Simultaneous Acquisition of EIT and ECG Signals on Active EIT Electrodes

OBJECTIVE

This paper introduces a new method of simultaneous acquisition of electrocardiogram (ECG) signals and electrical impedance tomography (EIT) measurements on active electrodes, i.e. electrodes that are applying current, in an EIT system.

METHODS

Howland noise reduction followed by an integrate-and-dump filter and adaptive filtering are used to extract the ECG signal without loss of amplitude.

RESULTS

Results of simultaneous ECG signals and EIT reconstructions on human subjects are shown. It is also demonstrated that the recovered ECG waveforms from 32 electrodes can be used to reconstruct the heart current source vectors during a cardiac cycle, yielding an approximate solution to the inverse problem of electrocardiography.

SIGNIFICANCE

Acquiring ECG signals from all electrodes attached to the body simultaneously with EIT data acquisition eliminates the need for a separate system to collect ECG signals. Time-aligned ECG signals are helpful in interpreting pulsatile perfusion images by providing exact timing of each image in relation to the cardiac cycle. Additionally, collecting ECG signals from many or all of the EIT electrodes enables reconstruction of the heart's moving dipole moment at the same time as the EIT images.

Minimizing Redundancy in Wireless Sensor Networks Using Sparse Vectors

In wireless sensor networks, sensors often collect and transmit a large amount of redundant data, which can lead to excessive battery consumption and subsequent performance degradation. To solve this problem, this paper proposes a Zoom-In Zoom-Out (ZIZO) method based on sparse vectors (SV-ZIZO). It operates in two parts: At the sensor level, given the temporal similarity of the data, a new compression method based on the sparse vector representation of segmented regions is proposed. This method can not only effectively ensure the compression ratio but also improve the accuracy of data restoration. At the cluster-head (CH) level, by utilizing the spatial similarity of the data, the fuzzy clustering theory is introduced to put some sensors into hibernation mode, thereby reducing data transmission. Meanwhile, the sampling frequency of the sensors is dynamically adjusted by calculating the redundancy rate of the collected periodic data. The experimental results show that compared with other existing methods, the algorithm proposed in this paper increases the data compression ratio by 21.8% and can reduce energy consumption by up to 95%.

Rotating radial injection pattern for highly sensitive electrical impedance tomography of human lung anomalies

Objective.Electrical impedance tomography (EIT) is a non-invasive technique used for lung imaging. A significant challenge in EIT is reconstructing images of deeper thoracic regions due to the low sensitivity of boundary voltages to internal conductivity variations. The current injection pattern is decisive as it influences the current path, boundary voltages, and their sensitivity to tissue changes.Approach.This study introduces a novel current injection pattern with radially placed electrodes excited in a rotating radial pattern. The effectiveness of the proposed pattern was investigated using a 3D computational model that mimics the human thorax, replicating its geometry and tissue electrical properties. To examine the detection of lung anomalies, models representing both healthy and unhealthy states, including cancer-like anomalies in three different positions, were developed. The new pattern was compared to common patterns-adjacent, skip 1, and opposite-using finite element analysis. The comparison focused on the current density within lung nodules and the sensitivity to changes in anomaly positions.Main results.Results showed that the new pattern achieved the maximum current density within anomalies compared to surrounding tissues, with peak values near the closest electrode pairs to the anomalies. Specifically, current density magnitudes reached72.73⋅10-9A⋅m,145.24⋅10-9A⋅m, and26.43⋅10-9A⋅mfor the three different positions, respectively. Furthermore, the novel pattern's sensitivity to anomaly position changes surpassed the common patterns.Significance.These results demonstrate the efficiency of the proposed injection pattern in detecting lung anomalies compared to the common injection patterns.

Development and Validation of a Portable EIT System for Real-Time Respiratory Monitoring

This work contributes to the improvement of novel medical technologies for the prevention and treatment of diseases. Electrical impedance tomography (EIT) has gained attention as a valuable tool for non-invasive monitoring providing real-time insights. The purpose of this work is to develop and validate a novel portable EIT system with a small form factor for respiratory monitoring. The device uses a 16-electrode architecture with adjacent stimulation and measurement patterns, an integrated circuit current source and a single high-speed ADC operating with multiplexers to stimulate and measure across all electrodes. Tests were conducted on 25 healthy subjects who performed a pulmonary function test with a flowmeter while using the EIT device. The results showed a good performance of the device, which was able to recognize all respirations correctly, and from the EIT signals and images, correlations of 96.7% were obtained for instantaneous respiratory rate and 96.1% for tidal volume prediction. These results validate the preliminary technical feasibility of the EIT system and demonstrates its potential as a reliable tool for non-invasive respiratory assessment. The significance of this work lies in its potential to democratize advanced respiratory monitoring technologies, making them accessible to a wider population, including those in remote or underserved areas.

Single Channel Based Interference-Free and Self-Powered Human-Machine Interactive Interface Using Eigenfrequency-Dominant Mechanism

The recent development of wearable devices is revolutionizing the way of human-machine interaction (HMI). Nowadays, an interactive interface that carries more embedded information is desired to fulfill the increasing demand in era of Internet of Things. However, present approach normally relies on sensor arrays for memory expansion, which inevitably brings the concern of wiring complexity, signal differentiation, power consumption, and miniaturization. Herein, a one-channel based self-powered HMI interface, which uses the eigenfrequency of magnetized micropillar (MMP) as identification mechanism, is reported. When manually vibrated, the inherent recovery of the MMP causes a damped oscillation that generates current signals because of Faraday's Law of induction. The time-to-frequency conversion explores the MMP-related eigenfrequency, which provides a specific solution to allocate diverse commands in an interference-free behavior even with one electric channel. A cylindrical cantilever model is built to regulate the MMP eigenfrequencies via precisely designing the dimensional parameters and material properties. It is shown that using one device and two electrodes, high-capacity HMI interface can be realized when the magnetic micropillars (MMPs) with different eigenfrequencies have been integrated. This study provides the reference value to design the future HMI system especially for situations that require a more intuitive and intelligent communication experience with high-memory demand.

Flexi-EIT: A Flexible and Reconfigurable Active Electrode Electrical Impedance Tomography System

Electrical Impedance Tomography (EIT) systems have shown great promise in many fields such as real-time wearable healthcare imaging, but their fixed number of electrodes and placement locations limit the system's flexibility and adaptability for further advancement. In this article, we propose a flexible and reconfigurable EIT system (Flexi-EIT) based on digital active electrode (DAE) architecture to address these limitations. By integrating a reconfigurable number of up to 32 replaceable DAEs into the flexible printed circuit (FPC) based wearable electrode belt, we can enable rapid, reliable, and easy placement while maintaining high device flexibility and reliability. We also explore hardware-software co-optimization image reconstruction solutions to balance the size and accuracy of the model, the power consumption, and the real-time latency. Each DAE is designed using commercial chips and fabricated on a printed circuit board (PCB) measuring 13.1 mm × 24.4 mm and weighing 2 grams. In current excitation mode, it can provide programmable sinusoidal current signal output with frequencies up to 100 kHz and amplitudes up to 1 mA p-p that meets IEC 60601-1 standard. In voltage acquisition mode, it can pre-amplify, filter, and digitize the external response voltage signal, improving the robustness of the system while avoiding the need for subsequent analog signal processing circuits. Measured results on a mesh phantom demonstrate that the Flexi-EIT system can be easily configured with different numbers of DAEs and scan patterns to provide EIT measurement frames at 38 fps and real-time EIT images with at least 5 fps, showing the potential to be deployed in a variety of application scenarios and providing the optimal balance of system performance and hardware resource usage solutions.

ACT5 Electrical Impedance Tomography System

OBJECTIVE

This article introduces the Adaptive Current Tomograph 5 (ACT5) Electrical Impedance Tomography (EIT) system. ACT5 is a 32 electrode applied-current multiple-source EIT system that can display real-time images of conductivity and susceptivity at 27 frames per second. The adaptive current sources in ACT5 can apply fully programmable current patterns with frequencies varying from 5 kHz to 500 kHz. The system also displays real-time ECG readings during the EIT imaging process.

METHODS

The hardware and software design and specifications are presented, including the current source design, FPGA hardware, safety features, calibration, and shunt impedance measurement.

RESULTS

Images of conductivity and susceptivity are presented from ACT5 data collected on tank phantoms and a human subject illustrating the system's ability to provide real-time images of pulsatile perfusion and ECG traces.

SIGNIFICANCE

The portability, high signal-to-noise ratio, and flexibility of applied currents over a wide range of frequencies enable this instrument to be used to obtain useful human subject data with relative clinical ease.

BRACETS: Bimodal repository of auscultation coupled with electrical impedance thoracic signals

BACKGROUND AND OBJECTIVE

Respiratory diseases are among the most significant causes of morbidity and mortality worldwide, causing substantial strain on society and health systems. Over the last few decades, there has been increasing interest in the automatic analysis of respiratory sounds and electrical impedance tomography (EIT). Nevertheless, no publicly available databases with both respiratory sound and EIT data are available.

METHODS

In this work, we have assembled the first open-access bimodal database focusing on the differential diagnosis of respiratory diseases (BRACETS: Bimodal Repository of Auscultation Coupled with Electrical Impedance Thoracic Signals). It includes simultaneous recordings of single and multi-channel respiratory sounds and EIT. Furthermore, we have proposed several machine learning-based baseline systems for automatically classifying respiratory diseases in six distinct evaluation tasks using respiratory sound and EIT (A1, A2, A3, B1, B2, B3). These tasks included classifying respiratory diseases at sample and subject levels. The performance of the classification models was evaluated using a 5-fold cross-validation scheme (with subject isolation between folds).

RESULTS

The resulting database consists of 1097 respiratory sounds and 795 EIT recordings acquired from 78 adult subjects in two countries (Portugal and Greece). In the task of automatically classifying respiratory diseases, the baseline classification models have achieved the following average balanced accuracy: Task A1 - 77.9±13.1%; Task A2 - 51.6±9.7%; Task A3 - 38.6±13.1%; Task B1 - 90.0±22.4%; Task B2 - 61.4±11.8%; Task B3 - 50.8±10.6%.

CONCLUSION

The creation of this database and its public release will aid the research community in developing automated methodologies to assess and monitor respiratory function, and it might serve as a benchmark in the field of digital medicine for managing respiratory diseases. Moreover, it could pave the way for creating multi-modal robust approaches for that same purpose.

In-Situ Measuring sEMG and Muscle Shape Change With a Flexible and Stretchable Hybrid Sensor for Hand Gesture Recognition

The accurate recognition of hand motion intentions is an essential prerequisite for efficient human-machine interaction (HMI) systems such as multifunctional prostheses and rehabilitation robots. Surface electromyography (sEMG) signals and muscle shape change (MSC) signals which are usually detected with different types of sensors have been used for human hand motion intention recognition. However, using different sensors to measure sEMG and MSC respectively, it would be inconvenient and add deploying difficulty for human-machine interaction systems. In this study, a novel flexible and stretchable sensor was fabricated with a nano gold conductive material, which could simultaneously sense both sEMG and MSC signals. Accordingly, a wireless signal acquisition device was developed to record both sEMG and MSC signals with the fabricated hybrid sensors. The performance of the proposed in-situ dual-mode signal measurement (IDSM) system was evaluated by the recording signal quality and the accuracy of hand gesture recognition. The results demonstrated that by using two pairs of the hybrid sensors, the proposed IDSM system could obtain two-channel sEMG at a noise level of about $0.89~\mu $ Vrms and four-channel MSC with a resolution of about $0.1~\Omega $ . For a recognition task of 11 classes of hand gestures, the results showed that only with two pairs of the hybrid sensors, the average accuracy over all the subjects was 95.6 ± 2.9%, which was about 7% higher than that with two-channel sEMG and six-channel accelerometer signals. These results suggest that the proposed IDSM method would be an efficient way to simplify the human-machine interaction system with fewer sensors for high recognition accuracy of hand motions.

Electrical Impedance Tomography: From the Traditional Design to the Novel Frontier of Wearables

Electrical impedance tomography (EIT) is a medical imaging technique based on the injection of a current or voltage pattern through electrodes on the skin of the patient, and on the reconstruction of the internal conductivity distribution from the voltages collected by the electrodes. Compared to other imaging techniques, EIT shows significant advantages: it does not use ionizing radiation, is non-invasive and is characterized by high temporal resolution. Moreover, its low cost and high portability make it suitable for real-time, bedside monitoring. However, EIT is also characterized by some technical limitations that cause poor spatial resolution. The possibility to design wearable devices based on EIT has recently given a boost to this technology. In this paper we reviewed EIT physical principles, hardware design and major clinical applications, from the classical to a wearable setup. A wireless and wearable EIT system seems a promising frontier of this technology, as it can both facilitate making clinical measurements and open novel scenarios to EIT systems, such as home monitoring.

A review of bio-impedance devices

Bio-impedance measurement analysis primarily refers to a safe and a non-invasive technique to analyze the electrical changes in living tissues on the application of low-value alternating current. It finds applications both in the biomedical and the agricultural fields. This paper concisely reviews the origin and measurement approaches for concepts and fundamentals of bio-impedance followed by a critical review on bio-impedance portable devices with main emphasis on the embedded system approach which is in demand due to its miniature size and present lifestyle preference of monitoring health in real time. The paper also provides a comprehensive review of various bio-impedance circuits with emphasis on the measurement and calibration techniques.

Evaluation of a Wearable System for Fetal ECG Monitoring Using Cooperative Sensors

Fetal electrocardiography (fECG) has gotten widespread interest in the last years as technology for fetal monitoring. Compared to cardiotocography (CTG), the current state of the art, it can be designed in smaller formfactor and is thus suited for long-term and unsupervised monitoring. In the present study we evaluated a wearable system which is based on CSEM's cooperative sensors, a versatile technology that allows for the measurement of multiple biosignals and an easy integration into a garment or patch. The system was tested on 25 patients with singleton pregnancies and an age of gestation ≥ 37 weeks. To reject unreliable fetal heart rate (fHR) estimations, the signal processing algorithm provides a signal quality index. In 12 out of 21 patients available for analysis, a good performance of fHR estimations was obtained with a mean absolute error < 5 bpm and an acceptance rate >70%. However, the remaining 9 patients showed low acceptance rates and high errors. Besides investigating the source of these high errors, future work includes the investigating improved signal processing algorithms, different body positions and the use of dry electrodes. Clinical Relevance - The aim of this work is to develop a wearable system that can be offered in hospitals as an alternative to cardiotocography, or as a home monitoring tool for at risk fetuses, in the era of evolving telemedicine.

Missing and Corrupted Data Recovery in Wireless Sensor Networks Based on Weighted Robust Principal Component Analysis

Although wireless sensor networks (WSNs) have been widely used, the existence of data loss and corruption caused by poor network conditions, sensor bandwidth, and node failure during transmission greatly affects the credibility of monitoring data. To solve this problem, this paper proposes a weighted robust principal component analysis method to recover the corrupted and missing data in WSNs. By decomposing the original data into a low-rank normal data matrix and a sparse abnormal matrix, the proposed method can identify the abnormal data and avoid the influence of corruption on the reconstruction of normal data. In addition, the low-rankness is constrained by weighted nuclear norm minimization instead of the nuclear norm minimization to preserve the major data components and ensure credible reconstruction data. An alternating direction method of multipliers algorithm is further developed to solve the resultant optimization problem. Experimental results demonstrate that the proposed method outperforms many state-of-the-art methods in terms of recovery accuracy in real WSNs.

Spatial Ventilation Inhomogeneity Determined by Electrical Impedance Tomography in Patients With Chronic Obstructive Lung Disease

The aim of this study was to examine whether electrical impedance tomography (EIT) could determine the presence of ventilation inhomogeneity in patients with chronic obstructive lung disease (COPD) from measurements carried out not only during conventional forced full expiration maneuvers but also from forced inspiration maneuvers and quiet tidal breathing and whether the inhomogeneity levels were comparable among the phases and higher than in healthy subjects. EIT data were acquired in 52 patients with exacerbated COPD (11 women, 41 men, 68 ± 11 years) and 14 healthy subjects (6 women, 8 men, 38 ± 8 years). Regional lung function parameters of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), forced inspiratory vital capacity (FIVC), forced inspiratory volume in 1 s (FIV₁), and tidal volume (V _T ) were determined in 912 image pixels. The spatial inhomogeneity of the pixel parameters was characterized by the coefficients of variation (CV) and the global inhomogeneity (GI) index. CV and GI values of pixel FVC, FEV₁, FIVC, FIV₁, and V_T were significantly higher in patients than in healthy subjects (p ≤ 0.0001). The ventilation distribution was affected by the analyzed lung function parameter in patients (CV: p = 0.0024, GI: p = 0.006) but not in healthy subjects. Receiver operating characteristic curves showed that CV and GI discriminated patients from healthy subjects with an area under the curve (AUC) of 0.835 and 0.852 (FVC), 0.845 and 0.867 (FEV₁), 0.903 and 0.903 (FIVC), 0.891 and 0.882 (FIV₁), and 0.821 and 0.843 (V_T), respectively. These findings confirm the ability of EIT to identify increased ventilation inhomogeneity in patients with COPD.

Mobile 5P-Medicine Approach for Cardiovascular Patients

Medicine is heading towards personalized care based on individual situations and conditions. With smartphones and increasingly miniaturized wearable devices, the sensors available on these devices can perform long-term continuous monitoring of several user health-related parameters, making them a powerful tool for a new medicine approach for these patients. Our proposed system, described in this article, aims to develop innovative solutions based on artificial intelligence techniques to empower patients with cardiovascular disease. These solutions will realize a novel 5P (Predictive, Preventive, Participatory, Personalized, and Precision) medicine approach by providing patients with personalized plans for treatment and increasing their ability for self-monitoring. Such capabilities will be derived by learning algorithms from physiological data and behavioral information, collected using wearables and smart devices worn by patients with health conditions. Further, developing an innovative system of smart algorithms will also focus on providing monitoring techniques, predicting extreme events, generating alarms with varying health parameters, and offering opportunities to maintain active engagement of patients in the healthcare process by promoting the adoption of healthy behaviors and well-being outcomes. The multiple features of this future system will increase the quality of life for cardiovascular diseases patients and provide seamless contact with a healthcare professional.

Identification and analysis of stable breathing periods in electrical impedance tomography recordings

Objective. In this paper, an automated stable tidal breathing period (STBP) identification method based on processing electrical impedance tomography (EIT) waveforms is proposed and the possibility of detecting and identifying such periods using EIT waveforms is analyzed. In wearable chest EIT, patients breathe spontaneously, and therefore, their breathing pattern might not be stable. Since most of the EIT feature extraction methods are applied to STBPs, this renders their automatic identification of central importance.Approach. The EIT frame sequence is reconstructed from the raw EIT recordings and the raw global impedance waveform (GIW) is computed. Next, the respiratory component of the raw GIW is extracted and processed for the automatic respiratory cycle (breath) extraction and their subsequent grouping into STBPs.Main results. We suggest three criteria for the identification of STBPs, namely, the coefficient of variation of (i) breath tidal volume, (ii) breath duration and (iii) end-expiratory impedance. The total number of true STBPs identified by the proposed method was 294 out of 318 identified by the expert corresponding to accuracy over 90%. Specific activities such as speaking, eating and arm elevation are identified as sources of false positives and their discrimination is discussed.Significance. Simple and computationally efficient STBP detection and identification is a highly desirable component in the EIT processing pipeline. Our study implies that it is feasible, however, the determination of its limits is necessary in order to consider the implementation of more advanced and computationally demanding approaches such as deep learning and fusion with data from other wearable sensors such as accelerometers and microphones.

Wearable Bioimpedance Monitoring: Viewpoint for Application in Chronic Conditions

Currently, nearly 6 in 10 US adults are suffering from at least one chronic condition. Wearable technology could help in controlling the health care costs by remote monitoring and early detection of disease worsening. However, in recent years, there have been disappointments in wearable technology with respect to reliability, lack of feedback, or lack of user comfort. One of the promising sensor techniques for wearable monitoring of chronic disease is bioimpedance, which is a noninvasive, versatile sensing method that can be applied in different ways to extract a wide range of health care parameters. Due to the changes in impedance caused by either breathing or blood flow, time-varying signals such as respiration and cardiac output can be obtained with bioimpedance. A second application area is related to body composition and fluid status (eg, pulmonary congestion monitoring in patients with heart failure). Finally, bioimpedance can be used for continuous and real-time imaging (eg, during mechanical ventilation). In this viewpoint, we evaluate the use of wearable bioimpedance monitoring for application in chronic conditions, focusing on the current status, recent improvements, and challenges that still need to be tackled.

Electrical Tomography Reconstruction Using Reconfigurable Waveforms in a FPGA

The principal objective of this research is to conceive a mobile system based on electrical tomography for subsurface imaging and monitoring in order to enable simultaneous recording of electrical potentials of cardiac and pulmonary activity. For an exploration of excitation waveforms in electrical tomography, specialized hardware is required. As the main principle of tomography is the measurement of electrical perturbations on an unknown object, it is crucial to synchronize excitation and sensing processes in a very precise way for the purpose of acquiring meaningful data. To cope with this problem, an FPGA device is used, with an architecture that allows us to trigger excitation signals and to read sensed data simultaneously via independent processes that share the same clock. In this way, waveform reconfiguration on frequency and shape can be provided and studied. The system is connected to a standard microcontroller SoC with a simple API that allows for IoT capabilities for on-line operation and tracking, given that the design is targeted for in vivo medical monitoring. As a result of the research work, a measuring device was developed, the surface data analyzed and the image was reconstructed using the selected configuration.

Sparse image reconstruction of intracerebral hemorrhage with electrical impedance tomography

Purpose: Intracerebral hemorrhage (ICH) is a common disease that is known for its high morbidity, high mortality, and high disability. The fast and accurate detection of ICH is essential for the acute care of patients. Electrical impedance tomography (EIT) offers an alternative with which pathological tissues can be detected by reconstructing conductivity variation. Nevertheless, the sensitive field of EIT is greatly affected by medium distribution, which is referred to as soft-field effect. In addition, the image reconstruction is a severely ill-posed inverse problem. Furthermore, due to the low conductivity of skull, the sensitivity in the sensing area is extremely low. Therefore, the reconstruction of ICH with EIT is great challenge. Approach: A sparse image reconstruction method is proposed for EIT to visualize the conductivity variation caused by ICH. To reduce the impact of soft-field effect, the normalization of sensitivity distribution is conducted for monolayer and three-layer head model. In addition, a constrained sparse L 1 -norm minimization model is developed for the image reconstruction. Augmented Lagrangian multiplier method and alternating minimization scheme are adopted to solve the proposed model. Results: The results show that the sensitivity in the sensing area is largely enhanced. Numerical simulation based on monolayer head model and three-layer head model is respectively carried out. Both the reconstructed images and the quantitative evaluations show that image reconstructed by the proposed method is much better than that reconstructed by traditional Tikhonov method. The reconstructions evaluated under the impact of noise also show that the proposed method has superior anti-noise performance. Conclusions: With the proposed method, the quality of the reconstructed image would be greatly improved. It is an effective approach for imaging ICH with EIT technique.

Development of a Portable, Reliable and Low-Cost Electrical Impedance Tomography System Using an Embedded System

Electrical impedance tomography (EIT) is a useful procedure with applications in industry and medicine, particularly in the lungs and brain area. In this paper, the development of a portable, reliable and low-cost EIT system for image reconstruction by using an embedded system (ES) is introduced herein. The novelty of this article is the hardware development of a complete low-cost EIT system, as well as three simple and efficient algorithms that can be implemented on ES. The proposed EIT system applies the adjacent voltage method, starting with an impedance acquisition stage that sends data to a Raspberry Pi 4 (RPi4) as ES. To perform the image reconstruction, a user interface was developed by using GNU Octave for RPi4 and the EIDORS library. A statistical analysis is performed to determine the best average value from the samples measured by using an analog-to-digital converter (ADC) with a capacity of 30 kSPS and 24-bit resolution. The tests for the proposed EIT system were performed using materials such as metal, glass and an orange to simulate its application in food industry. Experimental results show that the statistical median is more accurate with respect to the real voltage measurement; however, it represents a higher computational cost. Therefore, the mean is calculated and improved by discarding data values in a transitory state, achieving better accuracy than the median to determine the real voltage value, enhancing the quality of the reconstructed images. A performance comparison between a personal computer (PC) and RPi4 is presented. The proposed EIT system offers an excellent cost-benefit ratio with respect to a traditional PC, taking into account precision, accuracy, energy consumption, price, light weight, size, portability and reliability. The proposed EIT system has potential application in mechanical ventilation, food industry and structural health monitoring.

A Wearable Stethoscope for Long-Term Ambulatory Respiratory Health Monitoring

Lung sounds acquired by stethoscopes are extensively used in diagnosing and differentiating respiratory diseases. Although an extensive know-how has been built to interpret these sounds and identify diseases associated with certain patterns, its effective use is limited to individual experience of practitioners. This user-dependency manifests itself as a factor impeding the digital transformation of this valuable diagnostic tool, which can improve patient outcomes by continuous long-term respiratory monitoring under real-life conditions. Particularly patients suffering from respiratory diseases with progressive nature, such as chronic obstructive pulmonary diseases, are expected to benefit from long-term monitoring. Recently, the COVID-19 pandemic has also shown the lack of respiratory monitoring systems which are ready to deploy in operational conditions while requiring minimal patient education. To address particularly the latter subject, in this article, we present a sound acquisition module which can be integrated into a dedicated garment; thus, minimizing the role of the patient for positioning the stethoscope and applying the appropriate pressure. We have implemented a diaphragm-less acousto-electric transducer by stacking a silicone rubber and a piezoelectric film to capture thoracic sounds with minimum attenuation. Furthermore, we benchmarked our device with an electronic stethoscope widely used in clinical practice to quantify its performance.

A robust and novel electrical impedance metric of pulmonary function in ALS patients

OBJECTIVE

Pulmonary function tests (PFTs) are important for assessing respiratory function in amyotrophic lateral sclerosis (ALS) patients. However, weakness of oral and glottal closure, due to concomitant bulbar dysfunction, may result in unreliable PFT values stemming from leakage of air around the breathing tube and through the glottis. In this study, we assessed whether standard thoracic electrical impedance tomography (EIT) could serve as a surrogate measure for PFTs.

APPROACH

Thoracic EIT was performed simultaneously with standard PFTs on seven ALS patients without clinical bulbar weakness (six men and one woman, mean age of 63 years) and ten healthy volunteers (seven men and three women, mean age of 57 years). A raw impedance metric along with more standard EIT measures were computed and correlated with the normalized forced vital capacity (FVC). Additionally, test/re-test metrics and EIT images were analyzed.

MAIN RESULTS

The impedance metric was found to be robust and sensitive to lung activity. We also identified qualitative EIT differences between healthy volunteers and ALS patients, with the ALS images showing greater heterogeneity. Significant correlations with FVC were found for both impedance and EIT metrics in ALS patients (r² = 0.89) and for the impedance metric only in healthy volunteers (r² = 0.49).

SIGNIFICANCE

This suggests that EIT, using our novel impedance metric, has the potential to serve as an alternative technology to standard PFTs for assessing pulmonary function in patients with ALS, offering new metrics of disease status for those with bulbar weakness.

A 122 fps, 1 MHz Bandwidth Multi-Frequency Wearable EIT Belt Featuring Novel Active Electrode Architecture for Neonatal Thorax Vital Sign Monitoring

A highly integrated, wearable electrical impedance tomography (EIT) belt for neonatal thorax vital multiple sign monitoring is presented. The belt has 16 active electrodes. Each electrode has an application-specific integrated circuit (ASIC) connected to it. The ASIC contains a fully differential current driver, a high-performance instrumentation amplifier, a digital controller, and multiplexors. The belt features a new active electrode architecture that allows programmable flexible electrode current drive and voltage sense patterns under simple digital control. It provides intimate connections to the electrodes for the current drive and to the IA for direct differential voltage measurement, providing superior common-mode rejection ratio. The ASIC was designed in a CMOS 0.35-μm high-voltage technology. The high-specification EIT belt has an image frame rate of 122 fps, a wide operating bandwidth of 1 MHz, and multi-frequency operation. It measures impedance with 98% accuracy and has less than 0.5 Ω and 1° variation across all possible channels. The image results confirmed the advantage of the new active electrode architecture and the benefit of wideband, multi-frequency EIT operation. The system successfully captured high-quality lung-respiration EIT images, breathing cycle, and heart rate. It can also provide boundary-shape information by using an array of MEMS sensors interfaced to the ASICs.

Regional lung function in nonsmokers and asymptomatic current and former smokers

Electrical impedance tomography (EIT) is able to detect rapid lung volume changes during breathing. The aim of our observational study was to characterise the heterogeneity of regional ventilation distribution in lung-healthy adults by EIT and to detect the possible impact of tobacco consumption. A total of 219 nonsmokers, asymptomatic ex-smokers and current smokers were examined during forced full expiration using EIT. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC were determined in 836 EIT image pixels for the analysis of spatial and temporal ventilation distribution. Coefficients of variation (CVs) of these pixel values were calculated. Histograms and medians of FEV₁/FVC_EIT and times required to exhale 50%, 75%, 90% of FVC_EIT (t₅₀, t₇₅ and t₉₀) were generated. CV of FEV₁/FVC_EIT distinguished among all groups (mean±sd: nonsmokers 0.43±0.05, ex-smokers 0.52±0.09, smokers 0.62±0.16). Histograms of FEV₁/FVC_EIT differentiated between nonsmokers and the other groups (p<0.0001). Medians of t₅₀, t₇₅ and t₉₀ showed the lowest values in nonsmokers. Median t₉₀ separated all groups (median (interquartile range): nonsmokers 0.82 (0.67-1.15), ex-smokers 1.41 (1.03-2.21), smokers 1.91 (1.33-3.53)). EIT detects regional ventilation heterogeneity during forced expiration in healthy nonsmokers and its increase in asymptomatic former and current smokers. Therefore, EIT-derived reference values should only be collected from nonsmoking lung-healthy adults.