The impact of electrode area, contact impedance and boundary shape on EIT images

Electrical impedance tomography (EIT) measures the conductivity distribution within an object based on the current applied and voltage measured at surface electrodes. Thus, EIT images are sensitive to electrode properties (i.e. contact impedance, electrode area and boundary shape under the electrode). While some of these electrode properties have been investigated individually, this paper investigates these properties and their interaction using finite element method simulations and the complete electrode model (CEM). The effect of conformal deformations on image reconstruction when using the CEM was of specific interest. Observed artefacts were quantified using a measure that compared an ideal image to the reconstructed image, in this case a no-noise reconstruction that isolated the electrodes' effects. For electrode contact impedance and electrode area, uniform reductions to all electrodes resulted in ringing artefacts in the reconstructed images when the CEM was used, while parameter variations that were not correlated amongst electrodes resulted in artefacts distributed throughout the image. When the boundary shape changed under the electrode, as with non-symmetric conformal deformations, using the CEM resulted in structured distortions within the reconstructed image. Mean electrode contact impedance increases, independent of inter-electrode variation, did not result in artefacts in the reconstructed image.     

Application of internal electrodes to the oesophageal and tracheal tube in an animal trial: evaluation of its clinical and technical potentiality in electrical impedance tomography

Electrical impedance tomography (EIT) is of potential medical interest e.g., to optimize ventilator settings during mechanical ventilation. Nevertheless there are still several challenges. Although electrode belts are commonly used and promoted, they are not necessarily adequate for the long-term monitoring of patients in intensive-care units (ICU). ICU patients are usually equipped with breathing tubes and feeding tubes, ideal surfaces to attach EIT electrodes to. The aim of our study was therefore to examine the potentiality of internal electrodes in a porcine animal trial. Following an animal trial protocol studying acute lung injury, additional EIT measurements were obtained both with conventional electrodes set upon a rubber belt and after having moved the electrodes internally in seven pigs. For this reason the two most dorsally located electrodes were selected. An adjacent stimulation and measurement pattern was used, and resulting voltages in the time and frequency domains as well as within reconstructed images were examined to compare perfusion and ventilation data qualitatively and quantitatively. Particularly, lung morphology as well as signal strength for both the mediastinal and lung region were studied. All animals were submitted to the additional protocol without any adverse events. Distinguishability of lungs was improved in reconstructed frames. The resulting sensitivity of measured electrical impedance was enhanced around the mediastinal region and even cardiac-related activity was significantly increased by a factor of up to 6. In conclusion the application of internal electrodes appears to be beneficial for diverse clinical purposes and should be addressed in further studies.     

EIT images of ventilation: what contributes to the resistivity changes?

One promising application of electrical impedance tomography (EIT) is the monitoring of pulmonary ventilation and edema. Using three-dimensional (3D) finite difference human models as virtual phantoms, the factors that contribute to the observed lung resistivity changes in the EIT images were investigated. The results showed that the factors included not only tissue resistivity or vessel volume changes, but also chest expansion and tissue/organ movement. The chest expansion introduced artifacts in the center of the EIT images, ranging from -2% to 31% of the image magnitude. With the increase of simulated chest expansion, the percentage contribution of chest expansion relative to lung resistivity change in the EIT image remained relatively constant. The averaged resistivity changes in the lung regions caused by chest expansion ranged from 0.65% to 18.31%. Tissue/organ movement resulted in an increased resistivity in the lung region and in the center anterior region of EIT images. The increased resistivity with inspiration observed in the heart region was caused mainly by a drop in the heart position, which reduced the heart area at the electrode level and was replaced by the lung tissue with higher resistivity. This study indicates that for the analysis of EIT, data errors caused by chest expansion and tissue/organ movement need to be considered.     

Flexible electrode belt for EIT using nanofiber web dry electrodes

Efficient connection of multiple electrodes to the body for impedance measurement and voltage monitoring applications is of critical importance to measurement quality and practicality. Electrical impedance tomography (EIT) experiments have generally required a cumbersome procedure to attach the multiple electrodes needed in EIT. Once placed, these electrodes must then maintain good contact with the skin during measurements that may last several hours. There is usually also the need to manage the wires that run between the electrodes and the EIT system. These problems become more severe as the number of electrodes increases, and may limit the practicality and portability of this imaging method. There have been several trials describing human-electrode interfaces using configurations such as electrode belts, helmets or rings. In this paper, we describe an electrode belt we developed for long-term EIT monitoring of human lung ventilation. The belt included 16 embossed electrodes that were designed to make good contact with the skin. The electrodes were fabricated using an Ag-plated PVDF nanofiber web and metallic threads. A large contact area and padding were used behind each electrode to improve subject comfort and reduce contact impedances. The electrodes were incorporated, equally spaced, into an elasticated fabric belt. We tested the electrode belt in conjunction with the KHU Mark1 multi-frequency EIT system, and demonstrate time-difference images of phantoms and human subjects during normal breathing and running. We found that the Ag-plated PVDF nanofiber web electrodes were suitable for long-term measurement because of their flexibility and durability. Moreover, the contact impedance and stability of the Ag-plated PVDF nanofiber web electrodes were found to be comparable to similarly tested Ag/AgCl electrodes.     

Obstructive lung diseases: COPD, asthma, and many imitators.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that occurs in 10% to 15% of people who smoke, an estimated 16 million Americans. Asthma is also common. Spirometry is generally used to detect early COPD in smokers and to evaluate patients with respiratory symptoms. Although COPD and asthma account for most obstructive lung diseases, a broad spectrum of other disorders, including bronchiectasis, upper airway lesions, bronchiolar diseases, and some interstitial lung diseases, are associated with airflow obstruction. These less common forms of obstructive lung diseases are often misdiagnosed because of their uncommon occurrence and poor recognition. We describe the heterogeneous spectrum of disorders that can present with evidence of airflow obstruction and outline a diagnostic approach to obstructive lung disease.     

Accounting for hardware imperfections in EIT image reconstruction algorithms

Electrical impedance tomography (EIT) is a non-invasive technique for imaging the conductivity distribution of a body section. Different types of EIT images can be reconstructed: absolute, time difference and frequency difference. Reconstruction algorithms are sensitive to many errors which translate into image artefacts. These errors generally result from incorrect modelling or inaccurate measurements. Every reconstruction algorithm incorporates a model of the physical set-up which must be as accurate as possible since any discrepancy with the actual set-up will cause image artefacts. Several methods have been proposed in the literature to improve the model realism, such as creating anatomical-shaped meshes, adding a complete electrode model and tracking changes in electrode contact impedances and positions. Absolute and frequency difference reconstruction algorithms are particularly sensitive to measurement errors and generally assume that measurements are made with an ideal EIT system. Real EIT systems have hardware imperfections that cause measurement errors. These errors translate into image artefacts since the reconstruction algorithm cannot properly discriminate genuine measurement variations produced by the medium under study from those caused by hardware imperfections. We therefore propose a method for eliminating these artefacts by integrating a model of the system hardware imperfections into the reconstruction algorithms. The effectiveness of the method has been evaluated by reconstructing absolute, time difference and frequency difference images with and without the hardware model from data acquired on a resistor mesh phantom. Results have shown that artefacts are smaller for images reconstructed with the model, especially for frequency difference imaging.     

Electrical impedance tomography system based on active electrodes

Electrical impedance tomography (EIT) can image the distribution of ventilated lung tissue, and is thus a promising technology to help monitor patient breathing to help selection of mechanical ventilation parameters. Two key difficulties in EIT instrumentation make such monitoring difficult: (1) EIT data quality depends on good electrode contact and is sensitive to changes in contact quality, and (2) EIT electrodes are difficult and time consuming to place on patients. This paper presents the design and initial tests of an active electrode-based system to address these difficulties. Our active electrode EIT system incorporates an active electrode belt, a central voltage-driven current source, central analog to digital converters and digital to analog converters, a central FPGA-based demodulator and controller. The electrode belt is designed incorporating 32 active electrodes, each of which contains the electronic amplifiers, switches and associated logic. Tests show stable device performance with a convenient ease of use and good imaging ability in volunteer tests.     

Electrode placement configurations for 3D EIT

This paper investigates several configurations for placing electrodes on a 3D cylindrical medium to reconstruct 3D images using 16 electrode EIT equipment intended for use with a 2D adjacent drive protocol. Seven different electrode placement configurations are compared in terms of the following figures of merit: resolution, radial and vertical position error, image magnitude, immunity to noise, immunity to electrode placement errors, and qualitative evaluation of image artefacts. Results show that for ideal conditions, none of the configurations considered performed significantly better than the others. However, when noise and electrode placement errors were considered the planar electrode placement configuration (two rings of vertically aligned electrodes with electrodes placed sequentially in each ring) had the overall best performance. Based on these results, we recommend planar electrode placement configuration for 3D EIT lung imaging of the thorax.     

An optimized strategy for real-time hemorrhage monitoring with electrical impedance tomography

Delayed detection of an internal hemorrhage may result in serious disabilities and possibly death for a patient. Currently, there are no portable medical imaging instruments that are suitable for long-term monitoring of patients at risk of internal hemorrhage. Electrical impedance tomography (EIT) has the potential to monitor patients continuously as a novel functional image modality and instantly detect the occurrence of an internal hemorrhage. However, the low spatial resolution and high sensitivity to noise of this technique have limited its application in clinics. In addition, due to the circular boundary display mode used in current EIT images, it is difficult for clinicians to identify precisely which organ is bleeding using this technique. The aim of this study was to propose an optimized strategy for EIT reconstruction to promote the use of EIT for clinical studies, which mainly includes the use of anatomically accurate boundary shapes, rapid selection of optimal regularization parameters and image fusion of EIT and computed tomography images. The method was evaluated on retroperitoneal and intraperitoneal bleeding piglet data. Both traditional backprojection images and optimized images among different boundary shapes were reconstructed and compared. The experimental results demonstrated that EIT images with precise anatomical information can be reconstructed in which the image resolution and resistance to noise can be improved effectively.     

Electrical impedance tomography (EIT) in applications related to lung and ventilation: a review of experimental and clinical activities

This review article is a summary of the publications dealing with the pulmonary applications of electrical impedance tomography (EIT). Original papers on EIT lung imaging published over 15 years are analysed and several aspects of the performed EIT measurements summarized. Information on the type of the EIT device and electrodes used, the studied transverse thoracic planes, the data acquisition rate, the number of studied animals, normal subjects or patients, the kind of lung pathology, the performed ventilatory manoeuvres and other interventions, as well as the applied reference techniques, is given. The type of the generated pulmonary EIT images and the quantitative analysis of the EIT data are described. Finally, the major results achieved are presented, followed by an analysis of the perspectives of EIT in clinical applications. A comparative analysis of the EIT hardware and the quality of the evaluation tools was not performed.     

Evaluation of an EIT reconstruction algorithm using finite difference human thorax models as phantoms

A finite difference model of the human thorax with 113,400 control volumes (nodes) based on ECG gated MRI images was used to evaluate the Sheffield DAS-01P EIT system. Sixteen simulated electrode positions equally spaced around the thorax model at approximately the fourth intercostals space level were selected. Pairs of adjacent positions were excited sequentially by injecting current in a manner similar to that used by the Sheffield DAS-01P EIT system. The resulting voltages on the non-excited electrode positions were calculated and used to reconstruct the image using the Sheffield filtered back projection algorithm. By changing the resistivities of the lungs, the ventricles and the atria over a range of 1% to 40%, the resulting changes in the images were quantified by measuring the average resistivity change over a region defined automatically by two thresholds, 40% or 80% of the average of the first four pixels with the largest change. The results show that the changes observed in the images are consistently less than the changes in the model, but changed in a nearly linear manner as a function of resistivity in the model. For 40% resistivity changes in the model for right lung, right ventricle and right atrium, the observed resistivity changes in the region of interest (ROI, defined by the 80% threshold) of the images are 32% for the right lung, 11% for the right ventricle and 5.5% for the right atrium, which suggests strong volume dependence of EIT imaging. The effect of structural (size) change between end diastole and end systole was also studied, which showed large resistivity changes caused in the heart region of the constructed image. The study demonstrates that the Sheffield DAS-01P EIT reconstruction algorithm tracks the change occurring in the lungs most closely and with proper scaling may be used to observe physiological changes.     

Imaging and quantification of anomaly volume using an eight-electrode 'hemiarray' EIT reconstruction method

Electrical impedance tomography (EIT) is particularly well-suited to applications where its portability, rapid acquisition speed and sensitivity give it a practical advantage over other monitoring or imaging systems. An EIT system's patient interface can potentially be adapted to match the target environment, and thereby increase its utility. It may thus be appropriate to use different electrode positions from those conventionally used in EIT in these cases. One application that may require this is the use of EIT on emergency medicine patients; in particular those who have suffered blunt abdominal trauma. In patients who have suffered major trauma, it is desirable to minimize the risk of spinal cord injury by avoiding lifting them. To adapt EIT to this requirement, we devised and evaluated a new electrode topology (the 'hemiarray') which comprises a set of eight electrodes placed only on the subject's anterior surface. Images were obtained using a two-dimensional sensitivity matrix and weighted singular value decomposition reconstruction. The hemiarray method's ability to quantify bleeding was evaluated by comparing its performance with conventional 2D reconstruction methods using data gathered from a saline phantom. We found that without applying corrections to reconstructed images it was possible to estimate blood volume in a two-dimensional hemiarray case with an uncertainty of around 27 ml. In an approximately 3D hemiarray case, volume prediction was possible with a maximum uncertainty of around 38 ml in the centre of the electrode plane. After application of a QI normalizing filter, average uncertainties in a two-dimensional hemiarray case were reduced to about 15 ml. Uncertainties in the approximate 3D case were reduced to about 30 ml.     

Level-set-based reconstruction algorithm for EIT lung images: first clinical results

We show the first clinical results using the level-set-based reconstruction algorithm for electrical impedance tomography (EIT) data. The level-set-based reconstruction method (LSRM) allows the reconstruction of non-smooth interfaces between image regions, which are typically smoothed by traditional voxel-based reconstruction methods (VBRMs). We develop a time difference formulation of the LSRM for 2D images. The proposed reconstruction method is applied to reconstruct clinical EIT data of a slow flow inflation pressure-volume manoeuvre in lung-healthy and adult lung-injury patients. Images from the LSRM and the VBRM are compared. The results show comparable reconstructed images, but with an improved ability to reconstruct sharp conductivity changes in the distribution of lung ventilation using the LSRM.     

Electrical impedance tomography of human brain function using reconstruction algorithms based on the finite element method

Electrical impedance tomography (EIT) is a recently developed technique which enables the internal conductivity of an object to be imaged using rings of external electrodes. In a recent study, EIT during cortical evoked responses showed encouraging changes in the raw impedance measurements, but reconstructed images were noisy. A simplified reconstruction algorithm was used which modelled the head as a homogeneous sphere. In the current study, the development and validation of an improved reconstruction algorithm are described in which realistic geometry and conductivity distributions have been incorporated using the finite element method. Data from computer simulations and spherical or head-shaped saline-filled tank phantoms, in which the skull was represented by a concentric shell of plaster of Paris or a real human skull, have been reconstructed into images. There were significant improvements in image quality as a result of the incorporation of accurate geometry and extracerebral layers in the reconstruction algorithm. Image quality, assessed by blinded subjective expert observers, also improved significantly when data from the previous evoked response study were reanalysed with the new algorithm. In preliminary images collected during epileptic seizures, the new algorithm generated EIT conductivity changes which were consistent with the electrographic ictal activity. Incorporation of realistic geometry and conductivity into the reconstruction algorithm significantly improves the quality of EIT images and lends encouragement to the belief that EIT may provide a low-cost, portable functional neuroimaging system in the foreseeable future.     

多层螺旋CT阴性法胆管造影诊断胆管梗阻

目的评价多层螺旋CT(MSCT)阴性法胆管造影(N-CTCP)对胆管梗阻的诊断价值。方法对60例怀疑有胆管梗阻的病例进行N-CTCP成像,使用曲面重建(CPR)和最小密度投影(Min-IP)技术对有无胆管梗阻、梗阻部位及梗阻病变的性质进行评价,并将其结果与手术和(或)病理结果对照。结果60例均一次屏气完成扫描,N-CTCP成像显示胆管满意,CPR加Min-IP对胆管梗阻的定位诊断与定性诊断的灵敏度分别为89.86%、88.64%,特异度分别为94.59%、81.25%,阳性预测值分别为91.18%、92.86%,阴性预测值分别为93.75%、72.22%,阳性似然比分别为16.61、4.73,阴性似然比分别为0.11和0.14。结论N-CTCP对胆管梗阻性疾病定位准确,对良性及恶性胆管梗阻判断有较高准确性。     

Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants

OBJECTIVE: Established techniques used to examine lung function in critically ill infants cannot continuously follow regional aspects of lung ventilation although this information would be beneficial for proper therapy planning. We have studied the applicability and clinical relevance of a relatively new non-invasive radiation-free imaging method, electrical impedance tomography (EIT), in monitoring regional lung function in paediatric intensive care patients. DESIGN: Prospective study. SETTING: Neonatal and paediatric intensive care unit (ICU) at a university hospital. PATIENTS: Eight infants (1 day-7 years old) suffering from miscellaneous diseases requiring intensive care therapy. INTERVENTIONS: Adjustment of ventilator settings, surfactant administration, and postural changes. MEASUREMENTS AND RESULTS: Repeated EIT measurements were performed with the intention to monitor regional lung ventilation in mechanically ventilated and spontaneously breathing infants. The follow-up time ranged between 1 and 11 days. During individual EIT measurements of 100-s duration electrical voltages resulting from repetitive injection of small electrical currents were continuously measured on the thoracic circumference using conventional surface electrodes. Acquired data were used to generate functional cross-sectional thoracic images of regional lung ventilation. A total of 638 EIT measurements were performed. The redistribution of lung ventilation and changes in regional ventilation magnitude resulting from adjusted positive end-expiratory pressure, peak inspiratory pressure, inspiration-expiration ratio, surfactant instillation, and prone or supine positioning were identified. CONCLUSIONS: Provided that EIT hardware and software are further developed to guarantee stable and undisturbed measurements in the ICU and that practical handling is improved, this non-invasive method may become a useful bedside monitoring tool of regional lung ventilation in critically ill infants.     

多层螺旋CT多层面重建技术在胆道梗阻性疾病诊断中的应用

目的评价多层螺旋CT(MSCT)多层面重建技术(MPR)在胆道梗阻性疾病中的诊断价值.方法 201例经超声诊断为梗阻性黄疸的患者,行MSCT平扫及薄层增强扫描,并以MPR技术进行冠状位、矢状位及沿胆总管走行方向斜位重建,然后与超声及磁共振胰胆管成像(MRCP) 进行对比,以手术病理结果为标准.结果定位诊断超声为89.05%,MSCT MPR及MRCP均为100%;病因诊断超声为80.1%,MSCT MPR为97.0%,MRCP为92.0%.结论 MSCT MPR技术在胆道梗阻性疾病中定位诊断能力高于超声,与MRCP相同;病因诊断能力明显高于超声,略高于MRCP.MSCT MPR技术可以显示胆管腔内的肿物,结石等病变形态,显示与周围组织的关系.     

MR for the evaluation of obstructive pulmonary disease

Obstructive lung diseases include emphysema, chronic bronchitis, chronic obstructive pulmonary disease, asthma, and cystic fibrosis. These diseases are a heterogeneous group of pulmonary disorders that share in common obstruction of air flow and deranged gas exchange. Traditionally these diseases are evaluated with clinical testing, such as pulmonary function tests, but such tests provide only global measures of respiratory function. MR techniques designed for obstructive lung disease have the capability of directly imaging the anatomic and pathophysiologic derangements and may prove useful for monitoring response to therapy.     

Study of the optimum level of electrode placement for the evaluation of absolute lung resistivity with the Mk3.5 EIT system

Inter-subject variability has caused the majority of previous electrical impedance tomography (EIT) techniques to focus on the derivation of relative or difference measures of in vivo tissue resistivity. Implicit in these techniques is the requirement for a reference or previously defined data set. This study assesses the accuracy and optimum electrode placement strategy for a recently developed method which estimates an absolute value of organ resistivity without recourse to a reference data set. Since this measurement of tissue resistivity is absolute, in Ohm metres, it should be possible to use EIT measurements for the objective diagnosis of lung diseases such as pulmonary oedema and emphysema. However, the stability and reproducibility of the method have not yet been investigated fully. To investigate these problems, this study used a Sheffield Mk3.5 system which was configured to operate with eight measurement electrodes. As a result of this study, the absolute resistivity measurement was found to be insensitive to the electrode level between 4 and 5 cm above the xiphoid process. The level of the electrode plane was varied between 2 cm and 7 cm above the xiphoid process. Absolute lung resistivity in 18 normal subjects (age 22.6 +/- 4.9, height 169.1 +/- 5.7 cm, weight 60.6 +/- 4.5 kg, body mass index 21.2 +/- 1.6: mean +/- standard deviation) was measured during both normal and deep breathing for 1 min. Three sets of measurements were made over a period of several days on each of nine of the normal male subjects. No significant differences in absolute lung resistivity were found, either during normal tidal breathing between the electrode levels of 4 and 5 cm (9.3 +/- 2.4 Omega m, 9.6 +/- 1.9 Omega m at 4 and 5 cm, respectively: mean +/- standard deviation) or during deep breathing between the electrode levels of 4 and 5 cm (10.9 +/- 2.9 Omega m and 11.1 +/- 2.3 Omega m, respectively: mean +/- standard deviation). However, the differences in absolute lung resistivity between normal and deep tidal breathing at the same electrode level are significant. No significant difference was found in the coefficient of variation between the electrode levels of 4 and 5 cm (9.5 +/- 3.6%, 8.5 +/- 3.2% at 4 and 5 cm, respectively: mean +/- standard deviation in individual subjects). Therefore, the electrode levels of 4 and 5 cm above the xiphoid process showed reasonable reliability in the measurement of absolute lung resistivity both among individuals and over time.     

Electrical impedance tomography of human brain activity with a two-dimensional ring of scalp electrodes

Previously, electrical impedance tomography (EIT) has been used to image impedance decreases in the exposed cortex of rabbits during brain activity. These are due to increased blood volume at the site of the stimulated cortex; as blood has a lower impedance than brain, the impedance decreases. During human brain activity similar blood flow changes have been detected using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). If blood volume also changes then the impedance of human cortex will change during brain activity; this could theoretically be imaged with EIT. EIT data were recorded from a ring of 16 scalp electrodes in 34 recordings in 19 adult volunteers before, during and after stimulation with (1) a visual stimulus produced by an 8 Hz oscillating checkerboard pattern or (2) sensory stimulation of the median nerve at the wrist by a 3 Hz electrical square wave stimulus. Reproducible impedance changes, with a similar timecourse to the stimulus, were seen in all experiments. Significant impedance changes were seen in 21 +/- 5% (n = 16, mean +/- SEM) and 19 +/- 3% (n = 18) of the electrode measurements for visual and somatosensory paradigms respectively. The reconstructed 2D EIT images showed reproducible impedance changes in the approximate region of the stimulated cortex in 7/16 visual and 5/18 somatosensory experiments. This demonstrates that reproducible impedance changes can be measured during human brain activity. The final images contained spatial noise; the reasons for this and strategies to reduce this in future are discussed.