Measurement of ventilation and cardiac related impedance changes with electrical impedance tomography

Introduction Electrical impedance tomography (EIT) has been shown to be able to distinguish both ventilation and perfusion. With adequate filtering the regional distributions of both ventilation and perfusion and their relationships could be analysed. Several methods of separation have been suggested previously, including breath holding, electrocardiograph (ECG) gating and frequency filtering. Many of these methods require interventions inappropriate in a clinical setting. This study therefore aims to extend a previously reported frequency filtering technique to a spontaneously breathing cohort and assess the regional distributions of ventilation and perfusion and their relationship. Methods Ten healthy adults were measured during a breath hold and while spontaneously breathing in supine, prone, left and right lateral positions. EIT data were analysed with and without filtering at the respiratory and heart rate. Profiles of ventilation, perfusion and ventilation/perfusion related impedance change were generated and regions of ventilation and pulmonary perfusion were identified and compared. Results Analysis of the filtration technique demonstrated its ability to separate the ventilation and cardiac related impedance signals without negative impact. It was, therefore, deemed suitable for use in this spontaneously breathing cohort. Regional distributions of ventilation, perfusion and the combined ΔZV/ΔZQ were calculated along the gravity axis and anatomically in each position. Along the gravity axis, gravity dependence was seen only in the lateral positions in ventilation distribution, with the dependent lung being better ventilated regardless of position. This gravity dependence was not seen in perfusion. When looking anatomically, differences were only apparent in the lateral positions. The lateral position ventilation distributions showed a difference in the left lung, with the right lung maintaining a similar distribution in both lateral positions. This is likely caused by more pronounced anatomical changes in the left lung when changing positions. Conclusions The modified filtration technique was demonstrated to be effective in separating the ventilation and perfusion signals in spontaneously breathing subjects. Gravity dependence was seen only in ventilation distribution in the left lung in lateral positions, suggesting gravity based shifts in anatomical structures. Gravity dependence was not seen in any perfusion distributions.

Ventilation distribution in rats : Part I - The effect of gas composition as measured with electrical impedance tomography

The measurement of ventilation distribution is currently performed using inhaled tracer gases for multiple breath inhalation studies or imaging techniques to quantify spatial gas distribution. Most tracer gases used for these studies have properties different from that of air. The effect of gas density on regional ventilation distribution has not been studied. This study aimed to measure the effect of gas density on regional ventilation distribution. Methods Ventilation distribution was measured in seven rats using electrical impedance tomography (EIT) in supine, prone, left and right lateral positions while being mechanically ventilated with either air, heliox (30% oxygen, 70% helium) or sulfur hexafluoride (20% SF6, 20% oxygen, 60% air). The effect of gas density on regional ventilation distribution was assessed. Results Gas density did not impact on regional ventilation distribution. The non-dependent lung was better ventilated in all four body positions. Gas density had no further impact on regional filling characteristics. The filling characteristics followed an anatomical pattern with the anterior and left lung showing a greater impedance change during the initial phase of the inspiration. Conclusion It was shown that gas density did not impact on convection dependent ventilation distribution in rats measured with EIT.

Ventilation distribution in rats : part 2 – a comparison of electrical impedance tomography and hyperpolarised helium magnetic resonance imaging

Background: Hyperpolarised helium MRI (He3 MRI) is a new technique that enables imaging of the air distribution within the lungs. This allows accurate determination of the ventilation distribution in vivo. The technique has the disadvantages of requiring an expensive helium isotope, complex apparatus and moving the patient to a compatible MRI scanner. Electrical impedance tomography (EIT) a non-invasive bedside technique that allows constant monitoring of lung impedance, which is dependent on changes in air space capacity in the lung. We have used He3MRI measurements of ventilation distribution as the gold standard for assessment of EIT. Methods: Seven rats were ventilated in supine, prone, left and right lateral position with 70% helium/30% oxygen for EIT measurements and pure helium for He3 MRI. The same ventilator and settings were used for both measurements. Image dimensions, geometric centre and global in homogeneity index were calculated. Results: EIT images were smaller and of lower resolution and contained less anatomical detail than those from He3 MRI. However, both methods could measure positional induced changes in lung ventilation, as assessed by the geometric centre. The global in homogeneity index were comparable between the techniques. Conclusion: EIT is a suitable technique for monitoring ventilation distribution and inhomgeneity as assessed by comparison with He3 MRI.

Lung recruitment and endotracheal suction in ventilated preterm infants measured with electrical impedance tomography

Aims Although suctioning is a standard airway maintenance procedure, there are significant associated risks, such as loss of lung volume due to high negative suction pressures. This study aims to assess the extent and duration of change in end-expiratory level (EEL) resulting from endotracheal tube (ETT) suction and to examine the relationship between EEL and regional lung ventilation in ventilated preterm infants with respiratory distress syndrome. Methods A prospective observational clinical study of the effect of ETT suction on 20 non-muscle-relaxed preterm infants with respiratory distress syndrome (RDS) on conventional mechanical ventilation was conducted in a neonatal intensive care unit. Ventilation distribution was measured with regional impedance amplitudes and EEL using electrical impedance tomography. Results ETT suction resulted in a significant increase in EEL post-suction (P < 0.01). Regionally, anterior EEL decreased and posterior EEL increased post-suction, suggesting heterogeneity. Tidal volume was significantly lower in volume-guarantee ventilation compared with pressure-controlled ventilation (P = 0.04). Conclusions ETT suction in non-muscle-relaxed and ventilated preterm infants with RDS results in significant lung volume increase that is maintained for at least 90 min. Regional differences in distribution of ventilation with ETT suction suggest that the behaviour of the lung is heterogeneous in nature.

The time taken for the regional distribution of ventilation to stabilise: An investigation using electrical impedance tomography

Electrical impedance tomography is a novel technology capable of quantifying ventilation distribution in the lung in real time during various therapeutic manoeuvres. The technique requires changes to the patient’s position to place the electrical impedance tomography electrodes circumferentially around the thorax. The impact of these position changes on the time taken to stabilise the regional distribution of ventilation determined by electrical impedance tomography is unknown. This study aimed to determine the time taken for the regional distribution of ventilation determined by electrical impedance tomography to stabilise after changing position. Eight healthy, male volunteers were connected to electrical impedance tomography and a pneumotachometer. After 30 minutes stabilisation supine, participants were moved into 60 degrees Fowler’s position and then returned to supine. Thirty minutes was spent in each position. Concurrent readings of ventilation distribution and tidal volumes were taken every five minutes. A mixed regression model with a random intercept was used to compare the positions and changes over time. The anterior-posterior distribution stabilised after ten minutes in Fowler’s position and ten minutes after returning to supine. Left-right stabilisation was achieved after 15 minutes in Fowler’s position and supine. A minimum of 15 minutes of stabilisation should be allowed for spontaneously breathing individuals when assessing ventilation distribution. This time allows stabilisation to occur in the anterior-posterior direction as well as the left-right direction.

A FEM-Based Forward Solver for Studying the Forward Problem of Electrical Impedance Tomography (EIT) with A Practical Biological Phantom

A Finite Element Method based forward solver is developed for solving the forward problem of a 2D-Electrical Impedance Tomography. The Method of Weighted Residual technique with a Galerkin approach is used for the FEM formulation of EIT forward problem. The algorithm is written in MatLAB7.0 and the forward problem is studied with a practical biological phantom developed. EIT governing equation is numerically solved to calculate the surface potentials at the phantom boundary for a uniform conductivity. An EIT-phantom is developed with an array of 16 electrodes placed on the inner surface of the phantom tank filled with KCl solution. A sinusoidal current is injected through the current electrodes and the differential potentials across the voltage electrodes are measured. Measured data is compared with the differential potential calculated for known current and solution conductivity. Comparing measured voltage with the calculated data it is attempted to find the sources of errors to improve data quality for better image reconstruction.

A Simple Instrumentation Calibration Technique for Electrical Impedance Tomography (EIT) Using A 16-Electrode Phantom

A simple analog instrumentation for Electrical Impedance Tomography is developed and calibrated using the practical phantoms. A constant current injector consisting of a modified Howland voltage controlled current source fed by a voltage controlled oscillator is developed to inject a constant current to the phantom boundary. An instrumentation amplifier, 50 Hz notch filter and a narrow band pass filter are developed and used for signal conditioning. Practical biological phantoms are developed and the forward problem is studied to calibrate the EIT-instrumentation. An array of sixteen stainless steel electrodes is developed and placed inside the phantom tank filled with KCl solution. 1 mA, 50 kHz sinusoidal current is injected at the phantom boundary using adjacent current injection protocol. The differential potentials developed at the voltage electrodes are measured for sixteen current injections. Differential voltage signal is passed through an instrumentation amplifier and a filtering block and measured by a digital multimeter. A forward solver is developed using Finite Element Method in MATLAB7.0 for solving the EIT governing equation. Differential potentials are numerically calculated using the forward solver with a simulated current and bathing solution conductivity. Measured potential data is compared with the differential potentials calculated for calibrating the instrumentation to acquire the voltage data suitable for better image reconstruction.

A Study of Practical Biological Phantoms with Simple Instrumentation for Electrical Impedance Tomography (EIT)

16-electrode phantoms are developed and studied with a simple instrumentation developed for Electrical Impedance Tomography. An analog instrumentation is developed with a sinusoidal current generator and signal conditioner circuit. Current generator is developed withmodified Howland constant current source fed by a voltage controlled oscillator and the signal conditioner circuit consisting of an instrumentation amplifier and a narrow band pass filter. Electronic hardware is connected to the electrodes through a DIP switch based multiplexer module. Phantoms with different electrode size and position are developed and the EIT forward problem is studied using the forward solver. A low frequency low magnitude sinusoidal current is injected to the surface electrodes surrounding the phantom boundary and the differential potential is measured by a digital multimeter. Comparing measured potential with the simulated data it is intended to reduce the measurement error and an optimum phantom geometry is suggested. Result shows that the common mode electrode reduces the common mode error of the EIT electronics and reduces the error potential in the measured data. Differential potential is reduced up to 67 mV at the voltage electrode pair opposite to the current electrodes. Offset potential is measured and subtracted from the measured data for further correction. It is noticed that the potential data pattern depends on the electrode width and the optimum electrode width is suggested. It is also observed that measured potential becomes acceptable with a 20 mm solution column above and below the electrode array level.

Resistivity imaging of a reconfigurable phantom with circular inhomogeneities in 2D-electrical impedance tomography

Resistivity imaging of a reconfigurable phantom with circular inhomogeneities is studied with a simple instrumentation and data acquisition system for Electrical Impedance Tomography. The reconfigurable phantom is developed with stainless steel electrodes and a sinusoidal current of constant amplitude is injected to the phantom boundary using opposite current injection protocol. Nylon and polypropylene cylinders with different cross sectional areas are kept inside the phantom and the boundary potential data are collected. The instrumentation and the data acquisition system with a DIP switch-based multiplexer board are used to inject a constant current of desired amplitude and frequency. Voltage data for the first eight current patterns (128 voltage data) are found to be sufficient to reconstruct the inhomogeneities and hence the acquisition time is reduced. Resistivity images are reconstructed from the boundary data for different inhomogeneity positions using EIDORS-2D. The results show that the shape and resistivity of the inhomogeneity as well as the background resistivity are successfully reconstructed from the potential data for single or double inhomogeneity phantoms. The resistivity images obtained from the single and double inhomogeneity phantom clearly indicate the inhomogeneity as the high resistive material. Contrast to noise ratio (CNR) and contrast recovery (CR) of the reconstructed images are found high for the inhomogeneities near all the electrodes arbitrarily chosen for the entire study. (C) 2010 Elsevier Ltd. All rights reserved.

Studying the resistivity imaging of chicken tissue phantoms with different current patterns in Electrical Impedance Tomography (EIT)

A current injection pattern in Electrical Impedance Tomography (EIT) has its own current distribution profile within the domain under test. Hence, different current patterns have different sensitivity, spatial resolution and distinguishability. Image reconstruction studies with practical phantoms are essential to assess the performance of EIT systems for their validation, calibration and comparison purposes. Impedance imaging of real tissue phantoms with different current injection methods is also essential for better assessment of the biomedical EIT systems. Chicken tissue paste phantoms and chicken tissue block phantoms are developed and the resistivity image reconstruction is studied with different current injection methods. A 16-electrode array is placed inside the phantom tank and the tank is filled with chicken muscle tissue paste or chicken tissue blocks as the background mediums. Chicken fat tissue, chicken bone, air hole and nylon cylinders are used as the inhomogeneity to obtained different phantom configurations. A low magnitude low frequency constant sinusoidal current is injected at the phantom boundary with opposite and neighboring current patterns and the boundary potentials are measured. Resistivity images are reconstructed from the boundary data using EIDORS and the reconstructed images are analyzed with the contrast parameters calculated from their elemental resistivity profiles. Results show that the resistivity profiles of all the phantom domains are successfully reconstructed with a proper background resistivity and high inhomogeneity resistivity for both the current injection methods. Reconstructed images show that, for all the chicken tissue phantoms, the inhomogeneities are suitably reconstructed with both the current injection protocols though the chicken tissue block phantom and opposite method are found more suitable. It is observed that the boundary potentials of the chicken tissue block phantoms are higher than the chicken tissue paste phantom. SNR of the chicken tissue block phantoms are found comparatively more and hence the chicken tissue block phantom is found more suitable for its lower noise performance. The background noise is found less in opposite method for all the phantom configurations which yields the better resistivity images with high PCR and COC and proper IRMean and IRMax neighboring method showed higher noise level for both the chicken tissue paste phantoms and chicken tissue block phantoms with all the inhomogeneities. Opposite method is found more suitable for both the chicken tissue phantoms, and also, chicken tissue block phantoms are found more suitable compared to the chicken tissue paste phantom. (C) 2012 Elsevier Ltd. All rights reserved.

Common Ground Method of Current Injection in Electrical Impedance Tomography

Surface electrodes are essentially required to be switched for boundary data collection in electrical impedance tomography (Ell). Parallel digital data bits are required to operate the multiplexers used, generally, for electrode switching in ELT. More the electrodes in an EIT system more the digital data bits are needed. For a sixteen electrode system. 16 parallel digital data bits are required to operate the multiplexers in opposite or neighbouring current injection method. In this paper a common ground current injection is proposed for EIT and the resistivity imaging is studied. Common ground method needs only two analog multiplexers each of which need only 4 digital data bits and hence only 8 digital bits are required to switch the 16 surface electrodes. Results show that the USB based data acquisition system sequentially generate digital data required for multiplexers operating in common ground current injection method. The profile of the boundary data collected from practical phantom show that the multiplexers are operating in the required sequence in common ground current injection protocol. The voltage peaks obtained for all the inhomogeneity configurations are found at the accurate positions in the boundary data matrix which proved the sequential operation of multiplexers. Resistivity images reconstructed from the boundary data collected from the practical phantom with different configurations also show that the entire digital data generation module is functioning properly. Reconstructed images and their image parameters proved that the boundary data are successfully acquired by the DAQ system which in turn indicates a sequential and proper operation of multiplexers.

Studies on thin film based flexible gold electrode arrays for resistivity imaging in electrical impedance tomography

Practical phantoms are essential to assess the electrical impedance tomography (EIT) systems for their validation, calibration and comparison purposes. Metal surface electrodes are generally used in practical phantoms which reduce the SNR of the boundary data due to their design and development errors. Novel flexible and biocompatible gold electrode arrays of high geometric precision are proposed to improve the boundary data quality in EIT. The flexible gold electrode arrays are developed on flexible FR4 sheets using thin film technology and practical gold electrode phantoms are developed with different configurations. Injecting a constant current to the phantom boundary the surface potentials are measured by a LabVIEW based data acquisition system and the resistivity images are reconstructed in EIDORS. Boundary data profile and the resistivity images obtained from the gold electrode phantoms are compared with identical phantoms developed with stainless steel electrodes. Surface profilometry, microscopy and the impedance spectroscopy show that the gold electrode arrays are smooth, geometrically precised and less resistive. Results show that the boundary data accuracy and image quality are improved with gold electrode arrays. Results show that the diametric resistivity plot (DRP), contrast to noise ratio (CNR), percentage of contrast recovery (PCR) and coefficient of contrast (COC) of reconstructed images are improved in gold electrode phantoms. (C) 2013 Elsevier Ltd. All rights reserved.

Projection Error Propagation-based Regularization (PEPR) method for resistivity reconstruction in Electrical Impedance Tomography (EIT)

A novel Projection Error Propagation-based Regularization (PEPR) method is proposed to improve the image quality in Electrical Impedance Tomography (EIT). PEPR method defines the regularization parameter as a function of the projection error developed by difference between experimental measurements and calculated data. The regularization parameter in the reconstruction algorithm gets modified automatically according to the noise level in measured data and ill-posedness of the Hessian matrix. Resistivity imaging of practical phantoms in a Model Based Iterative Image Reconstruction (MoBIIR) algorithm as well as with Electrical Impedance Diffuse Optical Reconstruction Software (EIDORS) with PEPR. The effect of PEPR method is also studied with phantoms with different configurations and with different current injection methods. All the resistivity images reconstructed with PEPR method are compared with the single step regularization (STR) and Modified Levenberg Regularization (LMR) techniques. The results show that, the PEPR technique reduces the projection error and solution error in each iterations both for simulated and experimental data in both the algorithms and improves the reconstructed images with better contrast to noise ratio (CNR), percentage of contrast recovery (PCR), coefficient of contrast (COC) and diametric resistivity profile (DRP). (C) 2013 Elsevier Ltd. All rights reserved.

A MatLAB Based Virtual Phantom for 2D Electrical Impedance Tomography (MatVP2DEIT): Studying the Medical Electrical Impedance Tomography Reconstruction in Computer

Electrical Impedance Tomography (EIT) is a computerized medical imaging technique which reconstructs the electrical impedance images of a domain under test from the boundary voltage-current data measured by an EIT electronic instrumentation using an image reconstruction algorithm. Being a computed tomography technique, EIT injects a constant current to the patient's body through the surface electrodes surrounding the domain to be imaged (Omega) and tries to calculate the spatial distribution of electrical conductivity or resistivity of the closed conducting domain using the potentials developed at the domain boundary (partial derivative Omega). Practical phantoms are essentially required to study, test and calibrate a medical EIT system for certifying the system before applying it on patients for diagnostic imaging. Therefore, the EIT phantoms are essentially required to generate boundary data for studying and assessing the instrumentation and inverse solvers a in EIT. For proper assessment of an inverse solver of a 2D EIT system, a perfect 2D practical phantom is required. As the practical phantoms are the assemblies of the objects with 3D geometries, the developing of a practical 2D-phantom is a great challenge and therefore, the boundary data generated from the practical phantoms with 3D geometry are found inappropriate for assessing a 2D inverse solver. Furthermore, the boundary data errors contributed by the instrumentation are also difficult to separate from the errors developed by the 3D phantoms. Hence, the errorless boundary data are found essential to assess the inverse solver in 2D EIT. In this direction, a MatLAB-based Virtual Phantom for 2D EIT (MatVP2DEIT) is developed to generate accurate boundary data for assessing the 2D-EIT inverse solvers and the image reconstruction accuracy. MatVP2DEIT is a MatLAB-based computer program which simulates a phantom in computer and generates the boundary potential data as the outputs by using the combinations of different phantom parameters as the inputs to the program. Phantom diameter, inhomogeneity geometry (shape, size and position), number of inhomogeneities, applied current magnitude, background resistivity, inhomogeneity resistivity all are set as the phantom variables which are provided as the input parameters to the MatVP2DEIT for simulating different phantom configurations. A constant current injection is simulated at the phantom boundary with different current injection protocols and boundary potential data are calculated. Boundary data sets are generated with different phantom configurations obtained with the different combinations of the phantom variables and the resistivity images are reconstructed using EIDORS. Boundary data of the virtual phantoms, containing inhomogeneities with complex geometries, are also generated for different current injection patterns using MatVP2DEIT and the resistivity imaging is studied. The effect of regularization method on the image reconstruction is also studied with the data generated by MatVP2DEIT. Resistivity images are evaluated by studying the resistivity parameters and contrast parameters estimated from the elemental resistivity profiles of the reconstructed phantom domain. Results show that the MatVP2DEIT generates accurate boundary data for different types of single or multiple objects which are efficient and accurate enough to reconstruct the resistivity images in EIDORS. The spatial resolution studies show that, the resistivity imaging conducted with the boundary data generated by MatVP2DEIT with 2048 elements, can reconstruct two circular inhomogeneities placed with a minimum distance (boundary to boundary) of 2 mm. It is also observed that, in MatVP2DEIT with 2048 elements, the boundary data generated for a phantom with a circular inhomogeneity of a diameter less than 7% of that of the phantom domain can produce resistivity images in EIDORS with a 1968 element mesh. Results also show that the MatVP2DEIT accurately generates the boundary data for neighbouring, opposite reference and trigonometric current patterns which are very suitable for resistivity reconstruction studies. MatVP2DEIT generated data are also found suitable for studying the effect of the different regularization methods on reconstruction process. Comparing the reconstructed image with an original geometry made in MatVP2DEIT, it would be easier to study the resistivity imaging procedures as well as the inverse solver performance. Using the proposed MatVP2DEIT software with modified domains, the cross sectional anatomy of a number of body parts can be simulated in PC and the impedance image reconstruction of human anatomy can be studied.