Improving Maternal and Fetal Cardiac Monitoring Using Artificial Intelligence

Early diagnosis of possible risks in the physiological status of fetus and mother during pregnancy and delivery is critical and can reduce mortality and morbidity. For example, early detection of life-threatening congenital heart disease may increase survival rate and reduce morbidity while allowing parents to make informed decisions. To study cardiac function, a variety of signals are required to be collected. In practice, several heart monitoring methods, such as electrocardiogram (ECG) and photoplethysmography (PPG), are commonly performed. Although there are several methods for monitoring fetal and maternal health, research is currently underway to enhance the mobility, accuracy, automation, and noise resistance of these methods to be used extensively, even at home. Artificial Intelligence (AI) can help to design a precise and convenient monitoring system. To achieve the goals, the following objectives are defined in this research: The first step for a signal acquisition system is to obtain high-quality signals. As the first objective, a signal processing scheme is explored to improve the signal-to-noise ratio (SNR) of signals and extract the desired signal from a noisy one with negative SNR (i.e., power of noise is greater than signal). It is worth mentioning that ECG and PPG signals are sensitive to noise from a variety of sources, increasing the risk of misunderstanding and interfering with the diagnostic process. The noises typically arise from power line interference, white noise, electrode contact noise, muscle contraction, baseline wandering, instrument noise, motion artifacts, electrosurgical noise. Even a slight variation in the obtained ECG waveform can impair the understanding of the patient's heart condition and affect the treatment procedure. Recent solutions, such as adaptive and blind source separation (BSS) algorithms, still have drawbacks, such as the need for noise or desired signal model, tuning and calibration, and inefficiency when dealing with excessively noisy signals. Therefore, the final goal of this step is to develop a robust algorithm that can estimate noise, even when SNR is negative, using the BSS method and remove it based on an adaptive filter. The second objective is defined for monitoring maternal and fetal ECG. Previous methods that were non-invasive used maternal abdominal ECG (MECG) for extracting fetal ECG (FECG). These methods need to be calibrated to generalize well. In other words, for each new subject, a calibration with a trustable device is required, which makes it difficult and time-consuming. The calibration is also susceptible to errors. We explore deep learning (DL) models for domain mapping, such as Cycle-Consistent Adversarial Networks, to map MECG to fetal ECG (FECG) and vice versa. The advantages of the proposed DL method over state-of-the-art approaches, such as adaptive filters or blind source separation, are that the proposed method is generalized well on unseen subjects. Moreover, it does not need calibration and is not sensitive to the heart rate variability of mother and fetal; it can also handle low signal-to-noise ratio (SNR) conditions. Thirdly, AI-based system that can measure continuous systolic blood pressure (SBP) and diastolic blood pressure (DBP) with minimum electrode requirements is explored. The most common method of measuring blood pressure is using cuff-based equipment, which cannot monitor blood pressure continuously, requires calibration, and is difficult to use. Other solutions use a synchronized ECG and PPG combination, which is still inconvenient and challenging to synchronize. The proposed method overcomes those issues and only uses PPG signal, comparing to other solutions. Using only PPG for blood pressure is more convenient since it is only one electrode on the finger where its acquisition is more resilient against error due to movement. The fourth objective is to detect anomalies on FECG data. The requirement of thousands of manually annotated samples is a concern for state-of-the-art detection systems, especially for fetal ECG (FECG), where there are few publicly available FECG datasets annotated for each FECG beat. Therefore, we will utilize active learning and transfer-learning concept to train a FECG anomaly detection system with the least training samples and high accuracy. In this part, a model is trained for detecting ECG anomalies in adults. Later this model is trained to detect anomalies on FECG. We only select more influential samples from the training set for training, which leads to training with the least effort. Because of physician shortages and rural geography, pregnant women's ability to get prenatal care might be improved through remote monitoring, especially when access to prenatal care is limited. Increased compliance with prenatal treatment and linked care amongst various providers are two possible benefits of remote monitoring. If recorded signals are transmitted correctly, maternal and fetal remote monitoring can be effective. Therefore, the last objective is to design a compression algorithm that can compress signals (like ECG) with a higher ratio than state-of-the-art and perform decompression fast without distortion. The proposed compression is fast thanks to the time domain B-Spline approach, and compressed data can be used for visualization and monitoring without decompression owing to the B-spline properties. Moreover, the stochastic optimization is designed to retain the signal quality and does not distort signal for diagnosis purposes while having a high compression ratio. In summary, components for creating an end-to-end system for day-to-day maternal and fetal cardiac monitoring can be envisioned as a mix of all tasks listed above. PPG and ECG recorded from the mother can be denoised using deconvolution strategy. Then, compression can be employed for transmitting signal. The trained CycleGAN model can be used for extracting FECG from MECG. Then, trained model using active transfer learning can detect anomaly on both MECG and FECG. Simultaneously, maternal BP is retrieved from the PPG signal. This information can be used for monitoring the cardiac status of mother and fetus, and also can be used for filling reports such as partogram

Feature selection and artifact removal in sleep stage classification

The use of Electroencephalograms (EEG) are essential to the analysis of sleep disorders in patients. With the use of electroencephalograms, electro-oculograms (EOG), and electromyograms (EMG), doctors and EEG technician can make conclusions about the sleep patterns of patients. In particular, the classification of the sleep data into various stages, such as NREM I-IV, REM, Awake, is extremely important. The EEG signal itself is highly sensitive to physiological and non-physiological artifacts. Trained human experts can accommodate for these artifacts while they are analyzing the EEG signal. However, if some of these artifacts are removed prior to analysis, their job will be become easier. Furthermore, one of the biggest motivations, of our team's research is the construction of a portable device that can analyze the sleep data as they are being collected. For this task, the sleep data must be analyzed completely automatically in order to make the classifications. The research presented in this thesis concerns itself with the denoising and the feature selection aspects of the teams' goals. Since humans are able to process artifacts and ignore them prior to classification, an automated system should have the same capabilities or close to them. As such, the denoising step is performed to condition the data prior to any other stages of the sleep stage neoclassicisms. As mentioned before, the denoising step, by itself, is useful to human EEG technicians as well. The denoising step in this research mainly looks at EOG artifacts and artifacts isolated to a single EEG channel, such as electrode pop artifacts. The first two algorithms uses Wavelets exclusively (BWDA and WDA), while the third algorithm is a mixture of Wavelets and In- dependent Component Analysis (IDA). With the BWDA algorithm, determining consistent thresholds proved to be a difficult task. With the WDA algorithm, the performance was better, since the selection of the thresholds was more straight-forward and since there was more control over defining the duration of the artifacts. The IDA algorithm performed inferior to the WDA algorithm. This could have been due to the small number of measurement channels or the automated sub-classifier used to select the denoised EEG signal from the set of ICA demixed signals. The feature selection stage is extremely important as it selects the most pertinent features to make a particular classification. Without such a step, the classifier will have to process useless data, which might result in a poorer classification. Furthermore, unnecessary features will take up valuable computer cycles as well. In a portable device, due to battery consumption, wasting computer cycles is not an option. The research presented in this thesis shows the importance of a systematic feature selection step in EEG classification. The feature selection step produced excellent results with a maximum use of just 5 features. During automated classification, this is extremely important as the automated classifier will only have to calculate 5 features for each given epoch

Enhancement of Eeg Signal

This project is concerned with the rectification of EEG recording. EEG signal is often gets distorted due to the presence of various signals which are known as artifacts. Eye blinking is one of the major artifacts causing EEG to distort. Eye blinking distorts the EEG signal by varying the electric potential present over the scalp. To remove the artifacts, signal separation techniques are widely used in modern days. There are various methods used for removing different types of artifacts present in EEG recording and one of the techniques is Blind Source Separation which is used for separation of source signal from artifacts.This thesis also demonstrates the use of Second Order Blind Identification with Robust Orthogonalization (known as SOBI-RO) algorithm to remove the ocular artifacts and reconstruct the original EEG signal. Finally, the original signal and estimated signal is compared. To illustrate the algorithm a raw EEG data has been taken from the database. The data has been processed on MATLAB platform using the SOBI-RO algorithm. In the end it was found that the ocular artifacts are successfully removed from the raw EEG data. The performance is evaluated using signal to distortion ratio

Design of a wearable device for conditional neuromodulation of the pudendal nerve

After spinal cord injury, the normal functions of the lower urinary tract may be disrupted. Namely, incontinence and concurrent voiding problems may ensue. The troublesome side effects of the drugs, infection due to catheterisation, and the costs and risks associated with more invasive treatments indicate the need for alternative forms of treatment. The pudendal nerve neuromodulation may provide such an alternative. The unique aspect of this technique is that depending on the stimulus frequency it may result in micturition-like or continence-like reflexes. Also, the stimulus current can be applied trans-rectally, meaning that a minimally-invasive wearable solution may be developed. The major limitation of such a solution is the high level of the required stimulus current to activate the nerve trans-rectally. The efficacy of the trans-rectal neuromodulation of the pudendal may be increased by only applying the stimulus when needed, when employed to tackle incontinence. The electromyogram signal from the external anal sphincter may be used to detect the onset of hyper-reflexive contractions of the bladder. The ability of recording this signal can be readily incorporated in the neuromodulation device due to the proximity of the structures. However, the recording electrodes should be designed for an efficacious and chronic recording. Thus, the main objective of this thesis was to design and optimise the neuromodulation and recording electrodes on the said device. A volume conductor model of such a device in situ was developed and used in tandem with a double layer cable model of nerve fibres to minimise the stimulus current. It was demonstrated that a considerable reduction in the stimulus current may be achieved even when the variations of the nerve trajectory in different individuals are considered. Using computational models and experimental measurements, a recording assembly was identified for an efficacious recording of the electromyogram from the external anal sphincter

Independent component analysis techniques and their performance evaluation for electroencephalography.

The ongoing electrical activity of the brain is known as the electroencephalogram (EEG). Evoked potentials (EPs) are voltage deviations in the EEG elicited in association with stimuli. EPs provide clinical information by allowing an insight into neurological processes. The amplitude of EPs is typically several times less than the background EEG. The background EEG has the effect of obscuring the EPs and therefore appropriate signal processing is required for their recovery. The EEG waveforms recorded from electrodes placed on the scalp contains the ongoing background EEG, EPs from various brain sources as well as signal components with sources external to the brain. An example of externally generated signal which is picked up by the electrodes on the scalp is the electrooculogram (EOG). This signal is generated by the eyes when eye movements or blinks are performed. Saccade-related EEG waveforms were recorded from 7 normal subjects. A signal source separation technique, namely the independent component analysis (ICA) algorithm of Bell and Sejnowski (hereafter refereed to as BS_ICA), was employed to analyse the recorded waveforms. The effectiveness of the BS_ICA algorithm as well as that of the ICA algorithm of Cardoso, was investigated for removing ocular artefact (OA) from the EEG. It was quantitavely demonstrated that both ICA algorithms were more effective than the conventional correlation-based techniques for removing the OA from the EEG.A novel iterative synchronised averaging method for EPs was devised. The method optimally synchronised the waveforms from successive trials with respect to the event of interest prior to averaging and thus preserved the features of the signals components that were time-locked to the event. The recorded EEG waveforms were analysed using BS_ICA and saccade-related components (frontal and occipital pre-saccadic potentials, and the lambda wave) were extracted and their scalp topographies were obtained. This initial study highlighted some limitations of the conventional ICA approach of Bell and Sejnowski for analysing saccade-related EEG waveforms.Novel techniques were devised in order to improve the performance of the ICA algorithm of Bell and Sejnowski for extracting the lambda wave EP component. One approach involved designing a template-model that represented the temporal characteristics of a lambda wave. Its incorporation into the BS_ICA algorithm improved the signal source separation ability of the algorithm for extracting the lambda wave from the EEG waveforms. The second approach increased the effective length of the recorded EEG traces prior to their processing by the BS_ICA algorithm. This involved abutting EEG traces from an appropriate number of successive trials (a trial was a set of waveforms recorded from 64 electrode locations in a experiment involving a saccade performance). It was quantitatively demonstrated that the process of abutting EEG waveforms was a valuable pre-processing operation for the ICA algorithm of Bell and Sejnowski when extracting the lambda wave.A Fuzzy logic method was implemented to identify BS_ICA-extracted single-trial saccade-related lambda waves. The method provided an effective means to automate the identification of the lambda waves extracted by BS_ICA. The approach correctly identified the single-trial lambda waves with an Accuracy of 97.4%

Artefact detection and removal algorithms for EEG diagnostic systems

The electroencephalogram (EEG) is a medical technology that is used in the monitoring of the brain and in the diagnosis of many neurological illnesses. Although coarse in its precision, the EEG is a non-invasive tool that requires minimal set-up times, and is suitably unobtrusive and mobile to allow continuous monitoring of the patient, either in clinical or domestic environments. Consequently, the EEG is the current tool-of-choice with which to continuously monitor the brain where temporal resolution, ease-of- use and mobility are important. Traditionally, EEG data are examined by a trained clinician who identifies neurological events of interest. However, recent advances in signal processing and machine learning techniques have allowed the automated detection of neurological events for many medical applications. In doing so, the burden of work on the clinician has been significantly reduced, improving the response time to illness, and allowing the relevant medical treatment to be administered within minutes rather than hours. However, as typical EEG signals are of the order of microvolts (μV ), contamination by signals arising from sources other than the brain is frequent. These extra-cerebral sources, known as artefacts, can significantly distort the EEG signal, making its interpretation difficult, and can dramatically disimprove automatic neurological event detection classification performance. This thesis therefore, contributes to the further improvement of auto- mated neurological event detection systems, by identifying some of the major obstacles in deploying these EEG systems in ambulatory and clinical environments so that the EEG technologies can emerge from the laboratory towards real-world settings, where they can have a real-impact on the lives of patients. In this context, the thesis tackles three major problems in EEG monitoring, namely: (i) the problem of head-movement artefacts in ambulatory EEG, (ii) the high numbers of false detections in state-of-the-art, automated, epileptiform activity detection systems and (iii) false detections in state-of-the-art, automated neonatal seizure detection systems. To accomplish this, the thesis employs a wide range of statistical, signal processing and machine learning techniques drawn from mathematics, engineering and computer science. The first body of work outlined in this thesis proposes a system to automatically detect head-movement artefacts in ambulatory EEG and utilises supervised machine learning classifiers to do so. The resulting head-movement artefact detection system is the first of its kind and offers accurate detection of head-movement artefacts in ambulatory EEG. Subsequently, addtional physiological signals, in the form of gyroscopes, are used to detect head-movements and in doing so, bring additional information to the head- movement artefact detection task. A framework for combining EEG and gyroscope signals is then developed, offering improved head-movement arte- fact detection. The artefact detection methods developed for ambulatory EEG are subsequently adapted for use in an automated epileptiform activity detection system. Information from support vector machines classifiers used to detect epileptiform activity is fused with information from artefact-specific detection classifiers in order to significantly reduce the number of false detections in the epileptiform activity detection system. By this means, epileptiform activity detection which compares favourably with other state-of-the-art systems is achieved. Finally, the problem of false detections in automated neonatal seizure detection is approached in an alternative manner; blind source separation techniques, complimented with information from additional physiological signals are used to remove respiration artefact from the EEG. In utilising these methods, some encouraging advances have been made in detecting and removing respiration artefacts from the neonatal EEG, and in doing so, the performance of the underlying diagnostic technology is improved, bringing its deployment in the real-world, clinical domain one step closer