Acoustic Methods for Pulmonary Diagnosis

Early Diagnosis of Pneumonia and Chronic Obstructive Pulmonary Disease with a Smart Stethoscope with Cloud Server-Embedded Machine Learning in the Post-COVID-19 Era

Background/Objectives: Respiratory diseases are common and result in high mortality, especially in the elderly, with pneumonia and chronic obstructive pulmonary disease (COPD). Auscultation of lung sounds using a stethoscope is a crucial method for diagnosis, but it may require specialized training and the involvement of pulmonologists. This study aims to assist medical professionals who are non-pulmonologist doctors in early screening for pneumonia and COPD by developing a smart stethoscope with cloud server-embedded machine learning to diagnose lung sounds. Methods: The smart stethoscope was developed using a Micro-Electro-Mechanical system (MEMS) microphone to record lung sounds in the mobile application and then send them wirelessly to a cloud server for real-time machine learning classification. Results: The model of the smart stethoscope classifies lung sounds into four categories: normal, pneumonia, COPD, and other respiratory diseases. It achieved an accuracy of 89%, a sensitivity of 89.75%, and a specificity of 95%. In addition, testing with healthy volunteers yielded an accuracy of 80% in distinguishing normal and diseased lungs. Moreover, the performance comparison between the smart stethoscope and two commercial auscultation stethoscopes showed comparable sound quality and loudness results. Conclusions: The smart stethoscope holds great promise for improving healthcare delivery in the post-COVID-19 era, offering the probability of the most likely respiratory conditions for early diagnosis of pneumonia, COPD, and other respiratory diseases. Its user-friendly design and machine learning capabilities provide a valuable resource for non-pulmonologist doctors by delivering timely, evidence-based diagnoses, aiding treatment decisions, and paving the way for more accessible respiratory care.

Development and validation of a nomogram for predicting lung cancer based on acoustic-clinical features

Objective

Lung cancer-with its global prevalence and critical need for early diagnosis and treatment-is the focus of our study. This study aimed to develop a nomogram based on acoustic-clinical features-a tool that could significantly enhance the clinical prediction of lung cancer.

Methods

We reviewed the voice data and clinical information of 350 individuals: 189 pathologically confirmed lung cancer patients and 161 non-lung cancer patients, which included 77 patients with benign pulmonary lesions and 84 healthy volunteers. First, acoustic features were extracted from all participants, and optimal features were selected by least absolute shrinkage and selection operator (LASSO) regression. Subsequently, by integrating acoustic features and clinical features, a nomogram for predicting lung cancer was developed using a multivariate logistic regression model. The performance of the nomogram was evaluated by the area under the receiver operating characteristic curve (AUC) and the calibration curve. The clinical utility was estimated by decision curve analysis (DCA) to confirm the predictive value of the nomogram. Furthermore, the nomogram model was compared with predictive models that were developed using six additional machine-learning (ML) methods.

Results

Our acoustic-clinical nomogram model demonstrated a strong discriminative ability, with AUCs of 0.774 (95% confidence interval [CI], 0.716-0.832) and 0.714 (95% CI: 0.616-0.811) in the training and test sets, respectively. The nomogram achieved an accuracy of 0.642, a sensitivity of 0.673, and a specificity of 0.611 in the test set. The calibration curve showed excellent agreement between the predicted and actual values, and the DCA curve underscored the clinical usefulness of our nomogram. Notably, our nomogram model outperformed other models in terms of AUC, accuracy, and specificity.

Conclusion

The acoustic-clinical nomogram developed in this study demonstrates robust discrimination, calibration, and clinical application value. This nomogram, a unique contribution to the field, provides a reliable tool for predicting lung cancer.

Attenuation Tomography Using Low-Frequency Ultrasound With Variational Autoencoder for Thorax Imaging: Experimental Study

In this paper, we introduce a novel inversion methodology employing the variational autoencoder (VAE) for human thorax attenuation tomography using low-frequency ultrasound. The VAE is trained to assimilate the structural priors of the human thorax, utilizing training samples generated from computed tomography (CT) scans. This approach enables the compression of high-dimensional attenuation distributions into a lower-dimensional latent space. During the inversion process, the latent code is optimized, and then the reconstructed model is generated by the decoder of the VAE. This process can effectively integrate prior information of the domain of interest (DOI) into the inversion through coding and decoding, which would mitigate the ill-posedness of the inverse problem and facilitate better outcomes. Our method demonstrates robust generalization capabilities and noise resilience in numerical simulations, outperforming the conventional pixel-based Gauss-Newton method. Human subject experiment further corroborates the effectiveness of our approach. This is also the first experimental validation of the feasibility of low-frequency ultrasound functional imaging of the human thorax. Although the current study presents certain limitations, it underscores the potential of low-frequency ultrasound in the continuous monitoring of the human respiratory system.

Exploring explainable AI features in the vocal biomarkers of lung disease

This review delves into the burgeoning field of explainable artificial intelligence (XAI) in the detection and analysis of lung diseases through vocal biomarkers. Lung diseases, often elusive in their early stages, pose a significant public health challenge. Recent advancements in AI have ushered in innovative methods for early detection, yet the black-box nature of many AI models limits their clinical applicability. XAI emerges as a pivotal tool, enhancing transparency and interpretability in AI-driven diagnostics. This review synthesizes current research on the application of XAI in analyzing vocal biomarkers for lung diseases, highlighting how these techniques elucidate the connections between specific vocal features and lung pathology. We critically examine the methodologies employed, the types of lung diseases studied, and the performance of various XAI models. The potential for XAI to aid in early detection, monitor disease progression, and personalize treatment strategies in pulmonary medicine is emphasized. Furthermore, this review identifies current challenges, including data heterogeneity and model generalizability, and proposes future directions for research. By offering a comprehensive analysis of explainable AI features in the context of lung disease detection, this review aims to bridge the gap between advanced computational approaches and clinical practice, paving the way for more transparent, reliable, and effective diagnostic tools.

Attenuation Tomography Using Low-Frequency Ultrasound for Thorax Imaging: Feasibility Study

Low-frequency ultrasound can permeate human thorax and can be applied in functional imaging of the respiratory system. In this study, we investigate the transmission of low-frequency ultrasound through the human thorax and propose a waveform matching method to track the changes in the transmission signal during subject's respiration. The method's effectiveness is validated through experiments involving ten human subjects. Furthermore, the experimental findings indicate that the traveltime of the first-arrival signal remains consistent throughout the respiratory cycle. Leveraging this observation, we introduce an algorithm for ultrasound thorax attenuation factor differential imaging. By computing the paths and energy variation of the first-arrival signal from the received waveform, the algorithm reconstructs the distribution of attenuation factor differences between two different thorax states, providing insights into the functional status of the respiratory system. Numerical experiments, using both normal thorax and defective thorax models, confirm the algorithm's feasibility and its robustness against noise, variations in transducer position and orientation. These results highlight the potential of low-frequency ultrasound for bedside, continuous monitoring of human respiratory system through functional imaging.

Respiratory System Monitoring Based on Low-frequency Transmission Ultrasound Using Wearable Transducers

Ultrasound's application in respiratory system monitoring has been constrained by factors such as reflections at the lung-pleural interface and scattering within the lungs. Recent studies have shown that ultrasound from 10 kHz to 750 kHz can penetrate the human thorax during expiration. However, challenges persist in signal reception during inspiration due to low signal amplitude. In this study, we introduce a waveform matching method designed to ensure reliable transmission signal reception throughout the entire respiratory cycle by tracking waveform variations. The feasibility of this approach is demonstrated through a low-frequency ultrasound thorax transmission experiment using wearable transducers operating at 60 kHz. We observe that both the traveltime and energy of the first-arrival signal undergo significant changes that correlate with the breathing cycle. Furthermore, our findings indicate that variations in traveltime are predominantly due to thorax deformation, rather than changes in acoustic velocity distribution within the thorax as previously suggested by ex vivo studies. Besides, the energy variation curve features a heart rate frequency component. The experiment result affirms that low-frequency transmission ultrasound can detect variations in thorax state and holds promise for respiratory system monitoring.

Study on Thorax Attenuation Tomography Using Low-frequency Ultrasound Differential Imaging

Ultrasound is a preferred modality in the field of medical imaging. However, its application in the human thorax faces challenges due to issues such as reflections at the lung-pleural interface and scattering within the lungs. Recent research has shown that low-frequency ultrasound, ranging from 10 kHz to 750 kHz, can effectively penetrate the human thorax. Furthermore, it has been observed that the amplitude of ultrasound signals changes significantly during the subject's respiration, while its traveltime remains relatively constant.In this study, we derive the relationship between the energy attenuation of the first-arrival ultrasound signal as it penetrates the thorax and the attenuation factor of the thorax. Leveraging the principles of differential imaging, we demonstrate that it is possible to reconstruct variations in the thorax's attenuation factor under different ventilation states based on the energy variations and paths of the first-arrival signals that penetrate the thorax. The algorithm is verified with numerical simulation and human subject experiment. Apparent high-attenuation areas in both the left and right sides of the thorax are reconstructed, which substantiates the feasibility of utilizing low-frequency ultrasound for thorax attenuation differential imaging.

Vocal resonance: a narrative review

Physical examination is an important ritual of bedside medicine that establishes a strong bond between the patient and the physician. It provides practice to acquire important diagnostic skills. A poorly executed bedside examination may result in the wrong diagnosis and adverse outcomes. However, the ritual of obtaining a patient's history and performing a good clinical examination is declining globally. Even the quality of clinical examination skills is declining. One reason may be the short time spent by physicians at the bedside of patients. In addition, due to the substantial technological advancement, physicians often rely more on technology and consider clinical examinations less relevant. In resource-limited settings, thorough history-taking and physical examinations should always be prioritized. An important aspect of respiratory auscultation is the auscultation over the chest wall to detect abnormalities in the transmission of voice-generated sounds, which may provide an important diagnostic clue. Laënnec originally described in detail three types of voice-generated sounds and named them bronchophonism, pectoriloquism, and egophonism. Subsequently, they are known as bronchophony, whispering pectoriloquy, and egophony. A recent variant of egophony is "E-to-A" changes. We searched PubMed, EMBASE, and the CINAHL from inception to December 2023. We used the following search terms: vocal resonance, bronchophony, egophony, whispering pectoriloquy, auscultation, etc. All types of studies were chosen. This review will narrate the physics of sound waves, the types of vocal resonance, the mechanisms of vocal resonance, the methods to elicit them, and the accuracy of vocal resonance.

Enabling Continuous Breathing-Phase Contextualization via Wearable-Based Impedance Pneumography and Lung Sounds: A Feasibility Study

Chronic respiratory diseases affect millions and are leading causes of death in the US and worldwide. Pulmonary auscultation provides clinicians with critical respiratory health information through the study of Lung Sounds (LS) and the context of the breathing-phase and chest location in which they are measured. Existing auscultation technologies, however, do not enable the simultaneous measurement of this context, thereby potentially limiting computerized LS analysis. In this work, LS and Impedance Pneumography (IP) measurements were obtained from 10 healthy volunteers while performing normal and forced-expiratory (FE) breathing maneuvers using our wearable IP and respiratory sounds (WIRS) system. Simultaneous auscultation was performed with the Eko CORE stethoscope (EKO). The breathing-phase context was extracted from the IP signals and used to compute phase-by-phase (Inspiratory (I), expiratory (E), and their ratio (I:E)) and breath-by-breath acoustic features. Their individual and added value was then elucidated through machine learning analysis. We found that the phase-contextualized features effectively captured the underlying acoustic differences between deep and FE breaths, yielding a maximum F1 Score of 84.1 ±11.4% with the phase-by-phase features as the strongest contributors to this performance. Further, the individual phase-contextualized models outperformed the traditional breath-by-breath models in all cases. The validity of the results was demonstrated for the LS obtained with WIRS, EKO, and their combination. These results suggest that incorporating breathing-phase context may enhance computerized LS analysis. Hence, multimodal sensing systems that enable this, such as WIRS, have the potential to advance LS clinical utility beyond traditional manual auscultation and improve patient care.

Deep learning-based lung sound analysis for intelligent stethoscope

Auscultation is crucial for the diagnosis of respiratory system diseases. However, traditional stethoscopes have inherent limitations, such as inter-listener variability and subjectivity, and they cannot record respiratory sounds for offline/retrospective diagnosis or remote prescriptions in telemedicine. The emergence of digital stethoscopes has overcome these limitations by allowing physicians to store and share respiratory sounds for consultation and education. On this basis, machine learning, particularly deep learning, enables the fully-automatic analysis of lung sounds that may pave the way for intelligent stethoscopes. This review thus aims to provide a comprehensive overview of deep learning algorithms used for lung sound analysis to emphasize the significance of artificial intelligence (AI) in this field. We focus on each component of deep learning-based lung sound analysis systems, including the task categories, public datasets, denoising methods, and, most importantly, existing deep learning methods, i.e., the state-of-the-art approaches to convert lung sounds into two-dimensional (2D) spectrograms and use convolutional neural networks for the end-to-end recognition of respiratory diseases or abnormal lung sounds. Additionally, this review highlights current challenges in this field, including the variety of devices, noise sensitivity, and poor interpretability of deep models. To address the poor reproducibility and variety of deep learning in this field, this review also provides a scalable and flexible open-source framework that aims to standardize the algorithmic workflow and provide a solid basis for replication and future extension: https://github.com/contactless-healthcare/Deep-Learning-for-Lung-Sound-Analysis .

Acoustic Lung Imaging Utilized in Continual Assessment of Patients with Obstructed Airway: A Systematic Review

Smart respiratory therapy is enabled by continual assessment of lung functions. This systematic review provides an overview of the suitability of equipment-to-patient acoustic imaging in continual assessment of lung conditions. The literature search was conducted using Scopus, PubMed, ScienceDirect, Web of Science, SciELO Preprints, and Google Scholar. Fifteen studies remained for additional examination after the screening process. Two imaging modalities, lung ultrasound (LUS) and vibration imaging response (VRI), were identified. The most common outcome obtained from eleven studies was positive observations of changes to the geographical lung area, sound energy, or both, while positive observation of lung consolidation was reported in the remaining four studies. Two different modalities of lung assessment were used in eight studies, with one study comparing VRI against chest X-ray, one study comparing VRI with LUS, two studies comparing LUS to chest X-ray, and four studies comparing LUS in contrast to computed tomography. Our findings indicate that the acoustic imaging approach could assess and provide regional information on lung function. No technology has been shown to be better than another for measuring obstructed airways; hence, more research is required on acoustic imaging in detecting obstructed airways regionally in the application of enabling smart therapy.

Emerging Imaging Modalities for Functional Assessment of Donor Lungs Ex Vivo

The severe shortage of functional donor lungs that can be offered to recipients has been a major challenge in lung transplantation. Innovative ex vivo lung perfusion (EVLP) and tissue engineering methodologies are now being developed to repair damaged donor lungs that are deemed unsuitable for transplantation. To assess the efficacy of donor lung reconditioning methods intended to rehabilitate rejected donor lungs, monitoring of lung function with improved spatiotemporal resolution is needed. Recent developments in live imaging are enabling non-destructive, direct, and longitudinal modalities for assessing local tissue and whole lung functions. In this review, we describe how emerging live imaging modalities can be coupled with lung tissue engineering approaches to promote functional recovery of ex vivo donor lungs.

Sound-guided assessment and localization of pulmonary air leak

Pulmonary air leak is the most common complication of lung surgery, with air leaks that persist longer than 5 days representing a major source of post-surgery morbidity. Clinical management of air leaks is challenging due to limited methods to precisely locate and assess leaks. Here, we present a sound-guided methodology that enables rapid quantitative assessment and precise localization of air leaks by analyzing the distinct sounds generated as the air escapes through defective lung tissue. Air leaks often present after lung surgery due to loss of tissue integrity at or near a staple line. Accordingly, we investigated air leak sounds from a focal pleural defect in a rat model and from a staple line failure in a clinically relevant swine model to demonstrate the high sensitivity and translational potential of this approach. In rat and swine models of free-flowing air leak under positive pressure ventilation with intrapleural microphone 1 cm from the lung surface, we identified that: (a) pulmonary air leaks generate sounds that contain distinct harmonic series, (b) acoustic characteristics of air leak sounds can be used to classify leak severity, and (c) precise location of the air leak can be determined with high resolution (within 1 cm) by mapping the sound loudness level across the lung surface. Our findings suggest that sound-guided assessment and localization of pulmonary air leaks could serve as a diagnostic tool to inform air leak detection and treatment strategies during video-assisted thoracoscopic surgery (VATS) or thoracotomy procedures.

Enabling effective breathing sound analysis for automated diagnosis of lung diseases

With the emergence of the COVID-19 pandemic, early diagnosis of lung diseases has attracted growing attention. Generally, monitoring the breathing sound is the traditional means for assessing the status of a patient's respiratory health through auscultation; for that a stethoscope is one of the clinical tools used by physicians for diagnosis of lung disease and anomalies. On the other hand, recent technological advances have made telehealth systems a practical and effective option for health status assessment and remote patient monitoring. The interest in telehealth solutions have further grown with the COVID-19 pandemic. These telehealth systems aim to provide increased safety and help to cope with the massive growth in healthcare demand. Particularly, employing acoustic sensors to collect breathing sound would enable real-time assessment and instantaneous detection of anomalies. However, existing work focuses on autonomous determination of respiratory rate which is not suitable for anomaly detection due to inability to deal with noisy data recording. This paper presents a novel approach for effective breathing sound analysis. We promote a new segmentation mechanism of the captured acoustic signals to identify breathing cycles in recorded sound signals. A scoring scheme is applied to qualify the segment based on the targeted respiratory illness by the overall breathing sound analysis. We demonstrate the effectiveness of our approach via experiments using published COPD datasets.

Audio Recording Patient-Nurse Verbal Communications in Home Health Care Settings: Pilot Feasibility and Usability Study

Background

Patients’ spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients’ spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting.

Objective

This study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows.

Methods

This study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices—Saramonic Blink500, Sony ICD-TX6, and Black Vox 365—were further evaluated in a clinical setting (patients’ homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews.

Results

Saramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65% and 26%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management.

Conclusions

This study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation.

Body Acoustics for the Non-Invasive Diagnosis of Medical Conditions

In the past few decades, many non-invasive monitoring methods have been developed based on body acoustics to investigate a wide range of medical conditions, including cardiovascular diseases, respiratory problems, nervous system disorders, and gastrointestinal tract diseases. Recent advances in sensing technologies and computational resources have given a further boost to the interest in the development of acoustic-based diagnostic solutions. In these methods, the acoustic signals are usually recorded by acoustic sensors, such as microphones and accelerometers, and are analyzed using various signal processing, machine learning, and computational methods. This paper reviews the advances in these areas to shed light on the state-of-the-art, evaluate the major challenges, and discuss future directions. This review suggests that rigorous data analysis and physiological understandings can eventually convert these acoustic-based research investigations into novel health monitoring and point-of-care solutions.

Acquisition and Classification of Lung Sounds for Improving the Efficacy of Auscultation Diagnosis of Pulmonary Diseases

Purpose

Lung diseases are the third leading cause of death worldwide. Stethoscope-based auscultation is the most commonly used, non-invasive, inexpensive, and primary diagnostic approach for assessing lung conditions. However, the manual auscultation-based diagnosis procedure is prone to error, and its accuracy is dependent on the physician’s experience and hearing capacity. Moreover, the stethoscope recording is vulnerable to different noises that can mask the important features of lung sounds which may lead to misdiagnosis. In this paper, a method for the acquisition of lung sound signals and classification of the top 7 lung diseases has been proposed for improving the efficacy of auscultation diagnosis of pulmonary disease.

Methods

An electronic stethoscope has been constructed for signal acquisition. Lung sound signals were then collected from people with COPD, upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), pneumonia, bronchiectasis, bronchiolitis, asthma, and healthy people. Lung sounds were analyzed using a wavelet multiresolution analysis. To choose the most relevant features, feature selection using one-way ANOVA was performed. The classification accuracy of various machine learning classifiers was compared, and the Fine Gaussian SVM was chosen for final classification due to its superior performance. Model optimization was accomplished through the application of Bayesian optimization techniques.

Results

A test classification accuracy of 99%, specificity of 99.2%, and sensitivity of 99.04%, have been achieved for the 7 lung diseases using the optimized Fine Gaussian SVM classifier.

Conclusion

Our experimental results demonstrate that the proposed method has the potential to be used as a decision support system for the classification of lung diseases, especially in those areas where the expertise and the means are limited.

A Wearable Multimodal Sensing System for Tracking Changes in Pulmonary Fluid Status, Lung Sounds, and Respiratory Markers

Heart failure (HF) exacerbations, characterized by pulmonary congestion and breathlessness, require frequent hospitalizations, often resulting in poor outcomes. Current methods for tracking lung fluid and respiratory distress are unable to produce continuous, holistic measures of cardiopulmonary health. We present a multimodal sensing system that captures bioimpedance spectroscopy (BIS), multi-channel lung sounds from four contact microphones, multi-frequency impedance pneumography (IP), temperature, and kinematics to track changes in cardiopulmonary status. We first validated the system on healthy subjects (n = 10) and then conducted a feasibility study on patients (n = 14) with HF in clinical settings. Three measurements were taken throughout the course of hospitalization, and parameters relevant to lung fluid status—the ratio of the resistances at 5 kHz to those at 150 kHz (K)—and respiratory timings (e.g., respiratory rate) were extracted. We found a statistically significant increase in K (p < 0.05) from admission to discharge and observed respiratory timings in physiologically plausible ranges. The IP-derived respiratory signals and lung sounds were sensitive enough to detect abnormal respiratory patterns (Cheyne–Stokes) and inspiratory crackles from patient recordings, respectively. We demonstrated that the proposed system is suitable for detecting changes in pulmonary fluid status and capturing high-quality respiratory signals and lung sounds in a clinical setting.

Lung Health Analysis: Adventitious Respiratory Sound Classification Using Filterbank Energies

Audio-based healthcare technologies are among the most significant applications of pattern recognition and Artificial Intelligence. Lately, a major chunk of the World population has been infected with serious respiratory diseases such as COVID-19. Early recognition of lung health abnormalities can facilitate early intervention, and decrease the mortality rate of the infected population. Research has shown that it is possible to automatically monitor lung health abnormalities through respiratory sounds. In this paper, we propose an approach that employs filter bank energy-based features and Random Forests to classify lung problem types from respiratory sounds. The adventitious sounds, crackles and wheezes appear distinct to the human ear. Moreover, different sounds are characterized by different frequency ranges that are dominant. The proposed approach attempts to distinguish the adventitious sounds (crackles and wheezes) by modeling the human auditory perception of these sounds. Specifically, we propose a respiratory sounds representation technique capable of modeling the dominant frequency range present in such sounds. On a publicly available dataset (ICBHI) of size 6898 cycles spanning over 5[Formula: see text]h, our results can be compared with the state-of-the-art results, in distinguishing two different types of adventitious sounds: crackles and wheezes.

SpeechSpiro: Lung Function Assessment from Speech Pattern as an Alternative to Spirometry for Mobile Health Tracking

Respiratory illnesses are common in the United States and globally; people deal with these illnesses in various forms, such as asthma, chronic obstructive pulmonary diseases, or infectious respiratory diseases (e.g., coronavirus). The lung function of subjects affected by these illnesses degrades due to infection or inflammation in their respiratory airways. Typically, lung function is assessed using in-clinic medical equipment, and quite recently, via portable spirometry devices. Research has shown that the obstruction and restriction in the respiratory airways affect individuals' voice characteristics. Hence, audio features could play a role in predicting the lung function and severity of the obstruction. In this paper, we go beyond well-known voice audio features and create a hybrid deep learning model using CNN-LSTM to discover spatiotemporal patterns in speech and predict the lung function parameters with accuracy comparable to conventional devices. We validate the performance and generalizability of our method using the data collected from 201 subjects enrolled in two studies internally and in collaboration with a pulmonary hospital. SpeechSpiro measures lung function parameters (e.g., forced vital capacity) with a mean normalized RMSE of 12% and R² score of up to 76% using 60-second phone audio recordings of individuals reading a passage.Clinical relevance - Speech-based spirometry has the potential to eliminate the need for an additional device to carry out the lung function assessment outside clinical settings; hence, it can enable continuous and mobile track of the individual's condition, healthy or with a respiratory illness, using a smartphone.

A wearable eddy current based pulmonary function sensor for continuous non-contact point-of-care monitoring during the COVID-19 pandemic

Pulmonary function testing (PFT) allows for quantitative analysis of lung function. However, as a result of the coronavirus disease 2019 (COVID-19) pandemic, a majority of international medical societies have postponed PFTs in an effort to mitigate disease transmission, complicating the continuity of care in high-risk patients diagnosed with COVID-19 or preexisting lung pathologies. Here, we describe the development of a non-contact wearable pulmonary sensor for pulmonary waveform analysis, pulmonary volume quantification, and crude thoracic imaging using the eddy current (EC) phenomenon. Statistical regression analysis is performed to confirm the predictive validity of the sensor, and all data are continuously and digitally stored with a sampling rate of 6,660 samples/second. Wearable pulmonary function sensors may facilitate rapid point-of-care monitoring for high-risk individuals, especially during the COVID-19 pandemic, and easily interface with patient hospital records or telehealth services.

Novel Acoustic Biomarker of Quality of Life in Left Ventricular Assist Device Recipients

Background Although technological advances to pump design have improved survival, left ventricular assist device (LVAD) recipients experience variable improvements in quality of life. Methods for optimizing LVAD support to improve quality of life are needed. We investigated whether acoustic signatures obtained from digital stethoscopes can predict patient-centered outcomes in LVAD recipients. Methods and Results We followed precordial sounds over 6 months in 24 LVAD recipients (8 HeartWare HVAD™, 16 HeartMate 3 [HM3]). Subjects recorded their precordial sounds with a digital stethoscope and completed a Kansas City Cardiomyopathy Questionnaire weekly. We developed a novel algorithm to filter LVAD sounds from recordings. Unsupervised clustering of LVAD-mitigated sounds revealed distinct groups of acoustic features. Of 16 HM3 recipients, 6 (38%) had a unique acoustic feature that we have termed the pulse synchronized sound based on its temporal association with the artificial pulse of the HM3. HM3 recipients with the pulse synchronized sound had significantly better Kansas City Cardiomyopathy Questionnaire scores at baseline (median, 89.1 [interquartile range, 86.2-90.4] versus 66.1 [interquartile range, 31.1-73.7]; P=0.03) and over the 6-month study period (marginal mean, 77.6 [95% CI, 66.3-88.9] versus 59.9 [95% CI, 47.9-70.0]; P<0.001). Mechanistically, the pulse synchronized sound shares acoustic features with patient-derived intrinsic sounds. Finally, we developed a machine learning algorithm to automatically detect the pulse synchronized sound within precordial sounds (area under the curve, 0.95, leave-one-subject-out cross-validation). Conclusions We have identified a novel acoustic biomarker associated with better quality of life in HM3 LVAD recipients, which may provide a method for assaying optimized LVAD support.

Monophonic and Polyphonic Wheezing Classification Based on Constrained Low-Rank Non-Negative Matrix Factorization

The appearance of wheezing sounds is widely considered by physicians as a key indicator to detect early pulmonary disorders or even the severity associated with respiratory diseases, as occurs in the case of asthma and chronic obstructive pulmonary disease. From a physician's point of view, monophonic and polyphonic wheezing classification is still a challenging topic in biomedical signal processing since both types of wheezes are sinusoidal in nature. Unlike most of the classification algorithms in which interference caused by normal respiratory sounds is not addressed in depth, our first contribution proposes a novel Constrained Low-Rank Non-negative Matrix Factorization (CL-RNMF) approach, never applied to classification of wheezing as far as the authors' knowledge, which incorporates several constraints (sparseness and smoothness) and a low-rank configuration to extract the wheezing spectral content, minimizing the acoustic interference from normal respiratory sounds. The second contribution automatically analyzes the harmonic structure of the energy distribution associated with the estimated wheezing spectrogram to classify the type of wheezing. Experimental results report that: (i) the proposed method outperforms the most recent and relevant state-of-the-art wheezing classification method by approximately 8% in accuracy; (ii) unlike state-of-the-art methods based on classifiers, the proposed method uses an unsupervised approach that does not require any training.

Methods for Adventitious Respiratory Sound Analyzing Applications Based on Smartphones: A Survey

Detection and classification of adventitious acoustic lung sounds plays an important role in diagnosing, monitoring, controlling and, caring the patients with lung diseases. Such systems can be presented as different platforms like medical devices, standalone software or smartphone application. Ubiquity of smartphones and widespread use of the corresponding applications make such a device an attractive platform for hosting the detection and classification systems for adventitious lung sounds. In this paper, the smartphone-based systems for automatic detection and classification of the adventitious lung sounds are surveyed. Such adventitious sounds include cough, wheeze, crackle and, snore. Relevant sounds related to abnormal respiratory activities are considered as well. The methods are shortly described and the analyzing algorithms are explained. The analysis includes detection and/or classification of the sound events. A summary of the main surveyed methods together with the classification parameters and used features for the sake of comparison is given. Existing challenges, open issues and future trends will be discussed as well.

Wearable Sensing and Telehealth Technology with Potential Applications in the Coronavirus Pandemic

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic with serious clinical manifestations including death. A pandemic at the large-scale like COVID-19 places extraordinary demands on the world's health systems, dramatically devastates vulnerable populations, and critically threatens the global communities in an unprecedented way. While tremendous efforts at the frontline are placed on detecting the virus, providing treatments and developing vaccines, it is also critically important to examine the technologies and systems for tackling disease emergence, arresting its spread and especially the strategy for diseases prevention. The objective of this article is to review enabling technologies and systems with various application scenarios for handling the COVID-19 crisis. The article will focus specifically on 1) wearable devices suitable for monitoring the populations at risk and those in quarantine, both for evaluating the health status of caregivers and management personnel, and for facilitating triage processes for admission to hospitals; 2) unobtrusive sensing systems for detecting the disease and for monitoring patients with relatively mild symptoms whose clinical situation could suddenly worsen in improvised hospitals; and 3) telehealth technologies for the remote monitoring and diagnosis of COVID-19 and related diseases. Finally, further challenges and opportunities for future directions of development are highlighted.

Automatic Lung Health Screening Using Respiratory Sounds

Significant changes have been made on audio-based technologies over years in several different fields. Healthcare is no exception. One of such avenues is health screening based on respiratory sounds. In this paper, we developed a tool to detect respiratory sounds that come from respiratory infection carrying patients. Linear Predictive Cepstral Coefficient (LPCC)-based features were used to characterize such audio clips. With Multilayer Perceptron (MLP)-based classifier, in our experiment, we achieved the highest possible accuracy of 99.22% that was tested on a publicly available respiratory sounds dataset (ICBHI17) (Rocha et al. Physiol. Meas. 40(3):035,001 20) of size 6800+ clips. In addition to other popular machine learning classifiers, our results outperformed common works that exist in the literature.

Human forced expiratory noise. Origin, apparatus and possible diagnostic applications

Forced expiratory (FE) noise is a powerful bioacoustic signal containing information on human lung biomechanics. FE noise is attributed to a broadband part and narrowband components-forced expiratory wheezes (FEWs). FE respiratory noise is composed by acoustic and hydrodynamic mechanisms. An origin of the most powerful mid-frequency FEWs (400-600 Hz) is associated with the 0th-3rd levels of bronchial tree in terms of Weibel [(2009). Swiss Med. Wkly. 139(27-28), 375-386], whereas high-frequency FEWs (above 600 Hz) are attributed to the 2nd-6th levels of bronchial tree. The laboratory prototype of the apparatus is developed, which includes the electret microphone sensor with stethoscope head, a laptop with external sound card, and specially developed software. An analysis of signals by the new method, including FE time in the range from 200 to 2000 Hz and band-pass durations and energies in the 200-Hz bands evaluation, is applied instead of FEWs direct measures. It is demonstrated experimentally that developed FE acoustic parameters correspond to basic indices of lung function evaluated by spirometry and body plethysmography and may be even more sensitive to some respiratory deviations. According to preliminary experimental results, the developed technique may be considered as a promising instrument for acoustic monitoring human lung function in extreme conditions, including diving and space flights. The developed technique eliminates the contact of the sensor with the human oral cavity, which is characteristic for spirometry and body plethysmography. It reduces the risk of respiratory cross-contamination, especially during outpatient and field examinations, and may be especially relevant in the context of the COVID-19 pandemic.

The present and future of cough counting tools

The widespread use of cough counting tools has, to date, been limited by a reliance on human input to determine cough frequency. However, over the last two decades advances in digital technology and audio capture have reduced this dependence. As a result, cough frequency is increasingly recognised as a measurable parameter of respiratory disease. Cough frequency is now the gold standard primary endpoint for trials of new treatments for chronic cough, has been investigated as a marker of infectiousness in tuberculosis (TB), and used to demonstrate recovery in exacerbations of chronic obstructive pulmonary disease (COPD). This review discusses the principles of automatic cough detection and summarises key currently and recently used cough counting technology in clinical research. It additionally makes some predictions on future directions in the field based on recent developments. It seems likely that newer approaches to signal processing, the adoption of techniques from automatic speech recognition, and the widespread ownership of mobile devices will help drive forward the development of real-time fully automated ambulatory cough frequency monitoring over the coming years. These changes should allow cough counting systems to transition from their current status as a niche research tool in chronic cough to a much more widely applicable method for assessing, investigating and understanding respiratory disease.

An innovative technology of an athlete’s organism functional reserves increase based on bioacoustical stimulation of the respiratory system

In order to increase an athlete’s organism functional reserves we created the innovative technology based on low-frequency vibrations influence on respiratory system. First we measured acoustic impedance of an athlete’s organism for three phases of respiration at polyharmonic acoustic signal within the range of frequency from 3 Hz to 51 Hz. After that during 2 weeks we organized six sessions of bioacoustical stimulation among the group of 20 athletes, divided into subgroups with an effective (130 dB) and placebo (60 dB) effect. It was stated that six-fold effect of a scanning tonal signal with the level of sound pressure 130 dB within the range 22-36 Hz led to resonance frequency of respiratory system increase, respiratory system sound vibrations imbibitio coefficient decrease and its resistance to sound wave increase because of reserve alveoli opening and the increase of area of cross section of alveolar ways and respiratory bronchial tubes.

Dilatational and shear waves in poro-vioscoelastic media

Dynamic elastography methods are being developed for quantitatively and noninvasively mapping the viscoelastic properties of biological tissue that are often altered by disease and injury, as well as response to treatment. This involves inducing mechanical wave motion that also can be affected by the multiphase porous nature of the tissue, whether it be consideration of blood perfusion in the vascular network found in many regions of interest, or consideration of air movement in the complex bronchial tree within the lungs. Elastographic mapping requires reconstructing material properties based on interpretation of the measured wave motion. Reconstruction methods that explicitly incorporate poroelastic behavior are an active area of development. In the present article the equivalence of two theoretical approaches to modeling poroelastic behavior is demonstrated specifically in the frequency domain using parameter values that span the range expected in vivo for analysis of blood and air-infused regions. The two methods are known as (1) the mixture or biphasic formulation and (2) the poroelastic approach. The case of acoustic wave propagation in the lungs is specifically addressed by comparison of analytical predictions to recently reported experimental measurements. Establishing and validating this equivalence of theoretical approaches not only strengthens our fundamental understanding of the relevant physics, but also may lead to improved numerical methods for simulation and elastography reconstruction.