An electrode array that minimizes blood loss for radiofrequency-assisted hepatic resection.

Hepatic resection is currently the standard treatment for liver cancer. During hepatic resection part of the liver containing the tumor is surgically removed. This type of surgery is accompanied by high blood loss of approximately 0.6-1.35 L. Blood loss is associated with increased complication rates, prolonged hospital stay, and reduced patient survival, especially when transfusion is required. Other researchers have suggested using radiofrequency (rf) or microwave ablation to coagulate a tissue slice before resection to reduce blood loss, but conventional devices typically take several hours. We developed a device consisting of a linear array of blade-shaped, 1 cm wide radiofrequency (rf) electrodes 1.5 cm apart. Bipolar rf power is applied between pairs of adjacent electrodes, leading to high tissue temperatures between the electrodes that promote coagulation of large vessels (>3 mm) in the resection plane. Rapid switching of applied power between pairs of adjacent electrodes allows simultaneous heating and coagulation of the entire resection plane within 3-6 min. In seven in vivo trials in a porcine model, resection along a plane pre-coagulated with the device resulted in little (<20 mL) to no blood loss, while coagulating all vessels (up to 4.5 mm diameter in this study). Average treatment time (from placement of the device to transection) was 6.8+/-0.5 min when four electrodes were used, and 11.3+/-1.2 min when 5-7 electrodes were used. This device may reduce blood loss related morbidity during resection and reduce treatment time by coagulating all vessels in the resection plane.

Simultaneous comparison of 1 gel with 4 dry electrode types for electrocardiography.

We designed a spandex tank top with dry electrodes for continuous electrocardiogram (ECG) recording. This pilot study determined the best fabric, the best electrode types, sizes, and locations. Optimal electrodes provide high signal to artifact ratio (SAR) and reliability by meeting the following criteria: 1) low baseline shift, 2) high adhesion, 3) good physical stability, 4) large effective area, 5) thin with high flexibility (Luo et al 1992). We compared electrodes from three main groups: Ag/AgCl gel electrode, commercial conductive rubber and foam-metal based electrodes. Ag/AgCl gel electrodes are easy to apply, make good body contact and do not slip during the course of an experiment. We found that higher SARs are obtained when electrode area is increased (40 mm diameter) and the two dry measurement electrodes are located on convex areas (over chest muscle) rather than concave areas (over sternum), so the spandex will apply light pressure to the dry electrode to yield good electrode to skin contact. We experimentally validated findings with 24 subjects: 12 men and 12 women wearing the tank top with gel and dry electrodes, by monitoring movements imitating daily life while continuously recording their ECGs.

An impedance method for blood pressure measurement in awake rats without preheating.

The tail-cuff methods for measuring systolic blood pressure in the rat usually require preheating of the animal to obtain recordable pulse signals. To find a more sensitive method, we applied the principle of differentiated impedance (dZ/dt) to the tail-cuff measurement of systolic blood pressure. We obtained clear pulse signals from the tail in awake rats without preheating the animals, and the systolic blood pressure obtained by this method had an excellent correlation with the directly measured femoral artery pressure (correlation coefficient = 0.98). Heating the animals at 40 degrees C for 5 minutes increased systolic blood pressure by a mean of 6 mm Hg as compared with that determined at the ambient temperature of 21 to 24 degrees C. Mean systolic blood pressure in young female diabetic rats was 122 +/- 3 mm Hg, which was significantly higher than the 111 +/- 2 mm Hg of normal rats. It is concluded that the technique of electrical impedance as applied to the tail-cuff method is simple and highly sensitive and is suitable for measurement of tail systolic blood pressure in awake rats without preheating.

Improved methods to determine optimal currents in electrical impedance tomography.

An electrical impedance tomography (EIT) system that uses the optimal current method to inject currents and the regularized Newton-Raphson algorithm to reconstruct an image of resistivity distribution is discussed. Iterative methods to derive the optimal current patterns through iterative physical measurements are developed. Direct methods to first determine the resistance matrix of a resistivity distribution through a set of current bases is injected and the measured voltage responses are stored. This permits iterative reconstruction techniques to operate on the stored data without requiring lengthy data taking from the object and reduces the effects of motion artifacts. The direct methods have superior performance as compared to the iterative methods in both optimal current and voltage generation. The results obtained with three sets of current bases are studied.

Iterative reconstruction methods using regularization and optimal current patterns in electrical impedance tomography.

An iterative reconstruction method which minimizes the effects of ill-conditioning is discussed. Based on the modified Newton-Raphson algorithm, a regularization method which integrates prior information into the image reconstruction was developed. This improves the conditioning of the information matrix in the modified Newton-Raphson algorithm. Optimal current patterns were used to obtain voltages with maximal signal-to-noise ratio (SNR). A complete finite element model (FEM) was used for both the internal and the boundary electric fields. Reconstructed images from phantom data show that the use of regularization optimal current patterns, and a complete FEM model improves image accuracy. The authors also investigated factors affecting the image quality of the iterative algorithm such as the initial guess, image iteration, and optimal current updating.

A robust image reconstruction algorithm and its parallel implementation in electrical impedance tomography.

An efficient and robust image reconstruction algorithm for static impedance imaging using Hachtel's augmented matrix method was developed. This improved Newton-Raphson method produced more accurate images by reducing the undesirable effects of the ill-conditioned Hessian matrix. It is demonstrated that the electrical impedance tomography (EIT) system could produce two-dimensional static images from a physical phantom with 7% spatial resolution at the center and 5% at the periphery. Static EIT image reconstruction requires a large amount of computation. In order to overcome the limitations on reducing the computation time by algorithmic approaches, the improved Newton-Raphson algorithm was implemented on a parallel computer system. It is shown that the parallel computation could reduce the computation time from hours to minutes.

Walsh function current patterns and data synthesis for electrical impedance tomography.

A data collection method which uses Walsh functions as injection current patterns is presented. This method can satisfy two conditions: the optimality of current patterns in every iteration and the single-time data measurement condition. The use of Walsh functions simplifies the design of current sources since only two levels of current (+1 and -1) are required, whereas sinusoidal injection requires a digital-to-analog converter to produce many different values of currents. Compared to diagonal or neighboring type of pulses as injection current patterns, Walsh injection current patterns provide more information about the interior of the subject since Walsh function simulate low and high spatial frequency patterns. Therefore, Walsh function injection uses the simplicity of pulse type injection and yields the better distinguishability or SNR of sinusoidal injection.

Estimation of energy expenditure by a portable accelerometer.

A small portable accelerometer was developed to estimate the energy expenditure of daily activities. The accelerometer is reported to be an improvement over movement counters currently on the market. The oxygen requirement of 14 different activities was measured in 21 subjects while each wore the accelerometer on the waist. A movement counter (mercury switch), which is available commercially, was also worn on the waist and another was worn on the left wrist. The reproducibility of the accelerometer readings was high (4 subjects, 14 activities; r = 0.94) and was superior to either the waist movement counter (r = 0.63) or the wrist movement counter (r = 0.74). In estimating oxygen requirement (VO2) the standard error of estimate, based on 21 subjects and 14 activities, was 6.6 ml X min-1 X kg-1 for the accelerometer. This was also better (smaller) than for the waist movement counter (9.2 ml X min-1 X kg-1) or for the wrist movement counter (7.9 ml X min-1 X kg-1).

A conductive polymer sensor for measuring external finger forces.

This paper describes the construction and use of a durable and thin force sensor that can be attached to the palmar surface of the fingers and hands for studying the biomechanics of grasp and for use in hand injury rehabilitation. These force sensors were constructed using a modified commercially available conductive polymer pressure sensing element and installing an epoxy dome for directing applied forces through a 12 mm diameter active sensing area. The installation of an epoxy dome was effective for making the sensors insensitive to contact surfaces varying from 25 to 1100 mm2 and a 16 mm radius surface curved convex towards the finger. The completed sensors were only 1.8 mm thick and capable of being taped to the distal phalangeal finger pads. They were calibrated on the hand by pinching a strain gage dynamometer. The useful range was between 0 and 30 N with an accuracy of 1 N for both static loading and normal dynamic grasp activities. The sensor time constant was 0.54 ms for a step force input. Because of varying offset voltages every time the sensors were attached, these sensors should be calibrated on the hand before each use. The sensors were used for measuring finger forces during controlled pinching and lifting tasks, and during ordinary grasping activities, such as picking up a book or a box, where the useful force range and response for these sensors were adequate.

A database of cardiac arrhythmias.

OBJECTIVE: To describe a database of cardiac arrhythmia recordings, useful for the development and testing of ECG rhythm processing or monitoring algorithms and devices. METHODS: The raw data were acquired within the Wisconsin-Dane County emergency medical technician-defibrillation program and contained emergency rhythm recordings of an average length of 30 minutes. The raw data were integrated into a software platform designed for the annotation and visualization of the recordings. RESULTS: Currently the database contains the following arrhythmia episodes: ventricular fibrillation (56), asystole (65), electromechanical dissociation (31), and other arrhythmias (42). The software, resident on personal computers, also can transmit any of the database recordings, through a digital-to-analog converter board, to a device under test. CONCLUSIONS: The database technique described will provide a useful means of objectively assessing electronic devices for their ability to detect arrhythmias. The database is unique in that it contains lengthy episodes of arrhythmias. The database will be extended to include additional cases.

Signal-to-motion artifact ratio versus frequency for impedance pneumography.

We measured transthoracic impedance between 12.5 and 185 kHz in nine adults. We used a system with two impedance channels, both simultaneously detecting the real part of impedance at two different frequencies. We used only two electrodes in the midaxillary line, connecting both channels in parallel. The amplitude relation between the two channels was measured for different maneuvers and frequencies. Results show for normal breathing an increase of the signal of 20% and a decrease in motion artifacts from 12.5 to 185 kHz. We conclude that, for the maneuvers studied, it is better to work at higher frequencies than the ones commonly used. Also, we suggest a method to further increase the signal-to-motion artifact ratio based on measurement at two frequencies.

Bioelectric impedance measurements using synchronous sampling.

We have applied synchronous sampling to the demodulation of bioelectric impedance signals. This overcomes the need for analog demodulators in bioimpedance measurements. The sampling rate is determined by signal bandwidth, rather than by the highest frequency component before demodulation.

AC instrumentation amplifier for bioimpedance measurements.

We analyze the input impedance and CMRR requirements for an amplifier for bioimpedance measurements when considering the capacitive components of the electrode-skin contact impedance. We describe an ac-coupled instrumentation amplifier (IA) that, in addition to fulfilling those requirements, both provides interference and noise reduction, and yields a zero phase shift over a wide frequency band without using broadband op amps.

Noninvasive measurement of compliance of human leg arteries.

Electrical impedance plethysmography has been evaluated for early detection of peripheral atherosclerosis. A pressure cuff was wrapped around the lower leg and the cuff pressure increased. Two circumferential electrodes glued in the middle of the cuff recorded the impedance pulse, from which the arterial pulse volume was calculated. The ratio of maximal arterial volume change to the pulse pressure was determined as a measure of maximal compliance Cp. Based on the data from 118 human subjects, Cp was found to correlate well with known cardiovascular risk factors. For example, Cp decreased on the average from 3.08 to 1.92 microL.mm Hg-1.cm-1 (1 microL.mm Hg-1.cm-1 = 7.5 x 10(-10) m4.N-1) in groups of subjects of increasing age from 22 to 70 years. Subjects on a regular exercise program had an average value of 3.86, while those with proven peripheral vascular disease had a value of 0.70. In a related pathologic validation study on 15 monkeys fed a cholesterol-control diet a good correlation was found between the limb peak compliance and morphometric data obtained from iliac and carotid arteries.

Reduction of motion artifacts using a two-frequency impedance plethysmograph and adaptive filtering.

We measured transthoracic impedance in nine presumed healthy adult subjects with a two-frequency plethysmograph at 57 kHz and 185 kHz. The measurement protocol included periods of normal breathing without motion and periods of motion without breathing. We analyzed the cross-correlation and the ratio between the signals at both frequencies for all the different maneuvers. The correlation coefficient was between 0.97 and 1 for breathing, the minimal cross-correlation (0.81) was for simulated obstructive apnea. We found that the amplitude ratio between the two-frequency signals was different for normal breathing and for motion. Based on these results, we designed and tested an adaptive filter to increase the signal-to-artifact ratio (SAR). The increase in SAR (mean +/- standard deviation) compared with the signal at 57 kHz was: 183% +/- 117% for arm movement, 133% +/- 93% for leg movement, and 34% +/- 62% for simulated obstructive apnea.

Modeling current density distributions during transcutaneous cardiac pacing.

We developed a two-dimensional finite element model of a cross-section of the human thorax to study the current density distribution during transcutaneous cardiac pacing. The model comprises 964 nodes and 1842 elements and accounted for the electrical properties of eight different tissues or organs and also simulated the anisotropies of the intercostal muscles. The finite element software employed was a version for electrokinetics problems of Finite Element for Heat Transfer (FEHT) and we assessed the effects upon the efficacy of transcutaneous cardiac pacing of several electrode placements and sizes. To minimize pain in the chest wall and still be able to capture the heart, we minimized the ratio, R, between the current density in the thoracic wall (which causes pain) and the current density in the heart wall (which captures the heart). The best placement of the negative electrode was over the cardiac apex. The best placement of the positive electrode was under the right scapula, although other placements were nearly as good. The efficiency of pacing increased as electrode size increased up to 70 cm2 and showed little improvement for larger areas. Between different configurations of the precordial electrodes V1, V2, ..., V6 the most efficient configuration to pace with was V1 and V2 positive and V5 and V6 negative. A more efficient configuration uses an auxiliary electrode located at the right subscapular region.

A nonlinear electrical-thermal model of the skin.

This work presents a model for the skin which accounts for both the nonlinearities and the asymmetries in its voltage-current characteristic. This model consists of an electrical submodel and a heat transfer submodel. The electrical submodel uses nonlinear devices in which some parameters depend on skin temperature. The heat transfer submodel models the heat exchange between the skin, the surrounding tissues, and the ambient medium and calculates the temperature of the skin to update the necessary parameters of the electrical submodel. The model is based on experiments designed to determine: 1) the dry skin voltage-current characteristic; 2) the changes in the skin breakdown voltage with location; 3) the moist skin voltage-current characteristic; 4) the changes in the voltage-current characteristic of the skin with duration after the onset of stimulation; and 5) the effect of skin temperature on its voltage-current characteristic. During these experiments we used 84-mm2 square Ag-AgCl electrodes to apply sinusoidal voltage of 0.2 and 20 Hz. The simulations were performed using the Advanced Continuous Simulation Language (ACSL), capable of solving differential and integral equations with variable coefficients. The model predicted the skin behavior satisfactorily for a large range of amplitudes and frequencies. We found that the breakdown occurred when the energy delivered to the skin exceeded a threshold. Above this threshold the voltage-current characteristic of the skin became nonlinear and asymmetric and, in a real situation, the subject would experience an uncomfortable sensation which could rapidly develop into pain.

A nonlinear finite element model of the electrode-electrolyte-skin system.

This study presents a two-dimensional finite element model of the electrode-electrolyte-skin system which takes into account the nonlinear behavior of the skin with respect to the amplitude of the voltage. The nonlinear modeling approach has practical value for studies related to transcutaneous stimulation (e.g. maximizing the dynamic range of sensory substitution systems, optimization of TENS, optimization of transcutaneous cardiac pacing, etc.). The model has three main regions: 1) the electrolyte; 2) the skin; and 3) the body. The model consists of 364 nodes, 690 elements and was generated on a MacIntosh II using a version of FEHT (Finite Element for Heat Transfer) adapted for electromagnetics. The electrodes are equipotential lines and the electrolyte is modeled as a pure resistive region with constant conductivity. Although the electrode-electrolyte interface can introduce nonlinearities, we did not take them into account because the skin displays a much higher impedance. The skin is modeled as a nonlinear material with the conductivity dependent on the applied voltage. To account for the mosaic structure of the skin, we used ten different nonlinear subregions of five different values of breakdown voltage. The region designated "body" models the effects of the resistance associated with the dermis and the tissues underneath the skin, and has a constant high conductivity. We studied the effects of two different electrolytes on the comfort of stimulation and found that there was less potential pain delivered when high-resistivity electrolytes were used. This was due to the larger nonuniformities in the current density distribution which appeared for low-resistivity electrolytes.(ABSTRACT TRUNCATED AT 250 WORDS)

The electrode system in impedance-based ventilation measurement.

In this paper, we determined which electrode types, sizes, and locations were best suited for impedance-based ventilation measurement. Optimal electrodes provide high signal-to-(motion) artifact ratio (SAR) and reliability by meeting the following criteria: 1) low baseline impedance, 2) high adhesion, 3) good physical stability, 4) large effective area, 5) thin with high flexibility. We compared 14 electrodes from two main groups: adhesive-gel and conductive rubber electrodes. Adhesive-gel electrodes are easy to apply, make good body contact, and do not slip during the course of an experiment. We found that higher SAR's are obtained when electrode area is increased by connecting several small electrodes together rather than by using a single electrode with a larger area. The peak SAR is achieved when two electrode arrays (area = 70 cm2) are centered at the 8th intercostal spaces on opposite midaxillary lines. To determine the optimal electrode locations, we placed 32 electrodes on the trunk and recorded impedance between 171 electrode combinations on ten normal adult subjects. Based on these data, we conclude that the SAR's are highest when one electrode is placed on the midpoint between the left and right second intercostal spaces on the sternum and the other electrode is placed in the opposite position on the back.

Maximal dynamic range electrotactile stimulation waveforms.

A new method to measure the dynamic range of electrotactile (electrocutaneous) stimulation uses both steepest ascent (gradient) and one-variable-at-a-time methods to determine the waveform variables that maximize the subjective magnitude (intensity) of the electrotactile percept at the maximal current without discomfort for balanced-biphasic pulse bursts presented at a 15-Hz rate. The magnitude at the maximal current without discomfort is maximized by the following waveform (range tested in parentheses): number of pulses/burst = 6 (1-20), pulse repetition rate within a burst = 350 Hz (200-1500), and phase width = 150 microseconds (40-350). The interphase interval (separation between positive and negative phases in a biphasic pulse) does not affect dynamic range from 0-500 microseconds. The number of pulses/burst has a large effect on the perceived dynamic range when this is measured using a subjective-magnitude-based algorithm, whereas it has little effect on the traditional dynamic range measure, i.e., (maximal current without discomfort)/(sensation threshold current). The perceived stimulus magnitude at the maximal current without discomfort is approximately twice as strong with 6 pulses/burst as it is with 1 pulse/burst (a frequently-used waveform).