Electrical impedance tomography can monitor dynamic hyperinflation in dogs.

We assessed in eight dogs the accuracy with which electrical impedance tomography (EIT) can monitor changes in lung volume by comparing the changes in mean lung conductivity obtained with EIT to changes in esophageal pressure (Pes) and to airway opening pressure (Pao) measured after airway occlusion. The average volume measurement errors were determined: 26 ml for EIT; 35 ml for Pao; and 54 ml for Pes. Subsequently, lung inflation due to applied positive end-expiratory pressure was measured by EIT (delta VEIT) and Pao (delta VPAO) under both inflation and deflation conditions. Whereas delta VPAO was equal under both conditions, delta VEIT was 28 ml greater during deflation than inflation, indicating that EIT is sensitive to lung volume history. The average inflation delta VEIT was 67.7 +/- 78 ml greater than delta VPAO, for an average volume increase of 418 ml. Lung inflation due to external expiratory resistance was measured during ventilation by EIT (delta VEIT,vent) and Pes (delta VPes,vent) and at occlusion by EIT (delta VEIT,occl), Pes, and Pao. The average differences between EIT estimates and delta VEIT,occl were 5.8 +/- 44 ml for delta VEIT,vent and 49.5 +/- 34 ml for delta VEIT,occl. The average volume increase for all dogs was 442.2 ml. These results show that EIT can provide usefully accurate estimates of changes in lung volume over an extended time period and that the technique has promise as a means of conveniently and noninvasively monitoring lung hyperinflation.

Monitoring changes in lung air and liquid volumes with electrical impedance tomography.

Electrical impedance tomography (EIT) uses electrical measurements at electrodes placed around the thorax to image changes in the conductivity distribution within the thorax. This technique is well suited to studying pulmonary function because the movement of air, blood, and extravascular fluid induces significant conductivity changes within the thorax. We conducted three experimental protocols in a total of 19 dogs to assess the accuracy with which EIT can quantify changes in the volumes of both gas and fluid in the lungs. In the first protocol, lung volume increments from 50 to 1,000 ml were applied with a large syringe. EIT measured these volume changes with an average error of 27 +/- 6 ml. In the second protocol, EIT measurements were made at end expiration and end inspiration during regular ventilation with tidal volume ranging from 100 to 1,000 ml. The average error in the EIT estimates of tidal volume was 90 +/- 43 ml. In the third protocol, lung liquid volume was measured by instilling 5% albumin solution into a lung lobe in increments ranging from 10 to 100 ml. EIT measured these volume changes with an average error of 10 +/- 10 ml and was also able to detect into which lobe the fluid had been instilled. These results indicate that EIT can noninvasively measure changes in the volumes of both gas and fluid in the lungs with clinically useful accuracy.

Quantification of adipose tissue by MRI: relationship with anthropometric variables.

This study had two objectives: 1) to establish magnetic resonance imaging (MRI) as a tool for measuring total and regional adipose tissue (AT) distribution in humans and 2) to assess the relationship between selected anthropometric variables and MRI-measured AT. Twenty-seven healthy men varying in age [40.8 +/- 14.5 (SD) yr], body mass index (28.5 +/- 4.8), and waist-to-hip ratio (WHR, 0.96 +/- 0.07) participated in the study. Total AT volume was determined using a linear interpolation of AT areas obtained on consecutive slices (n = 41) taken from head to toe (10-mm thickness, 50-mm centers). The mean change for repeated measures of total AT volume was 2.9% (range 0.9-4.3%). Large interindividual differences were observed for total AT volume (6.9-59.3 liters), subcutaneous AT (6.3-49.8 liters), and visceral AT (0.5-8.5 liters). Visceral AT represented 18.3% of the total AT. The single best predictor of total adiposity was waist circumference (R2 = 0.92). For visceral AT volume, WHR was the strongest anthropometric correlate (r = 0.85, P less than 0.01). When controlled for age and adiposity, however, WHR explained only 12% of the variation in absolute visceral AT and less than 1% of the variation in visceral-to-subcutaneous ratio. Age was a better predictor of visceral-to-subcutaneous ratio than level of adiposity or WHR. The results of this study demonstrate that MRI offers a reliable measure of regional and total AT distribution in humans and, thus, is of value as a research tool.

Adipose tissue volume measured by magnetic resonance imaging and computerized tomography in rats.

The primary purpose of this study was to investigate the viability of magnetic resonance imaging (MRI) as a means of measuring the body composition of rodents. To do so we compared adipose tissue (AT) volumes measured by MRI with those obtained by X-ray computerized tomography (CT) in a group of rats (n = 17) varying in weight (465-815 g) and percent body fat (5.4-31.1%), with the latter determined by chemical analysis. For both MRI and CT, AT volumes (cm3) per transverse slice (3-mm thickness, 21-mm centers) were determined using a computer-based image analysis system that permitted detailed comparisons of both visceral and subcutaneous AT depots. Total AT volumes were calculated using a linear interpolation of AT areas obtained on consecutive slices. Correlation coefficients between MRI and CT for visceral [r = 0.98, standard error of estimate (SEE) = 6.8 cm3], subcutaneous (r = 0.98, SEE = 6.5 cm3), and total AT volumes (r = 0.99, SEE = 9.0 cm3) were highly significant (P less than 0.001). Both MRI- and CT-predicted AT mass (assuming fat density = 0.90 g/ml) correlated strongly with chemically extracted lipid (grams) values (r = 0.98, SEE 9.6 g and r = 0.99, SEE = 6.9 g, respectively). Post hoc Scheffé contrasts demonstrated that the mean AT and lipid mass values derived by the three methods were not significantly different (P = 0.01). No systematic differences were observed because the regression lines derived for either MRI or CT vs. chemical analysis were not significantly different from the identity line.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection and analysis of cartilage degeneration by spatially resolved streaming potentials.

Cartilage molecular changes in osteoarthritis are most commonly related to the degradation and loss of proteoglycan and collagen fibrils of the extracellular matrix, which directly influence tissue stiffness and compression-generated streaming potentials. In this study, we evaluated the potential of a new technique, spatially resolved mapping of streaming potentials, to non-destructively indicate cartilage health or degeneration. Matched pairs of bovine cartilage/bone explant disks were cultured for 11 days in a serum free medium with and without interleukin-lalpha (IL-1alpha). The electromechanical properties (static stiffness, dynamic stiffness and streaming potentials) of cartilage disks were measured during unconfined compression using a mechanical tester coupled with a linear array of eight 50 microm diameter platinum-iridium microelectrodes. After 11 days of culture, the proteoglycan content of IL-1alpha treated disks was significantly reduced and the denatured and cleaved collagen content was increased compared to control disks. These biochemical alterations were concomitant with the reductions in the amplitudes of the static stiffness, the dynamic stiffness and the streaming potential profile as well as changes in the shape of the streaming potential profile. We found that spatial mapping of streaming potentials presents several advantages for the development of a clinical instrument to evaluate the degeneration of articular cartilage.

A neural network image reconstruction technique for electrical impedance tomography.

Reconstruction of images in electrical impedance tomography requires the solution of a nonlinear inverse problem on noisy data. This problem is typically ill-conditioned and requires either simplifying assumptions or regularization based on a priori knowledge. The authors present a reconstruction algorithm using neural network techniques which calculates a linear approximation of the inverse problem directly from finite element simulations of the forward problem. This inverse is adapted to the geometry of the medium and the signal-to-noise ratio (SNR) used during network training. Results show good conductivity reconstruction where measurement SNR is similar to the training conditions. The advantages of this method are its conceptual simplicity and ease of implementation, and the ability to control the compromise between the noise performance and resolution of the image reconstruction.

Electrical impedance tomography: regularized imaging and contrast detection.

Dynamic electrical impedance tomography (EIT) images changes in the conductivity distribution of a medium from low frequency electrical measurements made at electrodes on the medium surface. Reconstruction of the conductivity distribution is an under-determined and ill-posed problem, typically requiring either simplifying assumptions or regularization based on a priori knowledge. This paper presents a maximum a posteriori (MAP) approach to linearized image reconstruction using knowledge of the noise variance of the measurements and the covariance of the conductivity distribution. This approach has the advantage of an intuitive interpretation of the algorithm parameters as well as fast (near real time) image reconstruction. In order to compare this approach to existing algorithms, the authors develop figures of merit to measure the reconstructed image resolution, the noise amplification of the image reconstruction, and the fidelity of positioning in the image. Finally, the authors develop a communications systems approach to calculate the probability of detection of a conductivity contrast in the reconstructed image as a function of the measurement noise and the reconstruction algorithm used.

Experimental evaluation of two iterative reconstruction methods for induced current electrical impedance tomography.

The Newton-Raphson (N-R) with two different regularization methods: the Levenberg-Marquardt (N-R-LM) and the Hachtel's Augmented Matrix (N-R-HAM), were used to reconstruct images of conductivity changes in a cylindrical medium by Induced Current Electrical Impedance Tomography (ic-EIT). Experimental data were obtained from an 8-cm high, 19.2-cm diameter tank with 16 electrodes on the boundary surface and surrounded by eight 50-cm diameter coils. The coils were angularly displaced by 45 degrees and offset 12.4 cm from the center of the tank. They were driven by a 150-mA (peak) 20-kHz sine wave. Potential differences between adjacent electrodes were measured with phase-sensitive demodulators. The scalar potential field in the electrode plane of the conducting medium, resulting from eddy currents generated by each coil, was computed by the Finite Element Method. Image reconstruction by the N-R-HAM method was found to provide higher resolution and better noise immunity than the N-R-LM method. Two 2.2-cm diameter nonconducting rods located 3.9 cm from the center of the tank, 180 degrees from each other, were clearly resolved. Spatial resolution is estimated at 15% of the tank diameter and is comparable to the resolution obtained by conventional EIT using the Sheffield protocol. Higher resolution could be achieved with more coils and/or electrodes. A 16-coil system should present no construction problems. However, voltages induced by stray magnetic flux through the electrode leads and measurement circuits are significant and may limit the ability of ic-EIT to perform static imaging of conductivity distributions.

Regularized reconstruction in electrical impedance tomography using a variance uniformization constraint.

This paper describes a new approach to reconstruction of the conductivity field in electrical impedance tomography. Our goal is to improve the tradeoff between the quality of the images and the numerical complexity of the reconstruction method. In order to reduce the computational load, we adopt a linearized approximation to the forward problem that describes the relationship between the unknown conductivity and the measurements. In this framework, we focus on finding a proper way to cope with the ill-posed nature of the problem, mainly caused by strong attenuation phenomena; this is done by devising regularization techniques well suited to this particular problem. First, we propose a solution which is based on Tikhonov regularization of the problem. Second, we introduce an original regularized reconstruction method in which the regularization matrix is determined by space-uniformization of the variance of the reconstructed condictivities. Both methods are nonsupervised, i.e., all tuning parameters are automatically determined from the measured data. Tests performed on simulated and real data indicate that Tikhonov regularization provides results similar to those obtained with iterative methods, but with a much smaller amount of computations. Regularization using a variance uniformization constraint yields further improvements, particularly in the central region of the unknown object where attenuation is most severe. We anticipate that the variance uniformization approach could be adapted to iterative methods that preserve the nonlinearity of the forward problem. More generally, it appears as a useful tool for solving other severely ill-posed reconstruction problems such as eddy current tomography.

Streaming potentials maps are spatially resolved indicators of amplitude, frequency and ionic strength dependant responses of articular cartilage to load.

Streaming potential distributions were measured on the surface of articular cartilage in uniaxial unconfined compression using a linear array of microelectrodes. Potential profiles were obtained for sinusoidal and ramp/stress-relaxation displacements and exhibited dependencies on radial position, sinusoidal amplitude and frequency, time during stress relaxation, and on ionic strength. The measurements agreed with trends predicted by biphasic and related models. In particular, the absolute potential amplitude was maximal at the disk center, as was the predicted fluid pressure and the potential gradient (the electric field) was seen to be maximal at the disk periphery, as was the predicted fluid velocity. We also observed a similarity between non-linear behavior of streaming potential amplitude and load amplitude with respect to sinusoidal displacement amplitude. Taken together, these results support many of the phenomena concerning relative fluid-solid movement and fluid pressurization predicted by biphasic and related models, and they indicate the general utility of spatially resolved measurements of streaming potentials for the investigation of electromechanical phenomena in tissues. For example, these streaming potential maps could be used to non-destructively diagnose cartilage extracellular matrix composition and function, as well as to quantify spatially and temporally varying physical signals in cartilage that can induce cellular and extracellular biological responses to load.

Impedance imaging of lung ventilation: do we need to account for chest expansion?

Electrical impedance tomography (EIT) uses surface electrical measurements to image changes in the conductivity distribution within a medium. When used to measure lung ventilation, however, measurements depend both on conductivity changes in the thorax and on rib cage movement. Given that currently available reconstruction techniques assume that only conductivity changes are present, certain errors are introduced. A finite element model (FEM) is used to calculate the effect of chest expansion on the reconstructed conductivity images. Results indicate that thorax expansion accounts for up to 20% of the reconstructed image amplitude and introduces an artifact in the center of the image tending to "move" the reconstructed lungs closer together. Although this contribution varies depending on anatomical factors, it is relatively independent of inspiration depth. For certain applications in which one is only interested in changes in the level of physiological activity, the effect of the expansion can be neglected because it varies linearly with impedance changes. We conclude that chest expansion can contribute significantly to the conductivity images of lung ventilation and should be taken into account in the interpretation of these images.

An experimental study in electrical impedance tomography using backprojection reconstruction.

This paper reports on experiments designed to evaluate the performance of the equipotentials backprojection method under conditions modeling those of proposed applications of electrical impedance tomography. Small spherical targets were placed inside a saline-filled tank with dimensions similar to a human torso. Data were acquired with a computer-based instrument that applies current to pairs of electrodes located on two horizontal planes and records potential differences between electrodes of a third plane. The relative contrast produced by nonconducting spheres in a uniform saline background was measured on the reconstructed images and used to determine system sensitivity to target volume and to the radial and vertical positions of single spheres. Results show that for radial positions within a critical radius sensitivity is always maximum when the spheres center is on the recording plane and decreases gradually when the target is moved outside this plane. Localization of simple targets in 3-D, with data acquired from multiple recording planes, appears feasible. The results provide guidelines for the interpretation of images with complex 3-D conductivity distributions.

Bias and variability of diagnostic spectral parameters extracted from closing sounds produced by bioprosthetic valves implanted in the mitral position.

A method is proposed to estimate the bias and variability of eight diagnostic spectral parameters extracted from mitral closing sounds produced by bioprosthetic heart valves. These spectral parameters are: the frequency of the dominant (F1) and second dominant (F2) spectral peaks, the highest frequency of the spectrum found at -3 dB (F-3), -10 dB (F-10) and -20 dB (F-20) below the highest peak, the relative integrated area above -20 dB of the dominant peak (RIA20), the bandwidth at -3 dB of the dominant spectral peak (BW3), and the ratio of F1 divided by BW3 (Q1). The bias and variability of four spectral techniques were obtained by comparing parameters extracted from each technique with the parameters of a spectral "standard." This "standard" consisted of 19 normal mitral sound spectra computed analytically by evaluating the Z transform of a sum of decaying sinusoids on the unit circle. Truncation of the synthesized mitral signals and addition of random noise were used to simulate the physiological characteristics of the closing sounds. Results show that the fast Fourier transform method with rectangular window provides the best estimates of F1 and Q1, that the Steiglitz-McBride method with maximum entropy (pole-zero modeling with four poles and four zeros) can best evaluate F2, F-20, RIA20 and BW3, and that the all-pole modeling with covariance method (16 poles) is best suited to compute F-3. It was also shown that both the all-pole modeling and the Steiglitz-McBride methods can be used to estimate F-10. It is concluded that a single algorithm would not provide the best estimates of all spectral parameters.

Development of a cardiac acoustic mapping system.

The authors describe a cardiac acoustic mapping system designed to acquire, analyse, and display the amplitude distribution of a phonocardiogram (PCG) recorded from 22 sites on the thorax. A new PCG envelope detection approach, implemented by analogue circuits, enables simultaneous sampling of PCG envelopes from the 22 sites at a rate of 250 Hz/channel. A calibration procedure removes channel-to-channel gain variations, and a coherent averaging of each PCG envelope over several cardiac cycles improves the signal-to-noise ratio. Time congruent samples from the 22 averaged PCG envelopes are then interpolated in 2D to generate the isoamplitude maps. Preliminary results show that the acoustic maps can help locate the source of heart sounds and murmurs, and characterise their radiation and propagation patterns. Cardiac acoustic mapping opens up new avenues for the study of the propagation of heart sounds and murmurs through the heart-thorax acoustic system. This technique could contribute to improvements in the diagnosis of valvular dysfunctions.

Time-frequency analysis of heart murmurs. Part I: Parametric modelling and numerical simulations.

The object of this study is to compare the performance of two new bilinear time-frequency representation techniques with the spectrogram to characterise the behaviour of heart murmurs produced by bioprosthetic heart valves implanted in the mitral or aortic position. The murmurs are those of mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, a diastolic musical murmur and a systolic musical murmur. In the first part of the study, the general characteristics of the amplitude and the spectral content of these murmurs are determined by visual observation of the spectrogram of phonocardiograms obtained from several patients with known valvular pathology complemented with a literature review. A parametric model is then generated for each murmur signal. Stenotic and regurgitant murmurs are modelled as the sequential output of a bank of low-pass filters excited by a white noise input signal. The basic parameters of each filter are selected to simulate, as a function of time, the basic characteristics of random heart murmurs. Musical murmurs are modelled as a frequency-modulated deterministic sinusoid of constant amplitude. Numerical simulations of these random and musical heart murmurs are then generated and will be used in Part II to determine the best of three time-frequency representation techniques for analysing heart murmur signals.

Time-frequency analysis of heart murmurs. Part II: Optimisation of time-frequency representations and performance evaluation.

The basic parameters of the spectrogram, the Choi-Williams, and the Bessel distributions are adjusted to provide the best time-frequency representations (TFRs) of the simulated murmur signals of mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, and of two musical murmurs. The initial adjustment of the parameters of each TFR technique is performed by computing and minimising the relative averaged absolute error between the frequency contours at -3 dB and -10 dB of each TFR of the simulated murmurs and those of the theoretical distribution of the same signals. The results show that the spectrogram generally provides very good to excellent performance in representing the TFRs of stenotic and regurgitant murmurs. Improvements provided by the Choi-Williams and the Bessel distributions are minor but not systematic for the two signal-to-noise ratios tested (0 and 30 dB) and for the two frequency contours estimated. The Bessel and the Choi-Williams distributions provide the best performance for the musical murmurs. The study shows that although a single technique cannot be optimal for all six murmurs, the spectrogram using a Hamming window of 30 ms is an acceptable compromise to detect the six simulated heart murmurs.

Evaluation of Karhunen-Loève expansion for feature selection in computer-assisted classification of bioprosthetic heart-valve status.

This paper analyses the performance of four different feature-selection approaches of the Karhunen-Loève expansion (KLE) method to select the most discriminant set of features for computer-assisted classification of bioprosthetic heart-valve status. First, an evaluation test reducing the number of initial features while maintaining the performance of the original classifier is developed. Secondly, the effectiveness of the classification in a simulated practical situation where a new sample has to be classified is estimated with a validation test. Results from both tests applied to a reference database show that the most efficient feature selection and classification (> or = 97% of correct classifications (CCs)) are performed by the Kittler and Young approach. For the clinical databases, this approach provides poor classification results for simulated 'new samples' (between 50 and 69% of CCs). For both the evaluation and the validation tests, only the Heydorn and Tou approach provides classification results comparable with those of the original classifier (a difference always < or = 7%). However, the degree of feature reduction is particularly variable. The study demonstrates that the KLE feature-selection approaches are highly population-dependent. It also shows that the validation method proposed is advantageous in clinical applications where the data collection is difficult to perform.

Design and preliminary evaluation of a portable instrument for assisting physiotherapists and occupational therapists in the rehabilitation of the hand.

This paper describes a portable instrument designed to monitor progress accomplished by patients participating in a hand rehabilitation program. The instrument is driven by a microcontroller and features signal conditioning circuits to measure and record the strength and duration of hand contractions. An alphanumeric display provides the patient with performance indications to allow biofeedback reinforcement, and clear instructions on how to perform the prescribed exercises. Exercise data acquired by the portable instrument can be transferred to a host computer for analysis and archival storage. Results of a preliminary clinical evaluation in 14 patients are presented.