which were estimated via visual interpretation using a color scale and an optional smartphone app for automated analysis.

RESULTS

POC Hgb levels correlated with hematology analyzer Hgb levels (r = 0.864 and r = 0.856 for visual interpretation and smartphone app, respectively), and both POC test methods yielded comparable sensitivity and specificity for detecting any anemia (n = 178) (<11 g/dl) (sensitivity: 90.2% and 91.1%, specificity: 83.7% and 79.2%, respectively) and severe anemia (n = 10) (<7 g/dl) (sensitivity: 90.0% and 100%, specificity: 94.6% and 93.9%, respectively).

CONCLUSIONS

These results demonstrate the feasibility of this POC color-based diagnostic test for self-screening/self-monitoring of anemia.

TRIAL REGISTRATION

Not applicable.

FUNDING

This work was funded by the FDA-funded Atlantic Pediatric Device Consortium, the Georgia Research Alliance, Children's Healthcare of Atlanta, the Georgia Center of Innovation for Manufacturing, and the InVenture Prize and Ideas to Serve competitions at the Georgia Institute of Technology.

Combined reflectance spectroscopy and stochastic modeling approach for noninvasive hemoglobin determination via palpebral conjunctiva

A combination of stochastic photon propagation model in a multilayered human eyelid tissue and reflectance spectroscopy was used to study palpebral conjunctiva spectral reflectance for hemoglobin (Hgb) determination. The developed model is the first biologically relevant model of eyelid tissue, which was shown to provide very good approximation to the measured spectra. Tissue optical parameters were defined using previous histological and microscopy studies of a human eyelid. After calibration of the model parameters the responses of reflectance spectra to Hgb level and blood oxygenation variations were calculated. The stimulated reflectance spectra in adults with normal and low Hgb levels agreed well with experimental data for Hgb concentrations from 8.1 to 16.7 g/dL. The extracted Hgb levels were compared with in vitro Hgb measurements. The root mean square error of cross-validation was 1.64 g/dL. The method was shown to provide 86% sensitivity estimates for clinically diagnosed anemia cases. A combination of the model with spectroscopy measurements provides a new tool for noninvasive study of human conjunctiva to aid in diagnosing blood disorders such as anemia.

Parkinson's disease-associated melanin steal

Urinary dopamine fluctuations in the competitive inhibition state were first documented in 2009. At that time, it was noted that progressively higher daily dosing values of L-tyrosine decreased the magnitude of these fluctuations. While extensive statistical analysis has been performed by the authors since 2004, it was not until 2012 that a plausible explanation was formulated. In the process, correlations with L-tyrosine administration and the on/off effect of Parkinson's disease were defined. This paper documents the current knowledge with regard to the management of retrograde phase 1 dopamine fluctuations and investigates the hypothesis that they are caused by a melanin steal phenomenon.

Evaluation of a new nonnvasive device in determining hemoglobin levels in emergency department patients

INTRODUCTION

The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device's estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED) patients.

METHODS

We conducted a prospective, observational, cross-sectional study of adult patients presenting to the ED. The subjects consisted of a convenience sample of adult ED patients who required a complete blood count as part of their care in the ED. A simultaneous probe hemoglobin was obtained and recorded.

RESULTS

Bias between probe and laboratory hemoglobin measurements was -0.5 (95% confidence interval, - 0.8 to -0.1) but this was not statistically significant from 0 (t 0.05,124 = 0.20, P > 0.5). The limits of agreement were -4.7 and 3.8, beyond the clinically relevant standard of equivalency of ± 1 g/dL.

CONCLUSION

These data suggest that noninvasive hemoglobin determination is not sufficiently accurate for emergency department use.

The current status of continuous noninvasive measurement of total, carboxy, and methemoglobin concentration

Intraoperative early detection of anemia, identifying toxic levels of carboxyhemoglobin after carbon monoxide exposure and titrating drug dosage to prevent toxic levels of methemoglobin are important goals. The pulse oximeter works by illuminating light into the tissue and sensing the amount of light absorbed. The same methodology is used by laboratory hemoglobinometers to measure hemoglobin concentration. Because both devices work in the same way, efforts were made to modify the pulse oximeter to also measure hemoglobin concentration. Currently there are 2 commercial pulse oximeters (Masimo Rainbow SET and OrSense NBM-200MP) that measure total hemoglobin concentration and one (Masimo) that also measures methemoglobin and carboxyhemoglobin. In this review, we describe the peer-reviewed literature addressing the accuracy of these monitors.

Continuous noninvasive hemoglobin monitoring during complex spine surgery

BACKGROUND

Monitoring hemoglobin levels in the operating room currently requires repeated blood draws, several steps, and a variable time delay to receive results. Consequently, blood transfusion management decisions may be delayed or made before hemoglobin results become available. The ability to measure hemoglobin continuously and noninvasively may enable a more rapid assessment of a patient's condition and more appropriate blood management. A new technology, Pulse CO-Oximetry, provides a continuous, noninvasive estimate of hemoglobin concentration (SpHb) from a sensor placed on the finger. We evaluated the accuracy of SpHb compared with laboratory CO-Oximetry measurements of total hemoglobin (tHb) during complex spine procedures in patients at high risk for blood loss.

METHODS

Patients eligible for the study were undergoing complex spine surgery with planned invasive arterial or central venous monitoring and hourly blood draws for hemoglobin measurement. During each surgery, blood samples were obtained hourly (or more often if clinically indicated) and analyzed by the central laboratory with CO-Oximetry, a standard method of hemoglobin measurement in many hospitals. The tHb measurements were compared with SpHb obtained at the time of the blood draw.

RESULTS

Twenty-nine patients were included in the study. The tHb values ranged from 6.9 to 13.9 g/dL, and the SpHb values ranged from 6.9 to 13.4 g/dL. A total of 186 data pairs (tHb/SpHb) were analyzed; after removal of SpHb readings with low signal quality, the bias (defined as the difference between SpHb and tHb) and precision (defined as 1 SD of the bias) were -0.1 g/dL ± 1.0 g/dL for the remaining 130 data pairs. Bland-Altman analysis showed good agreement of SpHb to tHb values over the range of values; limits of agreement were -2.0 to 1.8 g/dL. The absolute bias and precision were 0.8 ± 0.6 g/dL.

CONCLUSIONS

Continuous, noninvasive hemoglobin measurement via Pulse CO-Oximetry demonstrated clinically acceptable accuracy of hemoglobin measurement within 1.5 g/dL compared with a standard laboratory reference device when used during complex spine surgery. This technology may provide more timely information on hemoglobin status than intermittent blood sample analysis and thus has the potential to improve blood management during surgery.

A restoration framework for ultrasonic tissue characterization

Ultrasonic tissue characterization has become an area of intensive research. This procedure generally relies on the analysis of the unprocessed echo signal. Because the ultrasound echo is degraded by the non-ideal system point spread function, a deconvolution step could be employed to provide an estimate of the tissue response that could then be exploited for a more accurate characterization. In medical ultrasound, deconvolution is commonly used to increase diagnostic reliability of ultrasound images by improving their contrast and resolution. Most successful algorithms address deconvolution in a maximum a posteriori estimation framework; this typically leads to the solution of l(2)-norm or (1)-norm constrained optimization problems, depending on the choice of the prior distribution. Although these techniques are sufficient to obtain relevant image visual quality improvements, the obtained reflectivity estimates are, however, not appropriate for classification purposes. In this context, we introduce in this paper a maximum a posteriori deconvolution framework expressly derived to improve tissue characterization. The algorithm overcomes limitations associated with standard techniques by using a nonstandard prior model for the tissue response. We present an evaluation of the algorithm performance using both computer simulations and tissue-mimicking phantoms. These studies reveal increased accuracy in the characterization of media with different properties. A comparison with state-of-the-art Wiener and l(1)-norm deconvolution techniques attests to the superiority of the proposed algorithm.

Analyzing near-infrared scattering from human skin to monitor changes in hematocrit

Probing tissue with near-infrared radiation (NIR) simultaneously produces remitted fluorescence and Raman scattering (IE) plus Rayleigh∕Mie light scattering (EE) that noninvasively give chemical and physical information about the materials and objects within. We model tissue as a three-phase system: plasma and red blood cell (RBC) phases that are mobile and a static tissue phase. In vivo, any volume of tissue naturally experiences spatial and temporal fluctuations of blood plasma and RBC content. Plasma and RBC fractions may be discriminated from each other on the basis of their physical, chemical, and optical properties. Thus, IE and EE from NIR probing yield information about these fractions. Assuming there is no void volume in viable tissue, or that void volume is constant, changes in plasma and RBC volume fractions may be calculated from simultaneous measurements of the two observables, EE and IE. In a previously published analysis we showed the underlying phenomenology but did not provide an algorithm for calculating volume fractions from experimental data. Now, we present a simple analysis that allows monitoring of fluid fraction and hematocrit (Hct) changes by measuring IE and EE, and apply it to some experimental in vivo measurements.

pH-induced shift in hemoglobin spectra: a spectrophotometeric comparison of atlantic cod ( Gadus morhua ) and mammalian hemoglobin

Due to a pH-sensitive effect in many fish hemoglobins (Hb), analytical errors may occur when mammalian Hb is used as a standard in quantitative spectrophotometric multicomponent analysis of fish blood. The aim of this work was to examine differences in the optical spectra of mammalian (human) and fish (farmed Atlantic cod) Hb subjected to pH 7.4 and 6.5. The absorption spectra of the common derivatives, deoxy- (HHb), oxy- (OHb), carboxy- (COHb), and methemoglobin (metHb), were determined in the spectral range of 450-700 nm. The metHb spectra of fish differed considerably from the corresponding human Hb spectra, whereas only minor differences in OHb, HHb, and COHb were found. Cod Hb was significantly (P < 0.05) influenced by a drop in pH compared to mammalian Hb. This resulted in deoxygenation of the Hb and increased autoxidation. For human Hb, a pH-independent isosbestic point in the spectra of OHb, HHb, and metHb at 523 nm was found. This isosbestic point was not found in the absorption spectra of cod Hb. In conclusion, spectra of cod metHb and human metHb behave differently. This must thus be taken into account in spectrophotometric multicomponent analysis. Ideally, Hb in muscle or blood should be determined by comparison to a standard made from the same species.

Correspondence of Hemoglobin Values Obtained by a Noninvasive, Cutaneous-Contact Method with Values Obtained by Conventional Methods from Whole Blood Samples in a Guatemalan Field Setting

Background

Anemia is a widespread public health issue, conventionally diagnosed by analyzing the hemoglobin concentration in whole blood samples. Aspects of safety, comfort, and cultural acceptability would be obviated if reliable, noninvasive anemia screening were available.

Objective

To determine day-to-day variations within subjects in hemoglobin measurements and the correspondence of hemoglobin values obtained by a noninvasive, photometric, cutaneous-contact method with values obtained by conventional methods from blood samples.

Methods

The hemoglobin level was determined in 40 pregnant women from the Guatemalan coastal plain (low values) and 40 men from the highlands (high values). Hemoglobin concentrations (g/dl) were measured in an automated cell counter and, in parallel, estimated with the use of the Rad-87™ Rainbow pulse CO-Oximeter placed over the nail bed of the ring finger.

Results

The mean value for invasively determined hemoglobin was 13.5 g/dl, as compared with 12.2 and 12.1 g/dl for the noninvasive nail-bed estimate at 10 and 5 minutes, respectively. Measurements using the noninvasive technology were highly stable within days and from day to day. The noninvasive screening method showed satisfactory sensitivity and specificity at hemoglobin concentrations of < 12.0 g/dl (cutoff value for nonpregnant women) and < 13.0 g/dl (cutoff value for adult men). Diagnostic discrimination was poorer for the lower cutoff criteria; the anemia cutoff values were < 11.5 g/dl for school-age children and < 11.0 g/dl for pregnant women and children under 5 years of age.

Conclusions

Noninvasive hemoglobin screening shows considerable promise, although improvement of sensitivity and specificity in the anemic range and determination periods of less than 10 minutes are desirable.

Noninvasive monitoring of tissue hemoglobin using UV-VIS diffuse reflectance spectroscopy: a pilot study

We conducted a pilot study on 10 patients undergoing general surgery to test the feasibility of diffuse reflectance spectroscopy in the visible wavelength range as a noninvasive monitoring tool for blood loss during surgery. Ratios of raw diffuse reflectance at wavelength pairs were tested as a first-pass for estimating hemoglobin concentration. Ratios can be calculated easily and rapidly with limited post-processing, and so this can be considered a near real-time monitoring device. We found the best hemoglobin correlations were when ratios at isosbestic points of oxy- and deoxyhemoglobin were used, specifically 529/500 nm. Baseline subtraction improved correlations, specifically at 520/509 nm. These results demonstrate proof-of-concept for the ability of this noninvasive device to monitor hemoglobin concentration changes due to surgical blood loss. The 529/500 nm ratio also appears to account for variations in probe pressure, as determined from measurements on two volunteers.