A Multilayer Monte Carlo Analysis of Optical Interactions in Reflectance Neck Photoplethysmography.

This paper presents a multilayer Monte Carlo model of a healthy human neck to investigate the light-tissue interaction during different perfusion states within its dermal layer. Whilst there is great interest in advancing wearable technologies for medical applications, and non-invasive techniques like photoplethysmography (PPG) have been studied in detail, research has focused on more conventional body regions like the finger, wrist, and ear. Alternatively, the neck could offer access to additional physiological parameters which other body regions are unsuitable for. The aim of this work was to investigate the effects of several factors that would influence the optimum design of a reflectance PPG sensor for the neck. These included the source-detector separation on the optical path, penetration depth, and light detection efficiency. The results were generated from a static multilayer model in a reflectance mode geometry at two wavelengths, 660 nm and 880 nm, containing different blood volume fractions with a fixed oxygen saturation. Simulations indicated that both wavelengths penetrated similar depths, where optimal source-detector separation should not exceed 3 mm or 2.4 mm, for red and infrared respectively. Within this range, light interrogates the dermal-fat boundary corresponding to the last neck tissue layer positively contributing to a neck PPG acquisition.

Sleep Posture Detection Using an Accelerometer Placed on the Neck.

Sleep position monitoring is key when attempting to address posture triggered sleep disorders. Many studies have explored sleep posture detection from a dedicated physical sensing channel exploiting optimum body locations, such as the torso; or alternatively non-contact approaches. But, little work has been done to try to detect sleep position from a body location which, whilst being suboptimal for that purpose, does however allow for better extraction of more critical biomarkers from other sensing modalities, making possible multi-modal monitoring in certain clinical applications. This work presents two different approaches, at varying levels of complexity, for detecting 4 main sleep positions (supine, prone, lateral right and lateral left) from accelerometry data obtained by a single wearable device placed on the neck. An ultra light-weight threshold-based model is presented in this work, in addition to an Extra-Trees classifier. The threshold-based model was able to achieve 95% average accuracy and 0.89 F1-score on out-of-sample data, showing that it is possible to obtain a moderately high classification performance using a simple rule-based model. The ExtraTrees classifier, on the other hand, was able to achieve 99 % average accuracy and 0.99 average F1-score using only 25 base estimators with maximum depth of 20. Both models show promise in detecting sleep posture with high accuracy when collecting the signals from a neck-worn accelerometer sensor.

In silico and in vivo investigations using an endocavitary photoplethysmography sensor for tissue viability monitoring.

SIGNIFICANCE: Colorectal cancer is one of the major causes of cancer-related deaths worldwide. Surgical removal of the cancerous growth is the primary treatment for this disease. A colorectal cancer surgery, however, is often unsuccessful due to the anastomotic failure that may occur following the surgical incision. Prevention of an anastomotic failure requires continuous monitoring of intestinal tissue viability during and after colorectal surgery. To date, no clinical technology exists for the dynamic and continuous monitoring of the intestinal perfusion. AIM: A dual-wavelength indwelling bowel photoplethysmography (PPG) sensor for the continuous monitoring of intestinal viability was proposed and characterized through a set of in silico and in vivo investigations. APPROACH: The in silico investigation was based on a Monte Carlo model that was executed to quantify the variables such as penetration depth and detected intensity with respect to the sensor-tissue separations and tissue perfusion. Utilizing the simulated information, an indwelling reflectance PPG sensor was designed and tested on 20 healthy volunteers. Two sets of in vivo studies were performed using the driving current intensities 20 and 40 mA for a comparative analysis, using buccal tissue as a proxy tissue-site. RESULTS: Both simulated and experimental results showed the efficacy of the sensor to acquire good signals through the "contact" to a "noncontact" separation of 5 mm. A very slow wavelength-dependent variation was shown in the detected intensity at the normal and hypoxic states of the tissue, whereas a decay in the intensity was found with the increasing submucosal-blood volume. The simulated detected-to-incident-photon-ratio and the experimental signal-to-noise ratio exhibited strong positive correlations, with the Pearson product-moment correlation coefficient R ranging between 0.65 and 0.87. CONCLUSIONS: The detailed feasibility analysis presented will lead to clinical trials utilizing the proposed sensor.

The effects of optical sensor-tissue separation in endocavitary photoplethysmography.

OBJECTIVE: Intestinal anastomotic failure that occurs mainly due to ischaemia is a serious risk in colorectal cancer patients undergoing surgery. Surgeons continue to rely on subjective methods such as visual inspection to assess intestinal viability during surgery and there are no clinical tools to directly monitor viability postoperatively. A dual-wavelength reflectance optical sensor has been developed for continuous and dynamic monitoring of intestinal viability via the intestinal lumen. Maintaining direct contact between the sensor and the inner intestinal wall can be difficult in an intraluminal design, therefore impacting on signal acquisition and quality. This paper investigates the effect of direct contact versus variable distances between the sensor and the tissue surface of the buccal mucosa as a surrogate. APPROACH: The in vivo study involved 20 healthy volunteers to measure the effect of optical sensor-tissue distances on the ability to acquire photoplethysmography signals and their quality. Signals were acquired from the buccal mucosa at five optical sensor-tissue distances. MAIN RESULTS: Distances between 0 mm (contact) to 5 mm were the most optimal, producing signals of high quality and signal-to-noise ratio, resulting in reliable estimations of the blood oxygen saturation. Distances exceeding 5 mm compromised the acquired signals, and were of poor quality, thereby unreliably estimating the blood oxygen saturation. SIGNIFICANCE: The developed optical sensor proved to be reliable for acquiring photoplethysmography signals for cases where distances between the optical sensor-tissue may arise during the assessment of intraluminal intestinal viability.

Development of an intraluminal intestinal photoplethysmography sensor.

Intestinal ischemia is a serious medical condition and can lead to life threatening sepsis. Currently, there are no reliable techniques available for directly monitoring intestinal viability for prolonged periods of time, and intraoperatively, the majority of the surgeons still rely on subjective methods, such as visual inspection to assess viability of the intestine. The development of an intraluminal optical sensor for monitoring intestinal viability is being proposed. The sensor will continuously monitor changes in blood volume and oxygen saturation. The developed reflectance photoplethysmography/pulse oximetry sensor comprises of two emitters (red and infrared) and a photodiode. A photoplethysmography processing and data acquisition system was also utilized. The prototype sensor was evaluated in a pilot study in the buccal mucosa of 12 healthy volunteers, given the locations similarity to the intestinal mucosa and its easy accessibility. Good quality photoplethysmography signals with high signal-to-noise ratio were acquired from the buccal mucosa in all the volunteers. Preliminary blood oxygen saturation values from the intraluminal sensor were in broad agreement with the standard finger pulse oximeter probes.