Relaxation differences using EIS through bronchoscopy of healthy and pathological lung tissue.

The use of electrical impedance spectroscopy for lung tissue differentiation is an opportunity for the improvement of clinical diagnosis. The aim of this work is to distinguish among different lung tissue states by evaluating the differences among impedance spectrum parameters between two separate frequencies (15 kHz and 307 kHz) in the beta dispersion region. In previous studies we have used single frequency measurements for tissue differentiation. Differences (P < 0.05) are found between those tissues that undergo an increase in tissue density (neoplasm and fibrosis) and those tissues that lead to tissue destruction (emphysema). Electrical impedance spectroscopy shows its utility for lung tissue differentiation for diagnosis improvement among pathologies with different tissue structure. Further studies are necessary for the differentiation among those tissue states that are more similar to each other.Clinical Relevance- Expand the diagnostic tools currently available in bronchoscopy by using minimally-invasive bioimpedance measurements to differentiate between lung patterns.

Differentiation using minimally-invasive bioimpedance measurements of healthy and pathological lung tissue through bronchoscopy.

Purpose: To use minimally-invasive transcatheter electrical impedance spectroscopy measurements for tissue differentiation among healthy lung tissue and pathologic lung tissue from patients with different respiratory diseases (neoplasm, fibrosis, pneumonia and emphysema) to complement the diagnosis at real time during bronchoscopic procedures. Methods: Multi-frequency bioimpedance measurements were performed in 102 patients. The two most discriminative frequencies for impedance modulus (|Z|), phase angle (PA), resistance (R) and reactance (Xc) were selected based on the maximum mean pair-wise Euclidean distances between paired groups. One-way ANOVA for parametric variables and Kruskal-Wallis for non-parametric data tests have been performed with post-hoc tests. Discriminant analysis has also been performed to find a linear combination of features to separate among tissue groups. Results: We found statistically significant differences for all the parameters between: neoplasm and pneumonia (p < 0.05); neoplasm and healthy lung tissue (p < 0.001); neoplasm and emphysema (p < 0.001); fibrosis and healthy lung tissue (p ≤ 0.001) and pneumonia and healthy lung tissue (p < 0.01). For fibrosis and emphysema (p < 0.05) only in |Z|, R and Xc; and between pneumonia and emphysema (p < 0.05) only in |Z| and R. No statistically significant differences (p > 0.05) are found between neoplasm and fibrosis; fibrosis and pneumonia; and between healthy lung tissue and emphysema. Conclusion: The application of minimally-invasive electrical impedance spectroscopy measurements in lung tissue have proven to be useful for tissue differentiation between those pathologies that leads increased tissue and inflammatory cells and those ones that contain more air and destruction of alveolar septa, which could help clinicians to improve diagnosis.

Minimally Invasive Real-Time Electrical Impedance Spectroscopy Diagnostic Tool for Lung Parenchyma Pathologies.

Electrical Impedance Spectroscopy has already demonstrated the ability to distinguish different tissues types, or tumors from normal tissue, or tissues displaying diverse degrees of pathology. When applying the technique, however, the necessity to make contact with the tissue often constitutes a practical limitation. Electrical Impedance Imaging (EIT), or in a broader sense, regional impedance assessment, struggle to assess different tissue conditions out of measurements from the surface of the body. But sensitivity is very small even for tissue a few centimeters under the skin, and in-vivo measurements are often not viable.The lung offer a third approximation by introducing a catheter though a bronchoscope, which is a routine clinical procedure. Measurements have been obtained by using 3 or 4-electrode techniques and allow us to distinguish, at least, fibrotic, emphysema or neoplastic regions from normal parenchyma. New instrumental developments, clinical measurements and preliminary results are presented and discussed.

In vivo electrical bioimpedance characterization of human lung tissue during the bronchoscopy procedure. A feasibility study.

Lung biopsies form the basis for the diagnosis of lung cancer. However, in a significant number of cases bronchoscopic lung biopsies fail to provide useful information, especially in diffuse lung disease, so more aggressive procedures are required. Success could be improved using a guided electronic biopsy based on multisine electrical impedance spectroscopy (EIS), a technique which is evaluated in this paper. The theoretical basis of the measurement method and the instrument developed are described, characterized and calibrated while the performance of the instrument is assessed by experiments to evaluate the noise and nonlinear source of errors from measurements on phantoms. Additional preliminary results are included to demonstrate that it is both feasible and safe to monitor in vivo human lung tissue electrical bioimpedance (EBI) during the bronchoscopy procedure. The time required for performing bronchoscopy is not extended because the bioimpedance measurements, present no complications, tolerance problems or side effects among any of the patients measured.

Medición del patrón ventilatorio mediante tomografía por impedancia eléctrica en pacientes con EPOC / Measuring Breathing Pattern in Patients With Chronic Obstructive Pulmonary Disease by Electrical Impedance Tomography

Introducción. La medición del patrón ventilatorio (PV) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) mediante tomografía por impedancia eléctrica (TIE) requiere disponer de un modelo matemático de calibración que tenga en cuenta no sólo las características antropométricas (ya evaluadas en la persona sana), sino probablemente también las alteraciones funcionales propias de la enfermedad. El objetivo del presente estudio ha sido relacionar, en un grupo de pacientes (varones) con EPOC, las variables de la función pulmonar espirometría, volúmenes estáticos, transferencia de monóxido de carbono (CO) con las determinaciones de TIE y obtener una ecuación de calibración que permita convertir la señal eléctrica de la TIE en una señal de volumen.Material y métodosSe estudió a 28 pacientes volumen espiratorio forzado en el primer segundo (FEV1)/capacidad vital forzada (FVC)<70% con un equipo TIE-4 previamente validado y se compararon los resultados con los de un neumotacómetro estándar. Previamente se determinaron los siguientes parámetros: FVC, FEV1, FEV1/FVC, volumen residual, capacidad pulmonar total, capacidad de difusión de CO y coeficiente de transferencia de CO (KCO), además de las variables antropométricas habituales.ResultadosLos valores medios (±desviación estándar) de las diferentes pruebas funcionales fueron: FVC del 72±16%; FEV1 del 43±14%; FEV1/FVC del 42±9%; volumen residual del 161±44%, capacidad pulmonar total del 112±17%; capacidad de difusión de CO del 58±17%, y KCO del 76±25%. Los valores medios de volumen circulante de las determinaciones obtenidas con el neumotacómetro y la TIE fueron de 0,697±0,181 y 0,515±0,223l, respectivamente (p<0,001). Se encontraron relaciones significativas entre las medidas de la TIE y la transferencia de CO. El modelo matemático para ajustar las diferencias entre ambas determinaciones (R2=0,568; p<0,001) fue: factor de compensación=1,81 0,82×talla (m) 0,004×KCO (%). Conclusiones. La medición del PV mediante un equipo de TIE en pacientes con EPOC requiere una calibración previa que tenga en cuenta no sólo las características físicas de cada individuo, sino además la situación funcional del área de intercambio gaseoso (AU)

Background and ObjectiveThe measurement of breathing pattern in patients with chronic obstructive pulmonary disease (COPD) by electrical impedance tomography (EIT) requires the use of a mathematical calibration model incorporating not only anthropometric characteristics (previously evaluated in healthy individuals) but probably functional alterations associated with COPD as well. The aim of this study was to analyze the association between EIT measurements and spirometry parameters, static lung volumes, and carbon monoxide diffusing capacity (DLCO) in a group of male patients to develop a calibration equation for converting EIT signals into volume signals.Materials and MethodsWe measured forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, residual volume, total lung capacity, DLCO, carbon monoxide transfer coefficient (KCO) and standard anthropometric parameters in 28 patients with a FEV1/FVC ratio of <70%. We then compared tidal volume measurements from a previously validated EIT unit and a standard pneumotachometer.ResultsThe mean (SD) lung function results were FVC, 72 (16%); FEV1, 43% (14%); FEV1/FVC, 42% (9%); residual volume, 161% (44%); total lung capacity, 112% (17%); DLCO, 58% (17%); and KCO, 75% (25%). Mean (SD) tidal volumes measured by the pneumotachometer and the EIT unit were 0.697 (0.181)L and 0.515 (0.223)L, respectively (P<.001). Significant associations were found between EIT measurements and CO transfer parameters. The mathematical model developed to adjust for the differences between the 2 measurements (R2=0.568; P<.001) was compensation factor=1.81o 0.82o× height (m)o 0.004×KCO (%).ConclusionsThe measurement of breathing pattern by EIT in patients with COPD requires the use of a previously calculated calibration equation that incorporates not only individual anthropometric characteristics but gas exchange parameters as well(AU)

[Measuring breathing pattern in patients with chronic obstructive pulmonary disease by electrical impedance tomography]. / Medición del patrón ventilatorio mediante tomografía por impedancia eléctrica en pacientes con EPOC.

BACKGROUND AND OBJECTIVE: The measurement of breathing pattern in patients with chronic obstructive pulmonary disease (COPD) by electrical impedance tomography (EIT) requires the use of a mathematical calibration model incorporating not only anthropometric characteristics (previously evaluated in healthy individuals) but probably functional alterations associated with COPD as well. The aim of this study was to analyze the association between EIT measurements and spirometry parameters, static lung volumes, and carbon monoxide diffusing capacity (DLCO) in a group of male patients to develop a calibration equation for converting EIT signals into volume signals. MATERIALS AND METHODS: We measured forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), FEV(1)/FVC, residual volume, total lung capacity, DLCO, carbon monoxide transfer coefficient (KCO) and standard anthropometric parameters in 28 patients with a FEV(1)/FVC ratio of <70%. We then compared tidal volume measurements from a previously validated EIT unit and a standard pneumotachometer. RESULTS: The mean (SD) lung function results were FVC, 72 (16%); FEV(1), 43% (14%); FEV(1)/FVC, 42% (9%); residual volume, 161% (44%); total lung capacity, 112% (17%); DLCO, 58% (17%); and KCO, 75% (25%). Mean (SD) tidal volumes measured by the pneumotachometer and the EIT unit were 0.697 (0.181)L and 0.515 (0.223)L, respectively (P<.001). Significant associations were found between EIT measurements and CO transfer parameters. The mathematical model developed to adjust for the differences between the 2 measurements (R(2)=0.568; P<.001) was compensation factor=1.81# - 0.82# height (m)# -0.004 x KCO (%). CONCLUSIONS: The measurement of breathing pattern by EIT in patients with COPD requires the use of a previously calculated calibration equation that incorporates not only individual anthropometric characteristics but gas exchange parameters as well.

[Assessment of differential lung function by electrical impedance tomography]. / Evaluación de la función pulmonar unilateral mediante tomografía por impedancia eléctrica.

OBJECTIVE: To compare unilateral lung function estimated by 2 methods: electrical impedance tomography (EIT) and ventilation-perfusion lung scintigraphy. PATIENTS AND METHODS: This prospective clinical study was carried out in the pulmonary function laboratory of a general hospital. Twenty patients diagnosed with lung cancer (17 men and 3 women, ranging in age from 25 to 77 years) who were candidates for lung resection underwent ventilation-perfusion lung scanning breathing a radioactive gas. Differential lung function was estimated based on images taken at 2 intercostal spaces in which ventilation and perfusion were represented by changes in bioelectrical impedance. Each lung's contribution to overall respiratory function was also calculated based on scintigraphy. RESULTS: The right lung contributed a mean (SD) of 54% (9%) of ventilation (range, 32%-71%) according to EIT. Scintigraphy similarly estimated the right lung's contribution to be 52% (10%) of total ventilation (range, 31%-80%) and 50% (9%) of perfusion (range, 37%-71%). The difference between the 2 estimates was not significant (t test), and the correlation coefficients between them were r=0.90 for ventilation and r=0.72 for perfusion (P< .05 in both cases). The analysis of agreement showed that the mean difference between the methods was 1.9% (95% confidence interval [CI], 10.5% to -6.8%) for ventilation and 3.4% (95% CI, 17.1% to -10.3%) for perfusion. CONCLUSIONS: EIT is able to estimate differential lung function as accurately as ventilation-perfusion scintigraphy.

Evaluación de la función pulmonar unilateral mediante tomografía por impedancia eléctrica / Assessment of differential lung function by electrical impedance tomography

OBJETIVO: Comparar la función pulmonar unilateral (FPU) estimada mediante tomografía por impedancia eléctrica (TIE) con la misma determinación obtenida a partir de la gammagrafía de ventilación y perfusión pulmonar PACIENTES Y MÉTODOS: Se trata de un estudio clínico prospectivo, realizado en un laboratorio de función pulmonar de un hospital general. Se incluyó a 20 pacientes diagnosticados de cáncer de pulmón (17 varones y 3 mujeres, con edades comprendidas entre los 25 y los 77 años), candidatos a cirugía resectiva pulmonar, a quienes se realizó un estudio de ventilación/perfusión pulmonar con radioisótopos. La FPU se calculó a partir de imágenes en 2 espacios intercostales en las que se representaban la ventilación y la perfusión relacionadas con los cambios en la bioimpedancia eléctrica. Se determinó asimismo la participación de cada pulmón en la función global a partir de estudios isotópicos. RESULTADOS: El valor promedio ± desviación estándar de ventilación en el pulmón derecho obtenido mediante TIE fue del 54 ± 9% (rango: 32-71%). El mismo valor mediante radioisótopos fue del 52 ± 10% (rango: 31-80%) para la ventilación y del 50 ± 9% (rango: 37-71%) para la perfusión (prueba de la t de Student, p no significativa). El coeficiente de correlación entre ambas determinaciones fue de r = 0,90 (p < 0,05) para la ventilación y de r = 0,72 (p < 0,05) para la perfusión. El análisis de concordancia mostró una media de las diferencias del 1,9% (intervalo de confianza del 95%, del 10,5 al -6,8%) para la ventilación y del 3,4% (intervalo de confianza del 95%, entre el 17,1 y el -10,3%) para la perfusión. CONCLUSIONES: La TIE es capaz de cuantificar la FPU con una precisión similar a la gammagrafía de ventilación o perfusión con radioisótopos

OBJECTIVE: To compare unilateral lung function estimated by 2 methods: electrical impedance tomography (EIT) and ventilation-perfusion lung scintigraphy. PATIENTS AND METHODS: This prospective clinical study was carried out in the pulmonary function laboratory of a general hospital. Twenty patients diagnosed with lung cancer (17 men and 3 women, ranging in age from 25 to 77 years) who were candidates for lung resection underwent ventilation-perfusion lung scanning breathing a radioactive gas. Differential lung function was estimated based on images taken at 2 intercostal spaces in which ventilation and perfusion were represented by changes in bioelectrical impedance. Each lung's contribution to overall respiratory function was also calculated based on scintigraphy. RESULTS: The right lung contributed a mean (SD) of 54% (9%) of ventilation (range, 32%-71%) according to EIT. Scintigraphy similarly estimated the right lung's contribution to be 52% (10%) of total ventilation (range, 31%-80%) and 50% (9%) of perfusion (range, 37%-71%). The difference between the 2 estimates was not significant (t test), and the correlation coefficients between them were r=0.90 for ventilation and r=0.72 for perfusion (P<.05 in both cases). The analysis of agreement showed that the mean difference between the methods was 1.9% (95% confidence interval [CI], 10.5% to -6.8%) for ventilation and 3.4% (95% CI, 17.1% to -10.3%) for perfusion. CONCLUSIONS: EIT is able to estimate differential lung function as accurately as ventilation-perfusion scintigraphy

Initial analysis of SAR from a cell phone inside a vehicle by numerical computation.

The purpose of this paper is to analyze the influence of the metallic structures of a realistic car body frame on the specific absorption rate (SAR) produced by a cell phone when a complete human body model is placed at different locations inside the vehicle, and to identify the relevant parameters responsible for these changes. The modeling and analysis of the whole system was conducted by means of computer simulations based on the full wave finite-difference time-domain (FDTD) numerical method. The excitation considered was an 835 MHz lambda/2 dipole located as a hands-free communication device or as a hand-held portable system. We compared the SAR at different planes on the human model, placed inside the vehicle with respect to the free space situation. The presence of the car body frame significantly changes the SAR distributions, especially when the dipole is far from the body. Although the results are not conclusive on this point, this change in SAR distribution is not likely to produce an increase above the limits in current guidelines for partial body exposure, but may be significant for whole-body exposure. The most relevant change found was the change in the impedance of the dipole, affecting the radiated power. A complementary result from the electromagnetic computations performed is the change in the electromagnetic field distribution inside a vehicle when human bodies are present. The whole vehicle model has been optimized to provide accurate results for sources placed inside the vehicle, while keeping low requirements for computer storage and simulation time.

Assessment of the unilateral pulmonary function by means of electrical impedance tomography using a reduced electrode set.

The usefulness of electrical impedance tomography (EIT) to assess ventilation-related phenomena in the thorax has already been demonstrated, especially in controlled environments. We focus on our developments in the assessment of the unilateral pulmonary function (UPF) in real clinical environments. The impact of the reduction of the number of electrodes used is analysed theoretically and experimentally with different approaches. Sixteen-electrode EIT measurements were performed on a group of lung cancer patients (19 M, 2 F, ages 25-77 years). Results are compared with those obtained from ventilation scintigraphy. Eight-electrode measurements were synthesized from the 16-electrode ones. The Bland and Altman analysis indicates an agreement of about +/- 1 percent points in the estimation of UPF. On five of these patients real 8-electrode measurements were performed, obtaining differences from 0.2 percent to 6 percent points. It is concluded that reducing the number of electrodes does not adversely affect the assessment of UPF, but there is a reproducibility issue affecting all the techniques which needs further study.

Propagation of measurement noise through backprojection reconstruction in electrical impedance tomography.

A framework to analyze the propagation of measurement noise through backprojection reconstruction algorithms in electrical impedance tomography (EIT) is presented. Two measurement noise sources were considered: noise in the current drivers and in the voltage detectors. The influence of the acquisition system architecture (serial/semi-parallel) is also discussed. Three variants of backprojection reconstruction are studied: basic (unweighted), weighted and exponential backprojection. The results of error propagation theory have been compared with those obtained from simulated and experimental data. This comparison shows that the approach provides a good estimate of the reconstruction error variance. It is argued that the reconstruction error in EIT images obtained via backprojection can be approximately modeled as a spatially nonstationary Gaussian distribution. This methodology allows us to develop a spatial characterization of the reconstruction error in EIT images.

Use of electrical impedance tomography (EIT) for the assessment of unilateral pulmonary function.

We describe a fully automatable quantification process for the assessment of unilateral pulmonary function (UPF) by means of EIT and propose a measurement protocol for its clinical implementation. Measurements were performed at the fourth and sixth intercostal levels on a first group of ten healthy subjects (5M, 5F, ages 26-48 years) to define the proper protocol by evaluating the most common postures and ventilation modes. Several off-line processing tools were also evaluated, including the use of digital filters to extract the respiratory components from EIT time series. Comparative measures were then carried out on a second group consisting of five preoperatory patients with lung cancer (4M, IF, ages 25-77 years) scheduled for radionuclide scanning. Results show that measurements were best performed with the subject sitting down, holding his arms up and breathing spontaneously. As regards data processing, it is best to extract Fourier respiratory components. The mean of the healthy subject group leads to a left-right division of lung ventilation consistent with literature values (47% left lung, 53% right lung). The comparative study indicates a good correlation (r = 0.96) between the two techniques, with a mean difference of (-0.4+/-5.4)%, suggesting that the elimination of cardiac components from the thoracic transimpedance signal leads to a better estimation of UPF.