Fiber optofluidic Coriolis flowmeter based on a dual-antiresonant reflecting optical waveguide.

A microfiber optofluidic flowmeter based on the Coriolis principle and a dual-antiresonant reflecting optical waveguide (ARROW) is proposed and experimentally demonstrated. A hollow hole in a hollow-core fiber is fabricated as an optofluidic channel to move the liquid sample, which forms a dual-ARROW in the hollow-core fiber. Two sides of the hollow-core fiber are used as two adjacent Fabry-Perot resonators based on the refractive index modulation of a CO2 laser, which is used to investigate the vibration signals of the two resonators. The flow rate can be measured based on the Coriolis force by calculating the phase difference between the two ARROWs. The experimental results show that a flow rate sensitivity of 8.04 deg/(µl/s) can be achieved for ethanol solution. The proposed micro Coriolis fiber optic flowmeter can be used in various fields, such as food production, medicine, bioanalysis, etc.

Outcomes of Autogenous Radiocephalic Versus Brachiocephalic Arteriovenous Fistula Surgery Based on Transit-Time Flowmeter Assessment: A Retrospective Study.

BACKGROUND: Despite the better operative results of autogenous brachiocephalic arteriovenous fistula (BC-AVF), it is considered secondary to autogenous radiocephalic AVF (RC-AVF) failure. Here we compared the results of our multidisciplinary management protocol of BC-AVF versus RC-AVF. METHODS: A total of 194 matched patients who requested autogenous BC-AVF or RC-AVF surgery between 2017 and 2019 were included in this retrospective study. All patients strictly adhered to our departmental perioperative management protocol for AVF surgery, including vessel status monitoring, exercise with or without a tourniquet, intraoperative flow assessment, and antiplatelet and anticoagulant medications. AVF function and patient status data were acquired from the electronic medical records, and the final evaluation was made via outpatient department visit or phone call in October 2020. RESULTS: Patients who underwent elective BC-AVF or RC-AVF (n = 97 each) were included. The patient groups had similar preoperative clinical characteristics. Artery and vein sizes at the planned anastomosis site were larger in the BC-AVF group (P < 0.001). The mean intraoperative maximal flow rate was higher in the BC-AVF group (492.5 ± 186.9 mL/min) than in the RC-AVF group (307.3 ± 113.0 mL/min, P < 0.001). The simultaneously evaluated mean pulsatility index was 0.5 ± 0.2 in the BC-AVF group and 0.6 ± 0.2 in the RC-AVF group (P < 0.001). The median observation duration was 19.4 months (11.0‒31.3 months). The primary patency rate was higher in the BC-AVF group (88.7%) than in the RC-AVF group (62.9%, P < 0.001). Patency duration was similar between groups, and the primary patency maintenance duration was longer in the BC-AVF group. Three cases of cephalic arch stenosis were observed in the BC-AVF group, while no cases of arterial steal syndrome were observed during the indexed observation period. Mortality rates were 14.4% and 9.3% in the BC-AVF and RC-AVF groups, respectively (P = 0.267), and the cause of death did not differ significantly between groups. For mortality, the estimated hazard ratio of RC-AVF over BC-AVF was 0.47 (95% CI, 0.19‒1.17, P = 0.106) during the observation period. CONCLUSION: BC-AVF had good characteristics for hemodialysis without an increased risk of AVF related complications during a median 19-month observation period. BC-AVF did not feature high flow-related complications with the multimodal approach, including preoperative exercise, intraoperative flow assessment to guarantee an adequate flow rate, postoperative exercise, and medications.

Microfluidic Thermal Flowmeters for Drug Injection Monitoring.

This paper presents a microfluidic thermal flowmeter for monitoring injection pumps, which is essential to ensure proper patient treatment and reduce medication errors that can lead to severe injury or death. The standard gravimetric method for flow-rate monitoring requires a great deal of preparation and laboratory equipment and is impractical in clinics. Therefore, an alternative to the standard method suitable for remote, small-scale, and frequent infusion-pump monitoring is in great demand. Here, we propose a miniaturized thermal flowmeter consisting of a silicon substrate, a platinum heater layer on a silicon dioxide thin-membrane, and a polymer microchannel to provide accurate flow-rate measurement. The present thermal flowmeter is fabricated by the micromachining and micromolding process and exhibits sensitivity, linearity, and uncertainty of 0.722 mW/(g/h), 98.7%, and (2.36 ± 0.80)%, respectively, in the flow-rate range of 0.5-2.5 g/h when the flowmeter is operated in the constant temperature mode with the channel width of 0.5 mm. The measurement range of flow rate can be easily adjusted by changing the cross-sectional microchannel dimension. The present miniaturized thermal flowmeter shows a high potential for infusion-pump calibration in clinical settings.

Design and Implementation of an Ultrasonic Flowmeter Based on the Cross-Correlation Method.

Ultrasonic flowmeters play an important role in industrial production, aerospace and other fields. In this paper, a high-precision ultrasonic flowmeter based on the cross-correlation method is designed, and the commercial finite element software COMSOL Multiphysics 5.6 is used to simulate the propagation process of ultrasonic waves during flow measurement, and the implementation process of the cross-correlation algorithm is simulated by Python language. The flowmeter adopts the cross-correlation algorithm to improve the measurement accuracy of ultrasonic time of flight and adopts the method of combining FPGA and an embedded microprocessor to improve operation efficiency. In order to verify the performance of the flowmeter, we tested the flowmeter on the National Institute of Metrology and the self-built test platform, using the still water dragging method, the dynamic volume method and the field comparison method, respectively. The results show that the flowmeter has the ability to test the flow under the condition of high flow velocity (26 m/s) and a pipe diameter in the range of DN6~DN1600, that the absolute value of the relative indication error does not exceed 0.815% and that the repeatability does not exceed 0.150%. The designed ultrasonic flowmeter has high measurement accuracy, good repeatability, strong stability and a wide application range.

CFD Model of a Mechanical Oscillator Flowmeter.

Most of the studies on mechanical oscillator flowmeters were conducted in the '80s and '90s when computational fluid dynamics (CFD) was not a viable scientific tool in flow metrology. Still, many topics related to the application of mechanical oscillator flowmeters require further investigation. In the article, a numerical model of a mechanical oscillator flowmeter is developed with the commercial software ANSYS Fluent. The model is validated against experimental data obtained at a water calibration stand. The influence of the selected turbulence model, dynamic mesh method, as well as grid and time step size is studied. The model's qualitative behavior is correct, allowing investigation into the flowmeter operation in detail. It can provide a base for the improvement of the flowmeter's performance. Relative differences in the frequency of oscillations did not exceed 4% for a DN50 flowmeter in the flow rate range (2-40) m3/h.

Gingival blood flow before, during, and after clenching, measured by laser Doppler blood flowmeter: A pilot study.

INTRODUCTION: This study aimed to investigate the effects of the strong occlusal force on the hemodynamics of gingival microcirculation. METHODS: Eleven adult volunteers with healthy periodontium and normal occlusion participated in this study. Using a noncontact laser Doppler flowmeter placed at the attached gingiva and the interdental papilla of the maxillary first premolar, changes in gingival blood flow (GBF) were examined during and after clenching. RESULTS: When the strong occlusal pressure was applied on the maxillary first premolar by clenching, GBF in the attached gingiva on the buccal side decreased significantly compared with the resting GBF, with medians of 2.3 mL/min/100 g and 5.4 mL/min/100 g, respectively (P <0.05). After the release of the maximum clenching, GBF recovered immediately and transiently increased to a median of 2.4 mL/min/100 g, showing a significant difference to the resting GBF (P <0.05). In contrast, in the interdental papilla, no significant change in GBF was found by clenching. CONCLUSIONS: Ischemia of the buccal attached gingiva associated with strong clenching may be due to compression of the vascular network of the periodontal membrane. Through reactive hyperemia resulting from the release of clenching, it is possible not only that blood flow will be restored to the tissue but that the tissue itself may be damaged by the reperfusion. During active orthodontic treatment, it is suggested that occlusal management to prevent occlusal trauma is important to avoid detrimental effects on periodontal tissues.

A Rapid Prototyped Thermal Mass Flowmeter.

An innovative rapid prototyping technique for embedding microcomponents in PDMS replicas was developed and applied on a thermal mass flowmeter for closed loop micropump flowrate control. Crucial flowmeter design and thermal parameters were investigated with a 3-D fully coupled electro-thermal-fluidic model which was built in Comsol Multiphysics 5.2. The flowmeter was characterized for three distinct measuring configurations. For precise low flowrate applications, a sensor-heater-sensor flowmeter configuration with a constant heater temperature was found to be the most appropriate yielding the measuring range of 0 to 90 µL·min-1 and the sensitivity of 1.3 °C·µL-1·min in the lower flowrate range of 0 to 40 µL·min-1.

Non-Singleton Type-3 Fuzzy Approach for Flowmeter Fault Detection: Experimental Study in a Gas Industry.

The main contribution of this paper is to develop a new flowmeter fault detection approach based on optimized non-singleton type-3 (NT3) fuzzy logic systems (FLSs). The introduced method is implemented on an experimental gas industry plant. The system is modeled by NT3FLSs, and the faults are detected by comparison of measured end estimated signals. In this scheme, the detecting performance depends on the estimation and modeling performance. The suggested NT3FLS is used because of the existence of a high level of measurement errors and uncertainties in this problem. The designed NT3FLS with uncertain footprint-of-uncertainty (FOU), fuzzy secondary memberships and adaptive non-singleton fuzzification results in a powerful tool for modeling signals immersed in noise and error. The level of non-singleton fuzzification and membership parameters are tuned by maximum correntropy (MC) unscented Kalman filter (KF), and the rule parameters are learned by correntropy KF (CKF) with fuzzy kernel size. The suggested learning algorithms can handle the non-Gaussian noises that are common in industrial applications. The various types of flowmeters are investigated, and the effect of common faults are examined. It is shown that the suggested approach can detect the various faults with good accuracy in comparison with conventional approaches.

Assessment of Dynamic Properties of Variable Area Flowmeters.

In previous works, a non-linear equation describing variable area (VA) flowmeters in transient was presented. The use of a full nonlinear equation, despite giving accurate results, can be difficult and time-consuming and it requires having specific software and knowledge at one's disposal. The goal of this paper was to simplify the existing model so that it could be used in applications where ease of use and ease of implementation are more important than accuracy. The existing model was linearized and simple formulae describing natural frequency and damping coefficients were derived. With these parameters, it is possible to assess the dynamic properties of a variable area flowmeter. The step response form can be identified and natural frequency and settling time can be estimated. The linearized model and the experiment were in reasonable agreement. The step response type was captured correctly for each of the six VA meter types. The error in the undamped natural frequency was not larger than 15%, which means that the VA meter sensor's dynamic properties can be predicted at the design stage with sufficient precision.

A Four-Channel Low-Noise Readout IC for Air Flow Measurement Using Hot Wire Anemometer in 0.18 µm CMOS Technology.

Air flow measurements provide significant information required for understanding the characteristics of insect movement. This study proposes a four-channel low-noise readout integrated circuit (IC) in order to measure air flow (air velocity), which can be beneficial to insect biomimetic robot systems that have been studied recently. Instrumentation amplifiers (IAs) with low-noise characteristics in readout ICs are essential because the air flow of an insect's movement, which is electrically converted using a microelectromechanical systems (MEMS) sensor, generally produces a small signal. The fundamental architecture employed in the readout IC is a three op amp IA, and it accomplishes low-noise characteristics by chopping. Moreover, the readout IC has a four-channel input structure and implements an automatic offset calibration loop (AOCL) for input offset correction. The AOCL based on the binary search logic adjusts the output offset by controlling the input voltage bias generated by the R-2R digital-to-analog converter (DAC). The electrically converted air flow signal is amplified using a three op amp IA, which is passed through a low-pass filter (LPF) for ripple rejection that is generated by chopping, and converted to a digital code by a 12-bit successive approximation register (SAR) analog-to-digital converter (ADC). Furthermore, the readout IC contains a low-dropout (LDO) regulator that enables the supply voltage to drive digital circuits, and a serial peripheral interface (SPI) for digital communication. The readout IC is designed with a 0.18 µm CMOS process and the current consumption is 1.886 mA at 3.3 V supply voltage. The IC has an active area of 6.78 mm2 and input-referred noise (IRN) characteristics of 95.4 nV/√Hz at 1 Hz.

Thorpe tube and oxygen flow restrictor: what's flow accuracy?

Oxygen gas flowmeters (OGF) are used to regulate the oxygen flow in acute and chronic care. In hospitals, Thorpe tubes (TT) are the classical systems most used for delivering oxygen. In recent years, the oxygen flow restrictor (OFR) has appeared. These devices use a series of calibrated openings in a disk that can be adjusted to deliver different flow rates. These devices have a reputation for delivering more accurate oxygen flow rates compared to classical OGFs. However, to our knowledge, few study has examined this supposition. This study aimed to compare and evaluate the accuracy and precision of the ready-to-use TTs and OFRs. OGFs were selected from hospitals in Belgium and France. Before performing the flow measurements, the inlet pressure was checked. The accuracy of the OGF was analyzed with a calibrated thermal mass flowmeter (RED Y COMPACT™ GCM-0 to 20 L/min-VÖGTLIN Instruments). Different flows (2, 4, 6, 9 or 12 L/min) were evaluated. Linear regression analysis, bias (with confidence interval) and lower and upper limit of the agreement were calculated for TTs and OFRs. All measurements are expressed in absolute values. Four-hundred-seventy-six TTs and 96 OFRs were analyzed. The intra-class correlation coefficient calculated for the calibrated thermal mass flowmeter was > 0.99 and reflected the excellent reliability of our measurements. For TTs, the bias value was - 0.24 L/min (± 0.88), and the limits of agreement were - 1.97 to 1.48 L/min. For OFRs, the bias value was - 0.30 L/min (± 0.54), and the limits of agreement were - 1.36 to 0.77 L/min. As the flow increased, the accuracy of all analyzed OGFs decreased. With the increasing flow, some data fell outside the limits of agreement, and the trend increased with the elevated oxygen flow. TTs were less accurate compared to OFRs due to the increased flow variability. However, for TTs and OFRs, as the required flow is elevated, the dispersion of values increases on both sides of the actual flow.

Handheld flow meter improves COPD detectability regardless of using a conventional questionnaire: A split-sample validation study.

BACKGROUND AND OBJECTIVE: Improved detectability of chronic obstructive pulmonary disease (COPD) using a handheld flow meter (HFM) with symptom-based questionnaires has not been sufficiently evaluated. This study aimed to identify the benefit of using an HFM in COPD screening. METHODS: A total of 2008 participants, who were ≥ 40 years of age, from Isumi City, Japan, were recruited. We developed two novel point systems for detecting COPD, one incorporated score of HFM alone (sHFM) and the other incorporated the score of International Primary Care Airway Group questionnaire (IPAG) and HFM (sIPAG + HFM). Validation using random sample allocation (split-sample validation) was carried out to assess the predictive performance of these models. RESULTS: Participants were assigned to a data set for model creation (n = 1007) or a data set for model assessment (n = 1001) to perform split-sample validation. Decision curve analysis showed that the net benefits of sHFM and sIPAG + HFM were higher than that of the IPAG score (sIPAG) and specificity of the former two were also significantly higher than that of sIPAG. However, the curves of sHFM and sIPAG + HFM were crossing and practically the same with no significant difference in sensitivity and specificity. CONCLUSION: This study confirms that HFM is significantly advantageous in detecting COPD despite the use of a conventional questionnaire.

Real-Time Measurement of Xenon Concentration in a Binary Gas Mixture Using a Modified Ultrasonic Time-of-Flight Anesthesia Gas Flowmeter: A Technical Feasibility Study.

BACKGROUND: Xenon (Xe) is an anesthetic gas licensed for use in some countries. Fractional concentrations (%) of gases in a Xe:oxygen (O2) mixture are typically measured using a thermal conductivity meter and fuel cell, respectively. Speed of sound in such a binary gas mixture is related to fractional concentration, temperature, pressure, and molar masses of the component gases. We therefore performed a study to assess the feasibility of developing a novel single sterilizable device that uses ultrasound time-of-flight to measure both real-time flowmetry and fractional gas concentration of Xe in O2. METHODS: For the purposes of the feasibility study, we adapted an ultrasonic time-of-flight flowmeter from a conventional anesthetic machine to additionally measure real-time fractional concentration of Xe in O2. A total of 5095 readings of Xe % were taken in the range 5%-95%, and compared with simultaneous measurements from the gold standard of a commercially available thermal conductivity Xe analyzer. RESULTS: Ultrasonic measurements of Xe (%) showed agreement with thermal conductivity meter measurements, but there was marked discontinuity in the middle of the measurement range. Bland-Altman analysis (95% confidence interval in parentheses) yielded: mean difference (bias) 3.1% (2.9%-3.2%); lower 95% limit of agreement -4.6% (-4.8% to -4.4%); and upper 95% limit of agreement 10.8% (10.5%-11.0%). CONCLUSIONS: The adapted ultrasonic flowmeter estimated Xe (%), but the level of accuracy is insufficient for clinical use. With further work, it may be possible to develop a device to perform both flowmetry and binary gas concentration measurement to a clinically acceptable degree of accuracy.

A Device for the Quantification of Oxygen Consumption and Caloric Expenditure in the Neonatal Range.

BACKGROUND: The accurate measurement of oxygen consumption (VO2) and energy expenditure (EE) may be helpful to optimize the treatment of critically ill patients. However, current techniques are limited in their ability to accurately quantify these end points in infants due to a low VO2, low tidal volume, and rapid respiratory rate. This study describes and validates a new device intended to perform in this size range. METHODS: We created a customized device that quantifies inspiratory volume using a pneumotachometer and concentrations of oxygen and carbon dioxide gas in the inspiratory and expiratory limbs. We created a customized algorithm to achieve precise time alignment of these measures, incorporating bias flow and compliance factors. The device was validated in 3 ways. First, we infused a certified gas mixture (50% oxygen/50% carbon dioxide) into an artificial lung circuit, comparing measured with simulated VO2 and carbon dioxide production (VCO2) within a matrix of varying tidal volume (4-20 mL), respiratory rate (20-80 bpm), and fraction of inspired oxygen (0.21-0.8). Second, VO2, VCO2, and EE were measured in Sprague Dawley rats under mechanical ventilation and were compared to simultaneous Douglas bag collections. Third, the device was studied on n = 14 intubated, spontaneously breathing neonates and infants, comparing measured values to Douglas measurements. In all cases, we assessed for difference between the device and reference standard by linear regression and Bland-Altman analysis. RESULTS: In vitro, the mean ± standard deviation difference between the measured and reference standard VO2 was +0.04 ± 1.10 (95% limits of agreement, -2.11 to +2.20) mL/min and VCO2 was +0.26 ± 0.31 (-0.36 to +0.89) mL/min; differences were similar at each respiratory rate and tidal volume measured, but higher at fraction of inspired oxygen of 0.8 than at 0.7 or lower. In rodents, the mean difference was -0.20 ± 0.55 (-1.28 to +0.89) mL/min for VO2, +0.16 ± 0.25 (-0.32 to +0.65) mL/min for VCO2, and -0.84 ± 3.29 (-7.30 to +5.61) kcal/d for EE. In infants, the mean VO2 was 9.0 ± 2.5 mL/kg/min by Douglas method and was accurately measured by the device (bias, +0.22 ± 0.87 [-1.49 to +1.93] mL/kg/min). The average VCO2 was 8.1 ± 2.3 mL/kg/min, and the device exhibited a bias of +0.33 ± 0.82 (-1.27 to +1.94) mL/kg/min. Mean bias was +2.56% ± 11.60% of the reading for VO2 and +4.25% ± 11.20% of the reading for VCO2; among 56 replicates, 6 measurements fell outside of the 20% error range, and no patient had >1 of 4 replicates with a >20% error in either VO2 or VCO2. CONCLUSIONS: This device can measure VO2, VCO2, and EE with sufficient accuracy for clinical decision-making within the neonatal and pediatric size range, including in the setting of tachypnea or hyperoxia.

A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart.

The revision of an internal mammary artery graft anastomosis because of a technical error can be time-consuming and complicated and may lead to complications. Here, we describe the technical details and our early experience of using a standard transit-time flowmeter to exclude technical errors and facilitate rapid decision making for anastomosis revision in an arrested heart during aortic cross-clamping in the absence of ultrasound guidance.

On accuracy and precision of flowmeters used for oxygen therapy in a veterinary teaching hospital.

OBJECTIVE: To determine the accuracy and precision of flowmeters used for oxygen therapy in a veterinary teaching hospital. STUDY DESIGN: An observational study. METHODS: A total of 50 flowmeters used for oxygen therapy were evaluated using Defender 530 gas flow analyzers to measure flow. For each flowmeter, a minimum of seven flow settings were tested in random order and in triplicate. Flow measured at ambient conditions was converted to standardized flow specifications (21.1 °C and 760 mmHg) and analyzed using general linear mixed models. Flowmeters were considered accurate at a given flow setting when the targeted mean flow was within the corresponding 95% confidence interval. Precision of flow was characterized based on the magnitude of variance component estimates. RESULTS: Flowmeters of 1.0, 3.5 and 8.0 L minute-1 were considered accurate across flow settings corresponding to their capacity range. Flowmeters of 7.0 and 15.0 L minute-1 were accurate at flow settings ≤2.0 L minute-1. For flow settings ≥3.0 L minute-1, average oxygen flow was consistently below reference values. Precision varied with the capacity of the flowmeter, ranked by decreasing precision as 1.0 > 3.5 > 8.0 > 7.0 > 15.0 L minute-1. CONCLUSIONS AND CLINICAL RELEVANCE: A flowmeter of the smallest maximum capacity within the desired flow range is more appropriate for smaller patients where accurate, precise flow delivery is needed. Although 15.0 L minute-1 flowmeters were accurate at flow settings ≤2.0 L minute-1, the graduated increments do not allow exact flow settings <0.5 L minute-1. Flowmeters of 15 L minute-1 capacity should be useful for high-flow oxygen delivery for which accuracy and precision are not critical.

Effect of cleaning status on accuracy and precision of oxygen flowmeters of various ages.

OBJECTIVE: To evaluate oxygen flowmeters for accuracy and precision, assess the effects of cleaning and assess conformity to the American Society for Testing Materials (ASTM) standards. STUDY DESIGN: Experimental study. METHODS: The flow of oxygen flowmeters from 31 anesthesia machines aged 1-45 years was measured before and after cleaning using a volumetric flow analyzer set at 0.5, 1.0, 2.0, 3.0, and 4.0 L minute-1. A general linear mixed models approach was used to assess flow accuracy and precision. RESULTS: Flowmeters 1 year of age delivered accurate mean oxygen flows at all settings regardless of cleaning status. Flowmeters ≥5 years of age underdelivered at flows of 3.0 and 4.0 L minute-1. Flowmeters ≥12 years underdelivered at flows of 2.0, 3.0 and 4.0 L minute-1 prior to cleaning. There was no evidence of any beneficial effect of cleaning on accuracy of flowmeters 5-12 years of age (p > 0.22), but the accuracy of flowmeters ≥15 years of age was improved by cleaning (p < 0.05). Regardless of age, cleaning increased precision, decreasing flow variability by approximately 17%. Nine of 31 uncleaned flowmeters did not meet ASTM standards. After cleaning, a different set of nine flowmeters did not meet standards, including three that had met standards prior to cleaning. CONCLUSIONS: Older flowmeters were more likely to underdeliver oxygen, especially at higher flows. Regardless of age, cleaning decreased flow variability, improving precision. However, flowmeters still may fail to meet ASTM standards, regardless of cleaning status. CLINICAL RELEVANCE: Cleaning anesthesia machine oxygen flowmeters improved precision for all tested machines and partially corrected inaccuracies in flowmeters ≥15 years old. A notable proportion of flowmeters did not meet ASTM standards. Cleaning did not ensure that they subsequently conformed to ASTM standards. We recommend annual flow output validation to identify whether flowmeters are acceptable for continued clinical use.

The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator.

OBJECTIVE: The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. STUDY DESIGN: Prospective, experimental clinical study. METHODS: Participants included veterinary students at the beginning (group S1) and end (group S2) of their 2-week anaesthesia rotation and veterinary anaesthetists (group A). The feline airway simulator was designed to simulate an average size feline trachea, intubated with a 4.5 mm low-pressure, high-volume cuffed endotracheal tube, connected to a Bain breathing system with oxygen flow of 2 L minute-1. Participants inflated the on-endotracheal tube cuff by pilot balloon palpation and by instilling the minimum occlusive volume (MOV) required for loss of airway leaks during manual ventilation. Intracuff pressures were measured by manometers obscured to participants and ideally were 20-30 cm H2O. Student t, Fisher exact, and Chi-squared tests were used where appropriate to analyse data (p < 0.05). RESULTS: Participants were 12 students and eight anaesthetists. Measured intracuff pressures for palpation and MOV, respectively, were 19 ± 12 and 29 ± 19 cm H2O for group S1, 10 ± 5 and 20 ± 11 cm H2O for group S2 and 13 ± 6 and 29 ± 18 cm H2O for group A. All groups performed poorly at achieving intracuff pressures within the ideal range. There was no significant difference in intracuff pressures between techniques. Students administered lower (p = 0.02) intracuff pressures using palpation after their training. CONCLUSIONS AND CLINICAL RELEVANCE: When using palpation and MOV for cuff inflation operators rarely achieved optimal intracuff pressures. Experience had no effect on this skill and, as such, a cuff manometer is recommended.

Four-dimensional flow MRI for evaluation of post-stenotic turbulent flow in a phantom: comparison with flowmeter and computational fluid dynamics.

OBJECTIVES: To validate 4D flow MRI in a flow phantom using a flowmeter and computational fluid dynamics (CFD) as reference. METHODS: Validation of 4D flow MRI was performed using flow phantoms with 75 % and 90 % stenosis. The effect of spatial resolution on flow rate, peak velocity and flow patterns was investigated in coronal and axial scans. The accuracy of flow rate with 4D flow MRI was evaluated using a flowmeter as reference, and the peak velocity and flow patterns obtained were compared with CFD analysis results. RESULTS: 4D flow MRI accurately measured the flow rate in proximal and distal regions of the stenosis (percent error ≤3.6 % in axial scanning with 1.6-mm resolution). The peak velocity of 4D flow MRI was underestimated by more than 22.8 %, especially from the second half of the stenosis. With 1-mm isotropic resolution, the maximum thickness of the recirculating flow region was estimated within a 1-mm difference, but the turbulent velocity fluctuations mostly disappeared in the post-stenotic region. CONCLUSION: 4D flow MRI accurately measures the flow rates in the proximal and distal regions of a stenosis in axial scan but has limitations in its estimation of peak velocity and turbulent characteristics. KEY POINTS: • 4D flow MRI accurately measures the flow rate in axial scan. • The peak velocity was underestimated by 4D flow MRI. •4D flow MRI demonstrates the principal pattern of post-stenotic flow.