Monitoring Pleural Effusion in Elderly Patients Using Internal Thoracic Impedance

BACKGROUND

Internal thoracic impedance (ITI) measurement is a sensitive method for detecting preclinical pulmonary edema and pleural effusion.

OBJECTIVES

To investigate the efficacy of this non-invasive method for detecting early pleural effusion among geriatric patients and to monitor increased ITI during its resolution.

METHODS

This prospective, controlled study was conducted between July 2012 and August 2015. The study comprised 70 patients aged 65 to 94 years; and 39 of the patients had pleural effusion. ITI was measured continuously with a RS-207 monitor. The predictive value of ITI monitoring was determined based on a total of eight measurements taken at 12-hour intervals over 84 hours.

RESULTS

As a result of medical treatment, the median ITI of the study group increased from 31 (interquartile range [IQR] 28-33 ohms) to 41 ohms (IQR 38-41 ohms; P < 0.001) compared to non-significant changes in the control group. Average respiratory rate (per minute) in the study group decreased from 29 (IQR 28-34) to 19 (IQR 18-20).

CONCLUSIONS

ITI monitoring is efficient for diagnosis and for ongoing clinical evaluation of the treatment of elderly patients with pleural effusion. Timely treatment may prevent serious complications of effusions avoiding extended hospitalization.

Agreement Between 2 Segmental Bioimpedance Devices, BOD POD, and DXA in Obese Adults

This study examined the agreement between 2 segmental bioimpedance analysis (BIA) devices, air displacement plethysmography (BOD POD), and dual energy X-ray absorptiometry (DXA) for estimating body composition in obese adults. Fifty obese adults (25 men and 25 women; age = 34.20 ± 11.19 years; BMI = 36.14 ± 5.33 kg/m²) had their body fat percentage (BF%) and fat-free mass (FFM) evaluated with 2 segmental BIA devices (InBody 230 and InBody 720), BOD POD, and DXA (Lunar iDXA). Body composition via the BOD POD was determined using the Siri equation whereas manufacturer-based equations generated metrics (ie, BF% and FFM) for the InBody devices. The effect size of the mean differences for all BF% and FFM comparisons were trivial (Cohen's d < 0.20). The standard error of estimate (SEE), total error (TE), and 95% limits of agreement (LOAs) were low for both segmental BIA devices when compared to DXA (SEE < 2.26% and 2.35 kg; TE < 2.58% and 2.66 kg; 95% LOAs < ± 4.94% and 4.86kg). The error for BOD POD was also low when compared to DXA (SEE = 2.39% and 2.57 kg; TE = 2.34% and 2.56 kg; 95% LOAs = 4.63% and 5.06 kg). Validity statistics were slightly higher, but considered acceptable, when comparing the segmental BIA devices against BOD POD (SEE < 3.37% and 3.63 kg; TE < 3.44% and 3.79 kg; 95% LOAs < ± 6.62% and 7.19 kg). Lastly, the 2 segmental BIA devices produced nearly identical validity statistics when compared to each other. However, both BIA devices revealed proportional bias for BF% and FFM when compared to the BOD POD and DXA (all p < 0.05). The current study's findings indicate the InBody 230 is interchangeable with the InBody 720 in obese adults. Also, the trivial effect size, when compared against the BOD POD and DXA, suggest the InBody devices could be used for estimating group BF% and FFM. In contrast, the significant proportional bias demonstrates the BIA devices are not acceptable for individual estimates of body composition in an obese clinical population.

Aortic Frequency Response Determination via Bioimpedance Plethysmography

OBJECTIVE

Arterial stiffness is an important marker to predict cardiovascular events. Common measurement techniques to determine the condition of the aorta are limited to the acquisition of the arterial pulse wave at the extremities. The goal of this paper is to enable non-invasive measurements of the aortic pulse wave velocity, instead. An additional aim is to extract further information, related to the conditions of the aorta, from the pulse wave signal instead of only its velocity.

METHODS

After discussing the problems of common pulse wave analysis procedures, an approach to determine the frequency response of the aorta is presented. Therefore, the aorta is modeled as an electrical equivalent circuit. To determine the specific numeric values of this system, a measurement approach is presented, which is based on non-invasive bioimpedance plethysmography measurements above the aortic arch and at the inguinal region. The conversion of the measurement results to the system parameters is realized by a digital algorithm, which is proposed in this paper as well. To evaluate the approach, a study on three subjects is performed.

RESULTS

The measurement results demonstrate that the proposed approach yields realistic frequency responses. For better approximation of the aortic system function, more complex models are recommended to investigate in the future. Since this paper is limited to three subjects without a ground truth, further measurements will be necessary.

SIGNIFICANCE

The proposed approach could solve the problems of current methods to determine the condition of the aorta. Its application is non-invasive, harmless, and easy to execute.

A Versatile Noise Performance Metric for Electrical Impedance Tomography Algorithms

Electrical impedance tomography (EIT) is an emerging technology for real-time monitoring of patients under mechanical ventilation. EIT has the potential to offer continuous medical monitoring while being noninvasive, radiation free, and low cost. Due to their ill-posedness, image reconstruction typically uses regularization, which implies a hyperparameter controlling the tradeoff between noise rejection and resolution or other accuracies. In order to compare reconstruction algorithms, it is common to choose hyperparameter values such that the reconstructed images have equal noise performance (NP), i.e., the amount of measurement noise reflected in the images. For EIT many methods have been suggested, but none work well when the data originate from different measurement setups, such as for different electrode positions or measurement patterns. To address this issue, we propose a new NP metric based on the average signal-to-noise ratio in the image domain. The approach is validated for EIT using simulation experiments on a human thorax model and measurements on a resistor phantom. Results show that the approach is robust to the measurement configuration (i.e., number and position of electrodes, skip pattern) and the reconstruction algorithm used. We propose this novel approach as a way to select optimized measurement configurations and algorithms.

[CHANGES IN RHEOGRAPHIC INDICATORS OF SHIN IN ATHLETES OF DIFFERENT KINDS OF SPORTS]

We determined the changes of time, amplitude and derivatives of these indicators of rheovasograms of shin in sportsmen of youth age and high level of skills engaged in volleyball, athletics and wrestling with sports experience at least 3 years. We determined significant differences in the value of time, amplitude and derivatives of these indicators ofrheovazograms of shin in males youth age, depending on the impact of intense exercise. The volleyball players compared to youth who do not exercise, reliably large values of the overall tone of the arteries (11,2%), arteries of large diameter (8,2%), arteries of medium and small diameters (13,5%), time ascending part of rheovazograms (2%) and a slow passage (5,9%) and less dycrotycs index (17%), duration ofrheographic wave (3,7%), time descending part of rheovazograms (10%). The persons of control group had higher values of baseline impedance than wrestlers (9,9%) and athletes (13,7%) and all amplitude indicators rheograms of the shin than athletes (average 12-15%) and wrestlers (22-23%). The size and volume of blood flow to the arteries of the extremities adapted to the metabolic needs of the relevant muscles. In volleyball players compared to the athletes, a lower duration of rheographic wave (10%), time of downlink part of the rheograms (12,7%), the base impedance (17,2%), amplitude of the systolic wave (17%) and rapid blood filling (21%), all indicators tone of arteries (12,2-16,9%) and greater value of time of rising part of rheograms (3,5%) and slow blood filling (5,9%). Wrestlers compared to the athletes have a lower duration of rheographic wave (6,1%), time of downlink part of the rheograms (6,1%), the amplitude of the systolic wave (9,3%), compared with volleyball players set lower values of average speed of fast blood filling (15,6%), tone of arteries with different diameters (15-16,5%), all amplitude indicators (20-28%), time slow blood filling (9,7%), ascending parts rheogram (10,3%). Thus, the level ofphysical activity and especially muscle activity has a significant effect on the performance of regional blood flow.

Machine Learning for Characterization of Insect Vector Feeding

Insects that feed by ingesting plant and animal fluids cause devastating damage to humans, livestock, and agriculture worldwide, primarily by transmitting pathogens of plants and animals. The feeding processes required for successful pathogen transmission by sucking insects can be recorded by monitoring voltage changes across an insect-food source feeding circuit. The output from such monitoring has traditionally been examined manually, a slow and onerous process. We taught a computer program to automatically classify previously described insect feeding patterns involved in transmission of the pathogen causing citrus greening disease. We also show how such analysis contributes to discovery of previously unrecognized feeding states and can be used to characterize plant resistance mechanisms. This advance greatly reduces the time and effort required to analyze insect feeding, and should facilitate developing, screening, and testing of novel intervention strategies to disrupt pathogen transmission affecting agriculture, livestock and human health.

Estimation of Penetrated Bone Layers During Craniotomy via Bioimpedance Measurement

OBJECTIVE

Craniotomy is the removal of a bone flap from the skull and is a first step in many neurosurgical interventions. During craniotomy, an efficient cut of the bone without injuring adjoining soft tissues is very critical. The aim of this study is to investigate the feasibility of estimating the currently penetrated cranial bone layer by means of bioimpedance measurement.

METHODS

A finite-element model was developed and a simulation study conducted. Simulations were performed at different positions along an elliptical cutting path and at three different operation areas. Finally, the validity of the simulation was demonstrated by an ex vivo experiment based on use of a bovine shoulder blade bone and a commercially available impedance meter.

RESULTS

The curve of the absolute impedance and phase exhibits characteristic changes at the transition from one bone layer to the next, which can be used to determine the bone layer last penetrated by the cutting tool. The bipolar electrode configuration is superior to the monopolar measurement. A horizontal electrode arrangement at the tip of the cutting tool produces the best results.

CONCLUSION

This study successfully demonstrates the feasibility to detect the transition between cranial bone layers during craniotomy by bioimpedance measurements using electrodes located on the cutting tool.

SIGNIFICANCE

Based on the results of this study, bioimpedance measurement seems to be a promising option for intra operative ad hoc information about the bone layer currently penetrated and could contribute to patient safety during neurosurgery.

Efficient Simultaneous Reconstruction of Time-Varying Images and Electrode Contact Impedances in Electrical Impedance Tomography

OBJECTIVE

In electrical impedance tomography (EIT), we apply patterns of currents on a set of electrodes at the external boundary of an object, measure the resulting potentials at the electrodes, and, given the aggregate dataset, reconstruct the complex conductivity and permittivity within the object. It is possible to maximize sensitivity to internal conductivity changes by simultaneously applying currents and measuring potentials on all electrodes but this approach also maximizes sensitivity to changes in impedance at the interface.

METHODS

We have, therefore, developed algorithms to assess contact impedance changes at the interface as well as to efficiently and simultaneously reconstruct internal conductivity/permittivity changes within the body. We use simple linear algebraic manipulations, the generalized singular value decomposition, and a dual-mesh finite-element-based framework to reconstruct images in real time. We are also able to efficiently compute the linearized reconstruction for a wide range of regularization parameters and to compute both the generalized cross-validation parameter as well as the L-curve, objective approaches to determining the optimal regularization parameter, in a similarly efficient manner.

RESULTS

Results are shown using data from a normal subject and from a clinical intensive care unit patient, both acquired with the GE GENESIS prototype EIT system, demonstrating significantly reduced boundary artifacts due to electrode drift and motion artifact.

Quantitative analysis of the reconstruction errors of the currently popular algorithm of magnetic resonance electrical property tomography at the interfaces of adjacent tissues

This work quantitatively analyzed the reconstruction errors (REs) of electrical property (EP) images using a currently popular algorithm of magnetic resonance electrical property tomography (MREPT), which occurred along the tissue interfaces. Transmitted magnetic fields B1+ were acquired at 3 T using a birdcage coil loaded with a phantom consisting of various adjacent tissues. Homogeneous Helmholtz was employed to calculate the EP maps by Laplacian computation of central differences. The maps of absolute REs (aREs) and relative REs (rREs) were calculated. The maximum and mean rREs, in addition to rRE distributions at the interfaces, were presented. Reconstructed EP maps showed various REs along different interface boundaries. Among all the investigated tissue interfaces, the kidney-fat interface presented the maximum mean rREs for both conductivity and relative permittivity. The minimum mean rRE of conductivity was observed at the spleen-muscle interface, and the minimum mean rRE of relative permittivity was detected along the lung-heart interface. The mean rREs ranged from 0.3986 to 36.11 for conductivity and 0.2218 to 11.96 for relative permittivity. Overall, this research indicates that different REs occur at various tissue boundaries, as shown by the currently popular algorithm of MREPT. Thus, REs should be considered when applying MREPT to reconstruct the EP distributions inside the human body. Copyright © 2016 John Wiley & Sons, Ltd.

[Age-related changes of hemodynamic potential of the nasal cavity of a human]

Vascular system of the nasal cavity has a complex structural organization and a wide range of functionality. However, with age, the hemodynamics of the nasal cavity undergoes specific changes, detection of which is of practical importance for gerontology and medicine. This paper presents the results of the study of hemodynamics of the nasal cavity in Mature, elderly and senile age by the method of rheorinography . Identified critical periods of functional changes of blood flow of the nasal cavity: the elderly (exit definitivno state) and old age (involution hemodynamic function and the reduction of its compensatory capacity).

[Transpalpebral Tetrapolar Reoophtalmography in the Assessment of Parameters of the Eye Blood Circulatory System]

BACKGROUND

Quantitative assessment of hemodynamic parameters is an important element of ophthalmic diagnostics especially in early detection of myopia, glaucoma, diabetic retinopathy. The assessment of hemodynamic changes is essential in evaluating of the efficiency of treatment. Objective: Our aim was to determine the adequate of eye hemodynamics assessment using reoophtalmography in patients with various clinical refractions.

METHODS

A controlled study was carried out. All tests were performed using transpalpebral tetrapolar method. Signal registration lasted for 20 seconds in the supine position, and then the diagnostic parameters were calculated.

RESULTS

We present the results of examination of 76 patients aged 5 to 22 years (average age 13.0 ± 1.1). 32 patients had low myopia (62 reoophtalmography records), 23 patients had moderate myopia (42 records) and 5 patients had high myopia (12 records). The control group was composed of 16 patients. The main differences were found in the rheographic index, which is equal to 58.1 ± 4.1 mOhm in the control group. It is significantly reducing with refraction increase, from 47.8 ± 3.2 mOhm in low myopia to 34.0 ± 2.5 mOhm in high myopia (p = 0.050). This is an evidence of blood supply deficiency in the myopic eyes.

CONCLUSION

Rheographic index was shown to differ in different breathing phases, which agrees with the known physiological regularities. The proposed method is highly informative and sufficiently accurate what allows assessing the eye blood supply state objectively. It is easy to apply and requires no contact with the eye surface, which is especially important in pediatric practice.

A fast parallel solver for the forward problem in electrical impedance tomography

Electrical impedance tomography (EIT) is a noninvasive imaging modality, where imperceptible currents are applied to the skin and the resulting surface voltages are measured. It has the potential to distinguish between ischaemic and haemorrhagic stroke with a portable and inexpensive device. The image reconstruction relies on an accurate forward model of the experimental setup. Because of the relatively small signal in stroke EIT, the finite-element modeling requires meshes of more than 10 million elements. To study the requirements in the forward modeling in EIT and also to reduce the time for experimental image acquisition, it is necessary to reduce the run time of the forward computation. We show the implementation of a parallel forward solver for EIT using the Dune-Fem C++ library and demonstrate its performance on many CPU's of a computer cluster. For a typical EIT application a direct solver was significantly slower and not an alternative to iterative solvers with multigrid preconditioning. With this new solver, we can compute the forward solutions and the Jacobian matrix of a typical EIT application with 30 electrodes on a 15-million element mesh in less than 15 min. This makes it a valuable tool for simulation studies and EIT applications with high precision requirements. It is freely available for download.

Monitoring of lobectomy in cystic fibrosis with electrical impedance tomography - a new diagnostic tool

Electrical impedance tomography (EIT) is a radiation-free technique generating cross-sectional images of the lung. EIT visualizes global and regional ventilation by illustrating the distribution of electrical bioimpedance. With an electrode belt around the patient's thorax, rotating injection-couples of a harmless alternating current allow voltage measurement of the remaining electrodes. This enables the reconstruction of a tomogram with highly dynamic changes within ventilation. We report on a female six-year-old patient with cystic fibrosis and complete destruction of the upper and middle lobe of the right lung. Lobectomy, a rare therapeutic option in patients with cystic fibrosis that needs to be considered in cases of severe localized destruction, was performed. We show a pre- and postoperative documentation of static (radiology) and dynamic investigation tools (spirometry) in correlation with EIT as a new non-invasive and radiation-free diagnostic tool for this patient group.

A novel in vivo corneal trans-epithelial electrical resistance measurement device

PURPOSE

To develop a device that is capable of easily measuring corneal transepithelial electrical resistance (TER) and changes in the corneal barrier function.

METHODS

We had previously developed an in vivo method for measuring corneal TER using intraocular electrode. This method can be used to precisely measure the decline of the corneal barrier function after instillation of benzalkonium chloride (BAC). In order to lessen the invasiveness of that procedure, we further refined the method for measuring the corneal TER by developing electrodes that could be placed on the cornea and in the conjunctival sac instead of inserting them into the anterior chamber. TER was then calculated by subtracting the electrical resistance, which lacked the corneal epithelial input, from the whole electrical resistance that was measured between the electrodes. Slit lamp examination and scanning electron microscopy (SEM) were used to determine safety of the new device. Corneal TER changes after exposure to 0.02% BAC were determined using the new device as well as SEM and transmission electron microscopy (TEM).

RESULTS

Slit lamp examination before and after exposure of rabbits' corneas to the sensor confirmed safety of the device. SEM examination revealed no difference of the corneal epithelium which exposed to the new device with normal corneas. SEM and TEM pictures revealed damaged microvilli and tight junctions after instillation of 0.02% BAC. TER change after treatment with 0.02%BAC was similar to those determined by the established anterior chamber method.

CONCLUSION

We succeeded to develop a less invasive device for corneal TER measurement in vivo in animals. This new device may be applicable in the future for clinical use in humans.

Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition

Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD) can decompose a signal into several intrinsic mode functions (IMFs) that disclose nonstationary components as well as stationary components and, similarly, capture respiratory episodes from thoracic impedance. However, upper-body movements usually produce motion artifacts that are not easily removed by digital filtering. Moreover, large motion artifacts disable the EMD to decompose respiratory components. In this paper, motion artifacts are detected and replaced by the data mirrored from the prior and the posterior before EMD processing. A novel intrinsic respiratory reconstruction index that considers both global and local properties of IMFs is proposed to define respiration-related IMFs for respiration reconstruction and instantaneous respiratory estimation. Based on the experiments performing a series of static and dynamic physical activates, our results showed the proposed method had higher cross correlations between respiratory frequencies estimated from thoracic impedance and those from oronasal airflow based on small window size compared to the Fourier transform-based method.

Cardiac hemodynamic profile and its correlates by Impedance plethysmography in normal individuals of Central India

Evaluation of hemodynamic profile by impedance plethysmography (IPG) provides functional expression of cardiovascular performance with efficacy of treatment. Objective of this study was to establish normative hemodynamic parameters by IPG. In this cross-sectional study hemodynamic parameters including cardiac output (CO), Stroke volume (SV), left ventricular ejection time (LVET), impedance (Zo) Cardiac index (CI) and Stroke index (SI) of 50 normal individuals in mean age 38.9±15.2 years were evaluated. Mean CO and CI were 4.9±0.8L/min and 3.3±0.7 L/min/m2 respectively. A negative linear co-relation of CI with increasing age and body fat mass was observed. Mean LVET was 336±33ms with a significant positive linear correlation (r = 0.46) with advancing age and body fat mass while a negative linear correlation with BSA. To conclude preliminary normative data of cardiac parameters using IPG, in subjects of central India of different age groups has been presented.

Implantable impedance plethysmography

We demonstrate by theory, as well as by ex vivo and in vivo measurements that impedance plethysmography, applied extravascularly directly on large arteries, is a viable method for monitoring various cardiovascular parameters, such as blood pressure, with high accuracy. The sensor is designed as an implant to monitor cardiac events and arteriosclerotic progression over the long term.

The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases

Bioimpedance analysis is a noninvasive, low cost and a commonly used approach for body composition measurements and assessment of clinical condition. There are a variety of methods applied for interpretation of measured bioimpedance data and a wide range of utilizations of bioimpedance in body composition estimation and evaluation of clinical status. This paper reviews the main concepts of bioimpedance measurement techniques including the frequency based, the allocation based, bioimpedance vector analysis and the real time bioimpedance analysis systems. Commonly used prediction equations for body composition assessment and influence of anthropometric measurements, gender, ethnic groups, postures, measurements protocols and electrode artifacts in estimated values are also discussed. In addition, this paper also contributes to the deliberations of bioimpedance analysis assessment of abnormal loss in lean body mass and unbalanced shift in body fluids and to the summary of diagnostic usage in different kinds of conditions such as cardiac, pulmonary, renal, and neural and infection diseases.

The differential Howland current source with high signal to noise ratio for bioimpedance measurement system

The stability and signal to noise ratio (SNR) of the current source circuit are the important factors contributing to enhance the accuracy and sensitivity in bioimpedance measurement system. In this paper we propose a new differential Howland topology current source and evaluate its output characters by simulation and actual measurement. The results include (1) the output current and impedance in high frequencies are stabilized after compensation methods. And the stability of output current in the differential current source circuit (DCSC) is 0.2%. (2) The output impedance of two current circuits below the frequency of 200 KHz is above 1 MΩ, and below 1 MHz the output impedance can arrive to 200 KΩ. Then in total the output impedance of the DCSC is higher than that of the Howland current source circuit (HCSC). (3) The SNR of the DCSC are 85.64 dB and 65 dB in the simulation and actual measurement with 10 KHz, which illustrates that the DCSC effectively eliminates the common mode interference. (4) The maximum load in the DCSC is twice as much as that of the HCSC. Lastly a two-dimensional phantom electrical impedance tomography is well reconstructed with the proposed HCSC. Therefore, the measured performance shows that the DCSC can significantly improve the output impedance, the stability, the maximum load, and the SNR of the measurement system.

Epsilon-tube filtering: reduction of high-amplitude motion artifacts from impedance plethysmography signal

The impedance plethysmography (IP) has long been used to monitor respiration. The IP signal is also suitable for portable monitoring of respiration due to its simplicity. However, this signal is very susceptible to motion artifact (MA). As a result, MA reduction is an indispensable part of portable acquisition of the IP signal. Often, the amplitude of the MA is much larger than the amplitude of the respiratory component in the IP signal. This study proposes a novel filtering method to remove the high-amplitude MA's from the IP signal. The proposed method combines the idea of ε-tube loss function and an autoregressive exogenous model to estimate the MA while leaving the periodic respiratory component of the IP signal intact. Also, a regularization method is used to find the best filter coefficients that maximize the regularity of the output signal. The results indicate that the proposed method can effectively remove the MA, outperforming the popular MA reduction methods. Several different performance measures are used for the comparison and the differences are found to be statistically significant.

Reliability and accuracy of sleep apnea scans in novel cardiac resynchronization therapy devices: an independent report of two cases

Pacemaker apnea scan algorithms are able to screen for sleep apnea. We investigated whether these systems were able to accurately detect sleep-disordered breathing (SDB) in two patients from an outpatient clinic. The first patient suffered from ischemic heart failure and severe central sleep apnea (CSA) and underwent adaptive servoventilation therapy (ASV). The second patient suffered from dilated cardiomyopathy and moderate obstructive sleep apnea (OSA). Pacemaker read-outs did not match polysomnography (PSG) recordings well and overestimated the apnea-hypopnea index. However, ASV therapy-induced SDB improvements were adequately recognized by the apnea scan of the Boston Scientific INVIVE® cardiac resynchronization therapy pacemaker. Detection of obstructive respiratory events using impedance-based technology may underestimate the number of events, as frustrane breathing efforts induce impedance changes without significant airflow. By contrast, in the second case, apnea scan overestimated the number of total events and of obstructive events, perhaps owing to a very sensitive but less specific hypopnea definition and detection within the diagnostic algorithm of the device. These two cases show that a pacemaker apnea scan is able to reflect SDB, but PSG precision is not met by far. The device scan revealed the decline of SDB through ASV therapy for CSA in one patient, but not for OSA in the second case. To achieve reliable monitoring of SDB, further technical developments and clinical studies are necessary.

Simulation-based validation for four- dimensional multi-channel ultrasound current source density imaging

Ultrasound current source density imaging (UCSDI), which has application to the heart and brain, exploits the acoustoelectric (AE) effect and Ohm's law to detect and map an electrical current distribution. In this study, we describe 4-D UCSDI simulations of a dipole field for comparison and validation with bench-top experiments. The simulations consider the properties of the ultrasound pulse as it passes through a conductive medium, the electric field of the injected dipole, and the lead field of the detectors. In the simulation, the lead fields of detectors and electric field of the dipole were calculated by the finite element (FE) method, and the convolution and correlation in the computation of the detected AE voltage signal were accelerated using 3-D fast Fourier transforms. In the bench-top experiment, an electric dipole was produced in a bath of 0.9% NaCl solution containing two electrodes, which injected an ac pulse (200 Hz, 3 cycles) ranging from 0 to 140 mA. Stimulating and recording electrodes were placed in a custom electrode chamber made on a rapid prototype printer. Each electrode could be positioned anywhere on an x-y grid (5 mm spacing) and individually adjusted in the depth direction for precise control of the geometry of the current sources and detecting electrodes. A 1-MHz ultrasound beam was pulsed and focused through a plastic film to modulate the current distribution inside the saline-filled tank. AE signals were simultaneously detected at a sampling frequency of 15 MHz on multiple recording electrodes. A single recording electrode is sufficient to form volume images of the current flow and electric potentials. The AE potential is sensitive to the distance from the dipole, but is less sensitive to the angle between the detector and the dipole. Multi-channel UCSDI potentially improves 4-D mapping of bioelectric sources in the body at high spatial resolution, which is especially important for diagnosing and guiding treatment of cardiac and neurologic disorders, including arrhythmia and epilepsy.

Electrode placement in bioimpedance spectroscopy: evaluation of alternative positioning of electrodes when measuring relative dehydration in athletes

In order to maintain a homeostatic environment in human cells, the balance between absorption and separation of water must be retained. Imbalance will have consequences on both the cellular and organ levels. Studies performed on athletes have shown coherence between their hydration status and ability to perform. A dehydration of 2-7% of total body weight resulted in a marked decrease in performance. Measurement and monitoring of hydration status may be used to optimize athlete performance. Therefore, in this current study bioimpedance spectroscopy is used to determine the hydration status of athletes. Trials were made to investigate alternative ways of electrode placement when performing bioimpedance spectroscopy in order to measure relative dehydration. A total of 14 test subjects underwent measurements before, during, and after a cycle test of 3×25min. Electrodes where placed to measure body impedance in three different ways: wrist-ankle (recommended method), wrist-wrist, and transthoracic. Furthermore, the relative loss in weight of the subjects during the trial was registered. The study showed no relation between relative weight loss and the wrist-wrist and transthoracic placement method, using bioimpedance spectroscopy to measure relative dehydration. The inability of the method to detect such relative changes in hydration may be due to the bioimpedance spectroscopy technology being extremely sensitive to changes in skin temperature, movement artifacts, thoroughness in placing the electrodes, and the physiological impact on the human body when performing exercise. Therefore, further research into the area of bioimpedance spectroscopy is needed before this methodology can be applied in monitoring active athletes. Hence, a simple weight measurement still seems a more useful way of determining a relative change of hydration in an active setting.

Total and regional body volumes derived from dual-energy X-ray absorptiometry output

Total body volume is an important health metric used to measure body density, shape, and multicompartmental body composition but is currently only available through underwater weighing or air displacement plethysmography (ADP). The objective of this investigation was to derive an accurate body volume from dual-energy X-ray absorptiometry (DXA)-reported measures for advanced body composition models. Volunteers received a whole body DXA scan and an ADP measure at baseline (N = 25) and 6 mo (N = 22). Baseline measures were used to calibrate body volume from the reported DXA masses of fat, lean, and bone mineral content. A second population (N = 385) from the National Health and Nutrition Examination Survey was used to estimate the test-retest precision of regional (arms, legs, head, and trunk) and total body volumes. Overall, we found that DXA-volume was highly correlated to ADP-volume (R² = 0.99). The 6-mo change in total DXA-volume was highly correlated to change in ADP-volume (R² = 0.98). The root mean square percent coefficient of variation precision of DXA-volume measures ranged from 1.1% (total) to 3.2% (head). We conclude that the DXA-volume method can measure body volume accurately and precisely, can be used in body composition models, could be an independent health indicator, and is useful as a prospective or retrospective biomarker of body composition.

Simulations and phantom evaluations of magnetic resonance electrical impedance tomography (MREIT) for breast cancer detection

MREIT is a new imaging modality that can be used to reconstruct high-resolution conductivity images of the human body. Since conductivity values of cancerous tissues in the breast are significantly higher than those of surrounding normal tissues, breast imaging using MREIT may provide a new noninvasive way of detecting early stage of cancer. In this paper, we present results of experimental and numerical simulation studies of breast MREIT. We built a realistic three-dimensional model of the human breast connected to a simplified model of the chest including the heart and evaluated the ability of MREIT to detect cancerous anomalies in a background material with similar electrical properties to breast tissue. We performed numerical simulations of various scenarios in breast MREIT including assessment of the effects of fat inclusions and effects related to noise levels, such as changing the amplitude of injected currents, effect of added noise and number of averages. Phantom results showed straightforward detection of cancerous anomalies in a background was possible with low currents and few averages. The simulation results showed it should be possible to detect a cancerous anomaly in the breast, while restricting the maximal current density in the heart below published levels for nerve excitation.

Impedance measurements in the biomedical sciences

Biological organisms and their component organs, tissues and cells have unique electrical impedance properties. Impedance properties often change with changes in structure, composition, and metabolism, and can be indicative of the onset and progression of disease states. Over the past 100 years, instruments and analytical methods have been developed to measure the impedance properties of biological specimens and to utilize these measurements in both clinical and basic science settings. This chapter will review the applications of impedance measurements in the biomedical sciences, from whole body analysis to impedance measurements of single cells and cell monolayers, and how cellular impedance measuring instruments can now be used in high throughput screening applications.

Reconstruction of electrical impedance tomography (EIT) images based on the expectation maximum (EM) method

Electrical impedance tomography (EIT) calculates the internal conductivity distribution within a body using electrical contact measurements. The image reconstruction for EIT is an inverse problem, which is both non-linear and ill-posed. The traditional regularization method cannot avoid introducing negative values in the solution. The negativity of the solution produces artifacts in reconstructed images in presence of noise. A statistical method, namely, the expectation maximization (EM) method, is used to solve the inverse problem for EIT in this paper. The mathematical model of EIT is transformed to the non-negatively constrained likelihood minimization problem. The solution is obtained by the gradient projection-reduced Newton (GPRN) iteration method. This paper also discusses the strategies of choosing parameters. Simulation and experimental results indicate that the reconstructed images with higher quality can be obtained by the EM method, compared with the traditional Tikhonov and conjugate gradient (CG) methods, even with non-negative processing.

Electrical impedance simulation and characterization of cell growth using the Fricke model

For label-free and real-time monitoring of biological cells, electrical impedance sensing of the cells attached to the microelectrode has been used. In this article, the electrical impedance analysis of the cell growth using the Fricke model that consisted of the extracellular resistance parallel to the series combination of an intracellular resistance and the membrane-related capacitance was investigated. To relate the morphological changes in the cells that accompanied the cell growth in the Fricke model parameters, the impedance spectra of a cell model were simulated at different cell sizes and cell-cell gaps using the finite element method. The simulated results showed that the increase in the cell size results in an increment of the extracellular resistance and that the decrease in the cell-cell gap leads to an increment of the extracellular resistance and a decrement of the capacitance. Based on the theoretical relationship between the model parameters and the considered cellular behavior, it was shown that the measured impedance spectra of the cells were mostly governed by the change in the cell-cell gap at the beginning of the culture time, and then by the cell size or the density of the cells that covered the electrode surface with a limited area.

Evaluation of cardiac parameters using electrical impedance plethysmography

Impedance plethysmography is a method for determining changes in body tissue volumes, based on the measurement of electric impedance at the body surface. Because it is a non-invasive and cost-effective method to measure and analyze hemodynamics, it would bring to physiologists very important diagnostic information for the continuous care of critical patients with hemodynamic disorders.

METHODS

This study aimed at acquiring non-invasively and at analyzing plethysmografic waves by measuring the electrical impedance. For measurements we built a device that was designed as an injection module with a microcontroller, a programmable waveform generator, and a voltage controlled current source which generates a sinusoidal pulse with adjustable frequency (10-200 kHz) and adjustable intensity. In output, the device delivers an analogical signal representing the variation of the impedance of the explored section. The acquisition of the bioimpedance signal on PC was made easier by the use of a national instrument data acquisition device, the NI USB 6009.

RESULTS

The bioimpedance signal processing, the user interface and the display were managed by MATLAB. Sample impedance data for a test subject are presented. From the experimental results, it is shown that the proposed bioimpedance measuring system could provide good performance over the frequency range for central or peripheral territory.

CONCLUSION

The clinical importance of these findings is that this method can measure vascular parameters noninvasively, continuously and more conveniently in humans.

Cole parameter estimation from total right side electrical bioimpedance spectroscopy measurements--influence of the number of frequencies and the upper limit

Applications based on measurements of Electrical Bioimpedance Spectrocopy (EBIS) analysis are proliferating. The most spread and known application of EBIS is the non-invasive assessment of body composition. Fitting to the Cole function to obtain the Cole parameters, R(0) and R(∞), is the core of the EBIS analysis to obtain the body fluid distribution. An accurate estimation of the Cole parameters is essential for the Body Composition Assessment (BCA) and the estimation process depends on several factors. One of them is the upper frequency limit used for the estimation and the other is the number of measured frequencies in the measurement frequency range. Both of them impose requirements on the measurement hardware, influencing largely in the complexity of the bioimpedance spectrometer. In this work an analysis of the error obtained when estimating the Cole parameters with several frequency ranges and different number of frequencies has been performed. The study has been done on synthetic EBIS data obtained from experimental Total Right Side (TRS) measurements. The results suggest that accurate estimations of R(0) and R(∞) for BCA measurements can be achieved using much narrower frequency ranges and quite fewer frequencies than electrical bioimpedance spectrometers commercially available nowadays do.

Body composition analysis in bariatric surgery: use of air displacement plethysmograph

Body weight, body mass index (BMI), and percent excess weight loss are used to assess patient outcomes after bariatric surgery; however, they provide little insight into the true nature of the patient's weight loss. Body composition measurements monitor fat versus lean mass losses to permit interventions to reduce or avoid lean body mass loss after bariatric surgery. A retrospective review of patients who underwent bariatric surgery between 2002 and 2008 was performed. Patients underwent body composition testing via air displacement plethysmography before and after surgery (6 and 12 months). Body composition changes were assessed and compared with the BMI. Results include 330 patients (54 male, 276 female). Average preoperative weight was 139 kg, BMI was 50 kg/m(2), fat percentage was 55 per cent, and lean mass percent was 45 per cent. Twelve months after surgery average weight was 90 kg, mean BMI was 32 kg/m(2), fat percentage was 38 per cent, and lean mass percent was 62 per cent. Body composition measurements help monitor fat losses versus lean mass gains after bariatric surgery. This may give a better assessment of the patient's health and metabolic state than either BMI or excess weight loss and permits intervention if weight loss results in lean mass losses.

A multiscale model for bioimpedance dispersion of liver tissue

Radio-frequency ablation (RFA) has been used in liver surgery to minimize blood loss during tissue division. However, the current RFA tissue division method lacks an effective way of determining the stoppage of blood flow. There is limitation on the current state-of-the-art laser Doppler flow sensor due to its small sensing area. A new technique was proposed to use bioimpedance for blood flow sensing. This paper discusses a new geometrical multiscale model of the liver bioimpedance incorporating blood flow impedance. This model establishes correlation between the physical tissue structure and bioimpedance measurement. The basic Debye structure within a multilevel framework is used in the model to account for bioimpedance dispersion. This dispersion is often explained by the Cole-Cole model that includes a constant phase element without physical explanation. Our model is able to account for reduced blood flow in its output with changes in permittivity in gamma dispersion that is mainly due to the polarization of water molecules. This study demonstrates the potential of a multiscale model in determining the stoppage of blood flow during surgery.

Error analysis of nonconstant admittivity for MR-based electric property imaging

Magnetic resonance electrical property tomography (MREPT) is a new imaging modality to visualize a distribution of admittivity γ = σ+iωε inside the human body where σ and ε denote electrical conductivity and permittivity, respectively. Using B1 maps acquired by an magnetic resonance imaging scanner, it produces cross-sectional images of σ and ε at the Larmor frequency. Since current MREPT methods rely on an assumption of a locally homogeneous admittivity, there occurs a reconstruction error where this assumption fails. Rigorously analyzing the reconstruction error in MREPT, we showed that the error is fundamental and may cause technical difficulties in interpreting MREPT images of a general inhomogeneous object. We performed numerical simulations and phantom experiments to quantitatively support the error analysis. We compared the MREPT image reconstruction problem with that of magnetic resonance electrical impedance tomography (MREIT) to highlight distinct features of both methods to probe the same object in terms of its high- and low-frequency conductivity distributions, respectively. MREPT images showed large errors along boundaries where admittivity values changed whereas MREIT images showed no such boundary effects. Noting that MREIT makes use of the term neglected in MREPT, a novel MREPT admittivity image reconstruction method is proposed to deal with the boundary effects, which requires further investigation on the complex directional derivative in the real Euclidian space [Formula: see text].

[Device diagnosis and combined treatment of hyperventilation syndrome]

Hyperventilation syndrome is a separate disease and a symptom of other psychosomatic diseases. A variant of device diagnosis of the disease is proposed--integral rheoplethysmography by M. I. Tischenko and cardiointervalography by R. M. Baevsky. Hyper- and asthenic courses of the disease are described, the pathological psychoemotional pattern is recognized. The proposed treatment combines physiohemotherapy (laser treatment) and pharmacotherapy.

Analysis of human fibroadenomas using three-dimensional impedance maps

Three-dimensional impedance maps (3DZMs) are virtual volumes of acoustic impedance values constructed from histology to represent tissue microstructure acoustically. From the 3DZM, the ultrasonic backscattered power spectrum can be predicted and model based scatterer properties, such as effective scatterer diameter (ESD), can be estimated. Additionally, the 3DZM can be exploited to visualize and identify possible scattering sites, which may aid in the development of more effective scattering models to better represent the ultrasonic interaction with underlying tissue microstructure. In this study, 3DZMs were created from a set of human fibroadenoma samples. ESD estimates were made assuming a fluid-filled sphere form factor model from 3DZMs of volume 300×300×300 μm. For a collection of 33 independent human fibroadenoma tissue samples, the ESD was estimated to be 111±40.7 μm. The 3DZMs were then investigated visually to identify possible scattering sources which conformed to the estimated model scatterer dimensions. This estimation technique allowed a better understanding of the spatial distribution and variability of the estimates throughout the volume.

Magnetic resonance driven electrical impedance tomography: a simulation study

Magnetic resonance electrical impedance tomography (MREIT) is a method for reconstructing a three-dimensional image of the conductivity distribution in a target volume using magnetic resonance (MR). In MREIT, currents are applied to the volume through surface electrodes and their effects on the MR induced magnetic fields are analyzed to produce the conductance image. However, current injection through surface electrodes poses technical problems such as the limitation on the safely applicable currents. In this paper, we present a new method called magnetic resonance driven electrical impedance tomography (MRDEIT), where the magnetic resonance in each voxel is used as the applied magnetic field source, and the resultant electromagnetic field is measured through surface electrodes or radio-frequency (RF) detectors placed near the surface. Because the applied magnetic field is at the RF frequency and eddy currents are the integral components in the method, a vector wave equation for the electric field is used as the basis of the analysis instead of a quasi-static approximation. Using computer simulations, it is shown that complex permittivity images can be reconstructed using MRDEIT, but that improvements in signal detection are necessary for detecting moderate complex permittivity changes.

A convenient pulmonary volume and flow detection system

The pulmonary function test (PFT) is a widely used test in patients or for those who are at risk of respiratory dysfunction. In this study, we aimed to develop a more convenient system, namely, the impedance pulmonary function measurement system (IPFS), for overcoming the restrictions posed by the prevalent spirometric PFT. IPFS employs tetra polar electrodes that can measure pulmonary function using the subjects' hands alone. The impedance measured by IPFS extracts AC values of pulmonary impedance from DC values of body impedance in respiration. This system yields changes in the impedance of volume and flow. In order to verify IPFS, we compared the continuous waveforms obtained from the PFT module and developed IPFS using Pearson linear correlation coefficients (p < 0.01) for volume and flow. Further, we evaluated the potential application of IPFS for detecting pulmonary functions such as volume (FEV(1)/FVC Ratio) and flow (PEF), and compared the measured parameters between IPFS and spirometric PFT. Our results demonstrate that the measurements obtained using IPFS reflect pulmonary function parameters.

Comparison between EEMD, wavelet and FIR denoising: influence on event detection in impedance cardiography

During thoracic impedance signal acquisition, noise is inherently introduced and hence, denoising is required to allow for accurate event detection. This paper investigates the effectiveness of Ensemble Emperical Mode Decomposition to filter random noise. The performance of the EEMD method is compared with an optimal FIR filter and wavelet denoising. The IMF selection for signal reconstruction in the EEMD denoising method is optimized using a sequential search. Denoising performance was evaluated by the SNR and the accuracy in event detection after filtering. When all criteria are taken into account, wavelet seems to outperform both EEMD and FIR denoising.

Factorization method and its physical justification in frequency-difference electrical impedance tomography

Time-difference electrical impedance tomography (tdEIT) requires two data sets measured at two different times. The difference between them is utilized to produce images of time-dependent changes in a complex conductivity distribution inside the human body. Frequency-difference EIT (fdEIT) was proposed to image frequency-dependent changes of a complex conductivity distribution. It has potential applications in tumor and stroke imaging since it can visualize an anomaly without requiring any time-reference data obtained in the absence of an anomaly. In this paper, we provide a rigorous analysis for the detectability of an anomaly based on a constructive and quantitative physical correlation between a measured fdEIT data set and an anomaly. From this, we propose a new noniterative frequency-difference anomaly detection method called the factorization method (FM) and elaborate its physical justification. To demonstrate its practical applicability, we performed fdEIT phantom imaging experiments using a multifrequency EIT system. Applying the FM to measured frequency-difference boundary voltage data sets, we could quantitatively evaluate indicator functions inside the imaging domain, of which values at each position reveal presence or absence of an anomaly. We found that the FM successfully localizes anomalies inside an imaging domain with a frequency-dependent complex conductivity distribution. We propose the new FM as an anomaly detection algorithm in fdEIT for potential applications in tumor and stroke imaging.

Multi-excitation magnetoacoustic tomography with magnetic induction for bioimpedance imaging

Magnetoacoustic tomography with magnetic induction (MAT-MI) is an imaging approach proposed to conduct noninvasive electrical conductivity imaging of biological tissue with high spatial resolution. In the present study, based on the analysis of the relationship between the conductivity distribution and the generated MAT-MI acoustic source, we propose a new multi-excitation MAT-MI approach and the corresponding reconstruction algorithms. In the proposed method, multiple magnetic excitations using different coil configurations are employed and ultrasound measurements corresponding to each excitation are collected to derive the conductivity distribution inside the sample. A modified reconstruction algorithm is also proposed for the multi-excitation MAT-MI imaging approach when only limited bandwidth acoustic measurements are available. Computer simulation and phantom experiment studies have been done to demonstrate the merits of the proposed method. It is shown that if unlimited bandwidth acoustic data is available, we can accurately reconstruct the internal conductivity contrast of an object using the proposed method. With limited bandwidth data and the use of the modified algorithm we can reconstruct the relative conductivity contrast of an object instead of only boundaries at the conductivity heterogeneity. Benefits that come with this new method include better differentiation of tissue types with conductivity contrast using the MAT-MI approach, specifically for potential breast cancer screening application in the future.

Enhanced sensitivity current density imaging

One of the major weaknesses of current density imaging (CDI) is its poor sensitivity and therefore a need for the use of high voltage in CDI. In this work, a new CDI technique with enhanced sensitivity (ES-CDI) is presented. The ES-CDI sequence overcomes the sensitivity problem in samples with a long T(2) relaxation time that allows the use of a long current encoding period. As successful CDI detection is conditioned by a sufficiently large product of current and its application time a longer current encoding period enables the use of lower current and also lower voltage therefore significantly reducing any sample damage. In addition, the ES-CDI sequence also uses fast image signal acquisition and so enables heavy signal averaging and with it associated additional CDI sensitivity increase within the experiment time of the conventional CDI experiment. The feasibility of the ES-CDI sequence was tested on a model sample filled with physiological solution. Voltage of just 1 V and current application time of 800 ms were sufficient to detect current density of 20A/m(2) with a detection limit of 0.7A/m(2).

[Image reconstruction of conductivity on magnetoacoustic tomography with magnetic induction]

The electric characteristics such as impedance and conductivity of the organization will change in the case where pathological changes occurred in the biological tissue. The change in electric characteristics usually took place before the change in the density of tissues, and also, the difference in electric characteristics such as conductivity between normal tissue and pathological tissue is obvious. The method of magneto-acoustic tomography with magnetic induction is based on the theory of magnetic eddy current induction, the principle of vibration generation and acoustic transmission to get the boundary of the pathological tissue. The pathological change could be inspected by electricity characteristic imaging which is invasive to the tissue. In this study, a two-layer concentric spherical model is established to simulate the malignant tumor tissue surrounded by normal tissue mutual relations of the magneto-sound coupling effect and the coupling equations in the magnetic field are used to get the algorithms for reconstructing the conductivity. Simulation study is conducted to test the proposed model and validate the performance of the reconstructed algorithms. The result indicates that the use of signal processing method in this paper can image the conductivity boundaries of the sample in the scanning cross section. The computer simulating results validate the feasibility of applying the method of magneto-acoustic tomography with magnetic induction for malignant tumor imaging.

Respiratory impedance and corresponding phase-constancy in the 7.5 to 247.5 Hz frequency interval for healthy subjects

This paper presents contributions on respiratory impedance and its phase constancy effects at high frequencies; i.e. 7.5-247.5 Hz. Measurements of 14 healthy volunteers are used to provide the input impedance values. It is shown, via the modulus-phase characteristics, that the impedance poses a typical frequency-independent behavior, known as phase constancy. We propose an electrical ladder network analogue for which we identify a set of parameters from these real-life measurements. The results presented in this paper support earlier theoretical insights on the appearance of phase constancy in ladder networks and the estimated model parameters have meaningful values. The phase constancy implies that the respiratory system is fractal and that the tissue exhibits viscoelastic properties.

[Rheohepatography with ultrasound navigation of electrodes as biophysical method of the hepatic blood flow evaluation]

The transcutaneus Rheohepatography with ultrasound electrodes navigation (RUEN) discovered early specifically changes of hepatic blood flow in pts with diffuse hepatic pathology (DHP). It is necessary to use of the Conventional Rheohepatography for screening hepatics hemodynamics disorders in pts with DHP. For more differentiated approach it is necessary to use Doppler imaging of the hepatic blood flow. It is necessary to use the ultrasound electrodes navigation for increase of the self-descriptiveness Rheohepatography and for inclusion ofa maximum quantity hepatic parenchyma between interelectrodes space. As against the classical analysis extremities rheography in interpretation RUEN it is necessary to take into account, that the liver has 2 ways of inflow (proper hepatic artery and portal vein) and 1 way of outflow (hepatic veins running to cava inferior vein).

A study of forward problem of magnetoacoustic tomography with magnetic induction

Magnetoacoustic tomography with magnetic induction (MAT-MI) is a recently introduced method for imaging electrical impedance properties, which integrates classic electrical impedance tomography and ultrasonic technique. In this paper, a new method is proposed to avoid the singularity of the divergence of Lorentz force on the interfaces between two kinds of medium. A two-dimensional model was used for computer simulation studies to evaluate the proposed theory. The sound source distribution and the characteristics of the radiated acoustic field were investigated under three types of stimulation. The numerical results were derived through finite element method, and theoretical analysis was also carried out, both of which confirm the validity of the proposed method.

Induced current magnetic resonance electrical impedance tomography of brain tissues based on the J-substitution algorithm: a simulation study

We have investigated induced current magnetic resonance electrical impedance tomography (IC-MREIT) by means of computer simulations. The J-substitution algorithm was implemented to solve the IC-MREIT reconstruction problem. By providing physical insight into the charge accumulating on the interfaces, the convergence characteristics of the reconstruction algorithm were analyzed. The simulation results conducted on different objects were well correlated with the proposed theoretical analysis. The feasibility of IC-MREIT to reconstruct the conductivity distribution of head-brain tissues was also examined in computer simulations using a multi-compartment realistic head model. The present simulation results suggest that IC-MREIT may have the potential to become a useful conductivity imaging technique.