Monte Carlo simulation of the effect of melanin concentration on light-tissue interactions for transmittance pulse oximetry measurement.

Significance: Questions about the accuracy of pulse oximeters in measuring arterial oxygen saturation ( SpO 2 ) in individuals with darker skin pigmentation have resurfaced since the COVID-19 pandemic. This requires investigation to improve patient safety, clinical decision making, and research. Aim: We aim to use computational modeling to identify the potential causes of inaccuracy in SpO 2 measurement in individuals with dark skin and suggest practical solutions to minimize bias. Approach: An in silico model of the human finger was developed to explore how changing melanin concentration and arterial oxygen saturation ( SaO 2 ) affect pulse oximeter calibration algorithms using the Monte Carlo (MC) technique. The model generates calibration curves for Fitzpatrick skin types I, IV, and VI and an SaO 2 range between 70% and 100% in transmittance mode. SpO 2 was derived by inputting the computed ratio of ratios for light and dark skin into a widely used calibration algorithm equation to calculate bias ( SpO 2 - SaO 2 ). These were validated against an experimental study to suggest the validity of the Monte Carlo model. Further work included applying different multiplication factors to adjust the moderate and dark skin calibration curves relative to light skin. Results: Moderate and dark skin calibration curve equations were different from light skin, suggesting that a single algorithm may not be suitable for all skin types due to the varying behavior of light in different epidermal melanin concentrations, especially at 660 nm. The ratio between the mean bias in White and Black subjects in the cohort study was 6.6 and 5.47 for light and dark skin, respectively, from the Monte Carlo model. A linear multiplication factor of 1.23 and exponential factor of 1.8 were applied to moderate and dark skin calibration curves, resulting in similar alignment. Conclusions: This study underpins the careful re-assessment of pulse oximeter designs to minimize bias in SpO 2 measurements across diverse populations.

Monte Carlo simulation of the effect of melanin concentration on light-tissue interactions in transmittance and reflectance finger photoplethysmography.

Photoplethysmography (PPG) uses light to detect volumetric changes in blood, and is integrated into many healthcare devices to monitor various physiological measurements. However, an unresolved limitation of PPG is the effect of skin pigmentation on the signal and its impact on PPG based applications such as pulse oximetry. Hence, an in-silico model of the human finger was developed using the Monte Carlo (MC) technique to simulate light interactions with different melanin concentrations in a human finger, as it is the primary determinant of skin pigmentation. The AC/DC ratio in reflectance PPG mode was evaluated at source-detector separations of 1 mm and 3 mm as the convergence rate (Q), a parameter that quantifies the accuracy of the simulation, exceeded a threshold of 0.001. At a source-detector separation of 3 mm, the AC/DC ratio of light skin was 0.472 times more than moderate skin and 6.39 than dark skin at 660 nm, and 0.114 and 0.141 respectively at 940 nm. These findings are significant for the development of PPG-based sensors given the ongoing concerns regarding the impact of skin pigmentation on healthcare devices.

Multi-Modal Spectroscopic Assessment of Skin Hydration.

Human skin acts as a protective barrier, preserving bodily functions and regulating water loss. Disruption to the skin barrier can lead to skin conditions and diseases, emphasizing the need for skin hydration monitoring. The gold-standard sensing method for assessing skin hydration is the Corneometer, monitoring the skin's electrical properties. It relies on measuring capacitance and has the advantage of precisely detecting a wide range of hydration levels within the skin's superficial layer. However, measurement errors due to its front end requiring contact with the skin, combined with the bipolar configuration of the electrodes used and discrepancies due to variations in various interfering analytes, often result in significant inaccuracy and a need to perform measurements under controlled conditions. To overcome these issues, we explore the merits of a different approach to sensing electrical properties, namely, a tetrapolar bioimpedance sensing approach, with the merits of a novel optical sensing modality. Tetrapolar bioimpedance allows for the elimination of bipolar measurement errors, and optical spectroscopy allows for the identification of skin water absorption peaks at wavelengths of 970 nm and 1450 nm. Employing both electrical and optical sensing modalities through a multimodal approach enhances skin hydration measurement sensitivity and validity. This layered approach may be particularly beneficial for minimising errors, providing a more robust and comprehensive tool for skin hydration assessment. An ex vivo desorption experiment was carried out on fresh porcine skin, and an in vivo indicative case study was conducted utilising the developed optical and bioimpedance sensing devices. Expected outcomes were expressed from both techniques, with an increase in the output of the optical sensor voltage and a decrease in bioimpedance as skin hydration decreased. MLR models were employed, and the results presented strong correlations (R-squared = 0.996 and p-value = 6.45 × 10-21), with an enhanced outcome for hydration parameters when both modalities were combined as opposed to independently, highlighting the advantage of the multimodal sensing approach for skin hydration assessment.

Customisable Silicone Vessels and Tissue Phantoms for In Vitro Photoplethysmography Investigations into Cardiovascular Disease.

Age-related vessel deterioration leads to changes in the structure and function of the heart and blood vessels, notably stiffening of vessel walls, increasing the risk of developing cardiovascular disease (CVD), which accounts for 17.9 million global deaths annually. This study describes the fabrication of custom-made silicon vessels with varying mechanical properties (arterial stiffness). The primary objective of this study was to explore how changes in silicone formulations influenced vessel properties and their correlation with features extracted from signals obtained from photoplethysmography (PPG) reflectance sensors in an in vitro setting. Through alterations in the silicone formulations, it was found that it is possible to create elastomers exhibiting an elasticity range of 0.2 MPa to 1.22 MPa. It was observed that altering vessel elasticity significantly impacted PPG signal morphology, particularly reducing amplitude with increasing vessel stiffness (p < 0.001). A p-value of 5.176 × 10-15 and 1.831 × 10-14 was reported in the red and infrared signals, respectively. It has been concluded in this study that a femoral artery can be recreated using the silicone material, with the addition of a softener to achieve the required mechanical properties. This research lays the foundation for future studies to replicate healthy and unhealthy vascular systems. Additional pathologies can be introduced by carefully adjusting the elastomer materials or incorporating geometrical features consistent with various CVDs.

Arterial stiffness assessment using PPG feature extraction and significance testing in an in vitro cardiovascular system.

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, therefore understanding arterial stiffness is essential to developing innovative technologies to detect, monitor and treat them. The ubiquitous spread of photoplethysmography (PPG), a completely non-invasive blood-volume sensing technology suitable for all ages, highlights immense potential for arterial stiffness assessment in the wider healthcare setting outside specialist clinics, for example during routine visits to a General Practitioner or even at home with the use of mobile and wearable health devices. This study employs a custom-manufactured in vitro cardiovascular system with vessels of varying stiffness to test the hypothesis that PPG signals may be used to detect and assess the level of arterial stiffness under controlled conditions. Analysis of various morphological features demonstrated significant (p < 0.05) correlations with vessel stiffness. Particularly, area related features were closely linked to stiffness in red PPG signals, while for infrared PPG signals the most correlated features were related to pulse-width. This study demonstrates the utility of custom vessels and in vitro investigations to work towards non-invasive cardiovascular assessment using PPG, a valuable tool with applications in clinical healthcare, wearable health devices and beyond.

Photoplethysmography for the Assessment of Arterial Stiffness.

This review outlines the latest methods and innovations for assessing arterial stiffness, along with their respective advantages and disadvantages. Furthermore, we present compelling evidence indicating a recent growth in research focused on assessing arterial stiffness using photoplethysmography (PPG) and propose PPG as a potential tool for assessing vascular ageing in the future. Blood vessels deteriorate with age, losing elasticity and forming deposits. This raises the likelihood of developing cardiovascular disease (CVD), widely reported as the global leading cause of death. The ageing process induces structural modifications in the vascular system, such as increased arterial stiffness, which can cause various volumetric, mechanical, and haemodynamic alterations. Numerous techniques have been investigated to assess arterial stiffness, some of which are currently used in commercial medical devices and some, such as PPG, of which still remain in the research space.