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

A Novel Clustering-Based Algorithm for Continuous and Non-invasive Cuff-Less Blood Pressure Estimation

Extensive research has been performed on continuous, non-invasive, cuffless blood pressure (BP) measurement using artificial intelligence algorithms. This approach involves extracting certain features from physiological signals like ECG, PPG, ICG, BCG, etc. as independent variables and extracting features from Arterial Blood Pressure (ABP) signals as dependent variables, and then using machine learning algorithms to develop a blood pressure estimation model based on these data. The greatest challenge of this field is the insufficient accuracy of estimation models. This paper proposes a novel blood pressure estimation method with a clustering step for accuracy improvement. The proposed method involves extracting Pulse Transit Time (PTT), PPG Intensity Ratio (PIR), and Heart Rate (HR) features from Electrocardiogram (ECG) and Photoplethysmogram (PPG) signals as the inputs of clustering and regression, extracting Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) features from ABP signals as dependent variables, and finally developing regression models by applying Gradient Boosting Regression (GBR), Random Forest Regression (RFR), and Multilayer Perceptron Regression (MLP) on each cluster. The method was implemented using the MIMICII dataset with the silhouette criterion used to determine the optimal number of clusters. The results showed that because of the inconsistency, high dispersion, and multi-trend behavior of the extracted features vectors, the accuracy can be significantly improved by running a clustering algorithm and then developing a regression model on each cluster, and finally weighted averaging of the results based on the error of each cluster. When implemented with 5 clusters and GBR, this approach yielded an MAE of 2.56 for SBP estimates and 2.23 for DBP estimates, which were significantly better than the best results without clustering (DBP: 6.27, SBP: 6.36)

Machine learning techniques for the prediction of systolic and diastolic blood pressure utilising the photoplethysmogram

Blood pressure (BP) is one of the four primary vital signs that provides important information regarding patients' cardiovascular system conditions. Continuous and regular blood pressure monitoring is essential for the early diagnosis, prevention and management of cardiovascular disease (CVD) and haemodynamic diseases (hypertension and hypotension). Current clinical blood pressure measurement techniques are either invasive or cuff-based, which can be impractical, intermittent, and uncomfortable for patients during frequent measurements. Considering these challenges, several studies have suggested new non-invasive and cuffless blood pressuring measurement techniques using physiological signals, such as, the Electrocardiogram (ECG) and the Photoplethysmogram (PPG). In particular, indirect cuffless BP measurement techniques using pulse transit time and pulse arrival time have been extensively investigated over the last few decades. However, these techniques require two measurement sensors, frequent calibration, and hence, they are also impractical and inconvenient for continuous BP measurements. More recently, with the advancement of computational techniques, including machine learning and artificial intelligence, a new simple and innovative approach using only PPG signals have been proposed in the literature for cuffless and continuous monitoring of blood pressure. However, the majority of these studies have been unable to achieve acceptable accuracies that comply or satisfy the international standards for cuffless BP monitoring. Thus, further investigations are required to realise this approach. In this research, a total of 52 features have been extracted from the PPG and their individual impact on BP have been rigorously evaluated using several statistical and machine learning techniques. As a result, only the most important features for estimation of BP were selected, effectively reducing the input vector by more than half. Two datasets were created to accommodate the two input feature vectors. The PPG and reference BP signals were derived from the publicly available MIMIC II database. In order to estimate BP, a total of nine machine learning and neural network models have been implemented and evaluated on the two datasets. Out of the nine models, four are widely used classical machine learning models, and five neural network models, three of which are conventional models and two advanced models have been proposed for BP estimation using only one PPG signal. The results of all these models have also been compared against well established studies in the literature. The results obtained using the classical machine learning models, namely, multilinear regression, random forest, adaboost and support vector machine, were poor and inferior to all the neural network models. A slight performance improvement was achieved using the non-recurrent multi-layer perceptron, however, the error was still much higher than the internationally acceptable range. On the other hand, a significant improvement was achieved for the first time by using the recurrent neural network models, namely, Long Short-Term Memory (LSTM) and Gated Recurrent Units (GRU). The two proposed neural network models further enhanced the BP estimation accuracies and were able to reduce the mean absolute error (MAE) to a range below 5 mmHg. In particular, the best performing model was the one bidirectional GRU layer, followed by two unidirectional GRU layers, and an attention layer. The obtained MAE and standard deviation (SD) were 4.79+/-8.08 mmHg for systolic BP (SBP) and 2.77+/-4.72 mmHg for diastolic BP (DBP). Furthermore, the DBP estimation were well below the internationally acceptable limits (referring to the AAMI standards of mean error (ME), ME+/-SD less than 5+/-8), while the ME for the SBP estimation were acceptable but the SD exceeded the limits by only 1.34 mmHg. This research has successfully demonstrated that advanced neural network models can be used for the non-invasive and cuffless prediction of BP utilising the PPG

Hybrid Wearable Signal Processing/Learning via Deep Neural Networks

Wearable technologies are gaining considerable attention in recent years as a potential post-smartphone platform with several applications of significant engineering importance. Wearable technologies are expected to become more prevalent in a variety of areas, including modern healthcare practices, robotic prosthesis control, Artificial Reality (AR) and Virtual Reality (VR) applications, Human Machine Interface/Interaction (HMI), and remote support for patients and chronically ill patients at home. The emergence of wearable technologies can be attributed to the advancement of flexible electronic materials; the availability of advanced cloud and wireless communication systems, and; the Internet of Things (IoT) coupled with high demand from the tech-savvy population and the elderly population for healthcare management. Wearable devices in the healthcare realm gather various biological signals from the human body, among which Electrocardiogram (ECG), Photoplethysmogram (PPG), and surface Electromyogram (sEMG), are the most widely non-intrusive monitored signals. Utilizing these widely used non-intrusive signals, the primary emphasis of the proposed dissertation is on the development of advanced Machine Learning (ML), in particular Deep Learning (DL), algorithms to increase the accuracy of wearable devices in specific tasks. In this context and in the first part, using ECG and PPG bio-signals, we focus on development of accurate subject-specific solutions for continuous and cuff-less Blood Pressure (BP) monitoring. More precisely, a deep learning-based framework known as BP-Net is proposed for predicting continuous upper and lower bounds of blood pressure, respectively, known as Systolic BP (SBP) and Diastolic BP (DBP). Furthermore, by capitalizing on the fact that datasets used in recent literature are not unified and properly defined, a unified dataset is constructed from the MIMIC-I and MIMIC-III databases obtained from PhysioNet. In the second part, we focus on hand gesture recognition utilizing sEMG signals, which have the potential to be used in the myoelectric prostheses control systems or decoding Myo Armbands data to interpret human intent in AR/VR environments. Capitalizing on the recent advances in hybrid architectures and Transformers in different applications, we aim to enhance the accuracy of sEMG-based hand gesture recognition by introducing a hybrid architecture based on Transformers, referred to as the Transformer for Hand Gesture Recognition (TraHGR). In particular, the TraHGR architecture consists of two parallel paths followed by a linear layer that acts as a fusion center to integrate the advantage of each module. The ultimate goal of this work is to increase the accuracy of gesture classifications, which could be a major step towards the development of more advanced HMI systems that can improve the quality of life for people with disabilities or enhance the user experience in AR/VR applications. Besides improving accuracy, decreasing the number of parameters in the Deep Neural Network (DNN) architectures plays an important role in wearable devices. In other words, to achieve the highest possible accuracy, complicated and heavy-weighted Deep Neural Networks (DNNs) are typically developed, which restricts their practical application in low-power and resource-constrained wearable systems. Therefore, in our next attempt, we propose a lightweight hybrid architecture based on the Convolutional Neural Network (CNN) and attention mechanism, referred to as Hierarchical Depth-wise Convolution along with the Attention Mechanism (HDCAM), to effectively extract local and global representations of the input. The key objective behind the design of HDCAM was to ensure its resource efficiency while maintaining comparable or better performance than the current state-of-the-art methods

Intelligent Biosignal Processing in Wearable and Implantable Sensors

This reprint provides a collection of papers illustrating the state-of-the-art of smart processing of data coming from wearable, implantable or portable sensors. Each paper presents the design, databases used, methodological background, obtained results, and their interpretation for biomedical applications. Revealing examples are brain–machine interfaces for medical rehabilitation, the evaluation of sympathetic nerve activity, a novel automated diagnostic tool based on ECG data to diagnose COVID-19, machine learning-based hypertension risk assessment by means of photoplethysmography and electrocardiography signals, Parkinsonian gait assessment using machine learning tools, thorough analysis of compressive sensing of ECG signals, development of a nanotechnology application for decoding vagus-nerve activity, detection of liver dysfunction using a wearable electronic nose system, prosthetic hand control using surface electromyography, epileptic seizure detection using a CNN, and premature ventricular contraction detection using deep metric learning. Thus, this reprint presents significant clinical applications as well as valuable new research issues, providing current illustrations of this new field of research by addressing the promises, challenges, and hurdles associated with the synergy of biosignal processing and AI through 16 different pertinent studies. Covering a wide range of research and application areas, this book is an excellent resource for researchers, physicians, academics, and PhD or master students working on (bio)signal and image processing, AI, biomaterials, biomechanics, and biotechnology with applications in medicine

Deep learning-based signal processing approaches for improved tracking of human health and behaviour with wearable sensors

This thesis explores two lines of research in the context of sequential data and machine learning in the remote environment, i.e., outside the lab setting - using data acquired from wearable devices. Firstly, we explore Generative Adversarial Networks (GANs) as a reliable tool for time series generation, imputation and forecasting. Secondly, we investigate the applicability of novel deep learning frameworks to sequential data processing and their advantages over traditional methods. More specifically, we use our models to unlock additional insights and biomarkers in human-centric datasets. Our first research avenue concerns the generation of sequential physiological data. Access to physiological data, particularly medical data, has become heavily regulated in recent years, which has presented bottlenecks in developing computational models to assist in diagnosing and treating patients. Therefore, we explore GAN models to generate medical time series data that adhere to privacy-preserving regulations. We present our novel methods of generating and imputing synthetic, multichannel sequential medical data while complying with privacy regulations. Addressing these concerns allows for sharing and disseminating medical data and, in turn, developing clinical research in the relevant fields. Secondly, we explore novel deep learning technologies applied to human-centric sequential data to unlock further insights while addressing the idea of environmentally sustainable AI. We develop novel deep learning processing methods to estimate human activity and heart rate through convolutional networks. We also introduce our ‘time series-to-time series GAN’, which maps photoplethysmograph data to blood pressure measurements. Importantly, we denoise artefact-laden biosignal data to a competitive standard using a custom objective function and novel application of GANs. These deep learning methods help to produce nuanced biomarkers and state-of-the-art insights from human physiological data. The work laid out in this thesis provides a foundation for state-of-the-art deep learning methods for sequential data processing while keeping a keen eye on sustain- able AI

Translational Functional Imaging in Surgery Enabled by Deep Learning

Many clinical applications currently rely on several imaging modalities such as Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), Computed Tomography (CT), etc. All such modalities provide valuable patient data to the clinical staff to aid clinical decision-making and patient care. Despite the undeniable success of such modalities, most of them are limited to preoperative scans and focus on morphology analysis, e.g. tumor segmentation, radiation treatment planning, anomaly detection, etc. Even though the assessment of different functional properties such as perfusion is crucial in many surgical procedures, it remains highly challenging via simple visual inspection. Functional imaging techniques such as Spectral Imaging (SI) link the unique optical properties of different tissue types with metabolism changes, blood flow, chemical composition, etc. As such, SI is capable of providing much richer information that can improve patient treatment and care. In particular, perfusion assessment with functional imaging has become more relevant due to its involvement in the treatment and development of several diseases such as cardiovascular diseases. Current clinical practice relies on Indocyanine Green (ICG) injection to assess perfusion. Unfortunately, this method can only be used once per surgery and has been shown to trigger deadly complications in some patients (e.g. anaphylactic shock). This thesis addressed common roadblocks in the path to translating optical functional imaging modalities to clinical practice. The main challenges that were tackled are related to a) the slow recording and processing speed that SI devices suffer from, b) the errors introduced in functional parameter estimations under changing illumination conditions, c) the lack of medical data, and d) the high tissue inter-patient heterogeneity that is commonly overlooked. This framework follows a natural path to translation that starts with hardware optimization. To overcome the limitation that the lack of labeled clinical data and current slow SI devices impose, a domain- and task-specific band selection component was introduced. The implementation of such component resulted in a reduction of the amount of data needed to monitor perfusion. Moreover, this method leverages large amounts of synthetic data, which paired with unlabeled in vivo data is capable of generating highly accurate simulations of a wide range of domains. This approach was validated in vivo in a head and neck rat model, and showed higher oxygenation contrast between normal and cancerous tissue, in comparison to a baseline using all available bands. The need for translation to open surgical procedures was met by the implementation of an automatic light source estimation component. This method extracts specular reflections from low exposure spectral images, and processes them to obtain an estimate of the light source spectrum that generated such reflections. The benefits of light source estimation were demonstrated in silico, in ex vivo pig liver, and in vivo human lips, where the oxygenation estimation error was reduced when utilizing the correct light source estimated with this method. These experiments also showed that the performance of the approach proposed in this thesis surpass the performance of other baseline approaches. Video-rate functional property estimation was achieved by two main components: a regression and an Out-of-Distribution (OoD) component. At the core of both components is a compact SI camera that is paired with state-of-the-art deep learning models to achieve real time functional estimations. The first of such components features a deep learning model based on a Convolutional Neural Network (CNN) architecture that was trained on highly accurate physics-based simulations of light-tissue interactions. By doing this, the challenge of lack of in vivo labeled data was overcome. This approach was validated in the task of perfusion monitoring in pig brain and in a clinical study involving human skin. It was shown that this approach is capable of monitoring subtle perfusion changes in human skin in an arm clamping experiment. Even more, this approach was capable of monitoring Spreading Depolarizations (SDs) (deoxygenation waves) in the surface of a pig brain. Even though this method is well suited for perfusion monitoring in domains that are well represented with the physics-based simulations on which it was trained, its performance cannot be guaranteed for outlier domains. To handle outlier domains, the task of ischemia monitoring was rephrased as an OoD detection task. This new functional estimation component comprises an ensemble of Invertible Neural Networks (INNs) that only requires perfused tissue data from individual patients to detect ischemic tissue as outliers. The first ever clinical study involving a video-rate capable SI camera in laparoscopic partial nephrectomy was designed to validate this approach. Such study revealed particularly high inter-patient tissue heterogeneity under the presence of pathologies (cancer). Moreover, it demonstrated that this personalized approach is now capable of monitoring ischemia at video-rate with SI during laparoscopic surgery. In conclusion, this thesis addressed challenges related to slow image recording and processing during surgery. It also proposed a method for light source estimation to facilitate translation to open surgical procedures. Moreover, the methodology proposed in this thesis was validated in a wide range of domains: in silico, rat head and neck, pig liver and brain, and human skin and kidney. In particular, the first clinical trial with spectral imaging in minimally invasive surgery demonstrated that video-rate ischemia monitoring is now possible with deep learning

Wearable and Nearable Biosensors and Systems for Healthcare

Biosensors and systems in the form of wearables and “nearables” (i.e., everyday sensorized objects with transmitting capabilities such as smartphones) are rapidly evolving for use in healthcare. Unlike conventional approaches, these technologies can enable seamless or on-demand physiological monitoring, anytime and anywhere. Such monitoring can help transform healthcare from the current reactive, one-size-fits-all, hospital-centered approach into a future proactive, personalized, decentralized structure. Wearable and nearable biosensors and systems have been made possible through integrated innovations in sensor design, electronics, data transmission, power management, and signal processing. Although much progress has been made in this field, many open challenges for the scientific community remain, especially for those applications requiring high accuracy. This book contains the 12 papers that constituted a recent Special Issue of Sensors sharing the same title. The aim of the initiative was to provide a collection of state-of-the-art investigations on wearables and nearables, in order to stimulate technological advances and the use of the technology to benefit healthcare. The topics covered by the book offer both depth and breadth pertaining to wearable and nearable technology. They include new biosensors and data transmission techniques, studies on accelerometers, signal processing, and cardiovascular monitoring, clinical applications, and validation of commercial devices

On Improving Generalization of CNN-Based Image Classification with Delineation Maps Using the CORF Push-Pull Inhibition Operator

Deployed image classification pipelines are typically dependent on the images captured in real-world environments. This means that images might be affected by different sources of perturbations (e.g. sensor noise in low-light environments). The main challenge arises by the fact that image quality directly impacts the reliability and consistency of classification tasks. This challenge has, hence, attracted wide interest within the computer vision communities. We propose a transformation step that attempts to enhance the generalization ability of CNN models in the presence of unseen noise in the test set. Concretely, the delineation maps of given images are determined using the CORF push-pull inhibition operator. Such an operation transforms an input image into a space that is more robust to noise before being processed by a CNN. We evaluated our approach on the Fashion MNIST data set with an AlexNet model. It turned out that the proposed CORF-augmented pipeline achieved comparable results on noise-free images to those of a conventional AlexNet classification model without CORF delineation maps, but it consistently achieved significantly superior performance on test images perturbed with different levels of Gaussian and uniform noise

Sensing and Signal Processing in Smart Healthcare

In the last decade, we have witnessed the rapid development of electronic technologies that are transforming our daily lives. Such technologies are often integrated with various sensors that facilitate the collection of human motion and physiological data and are equipped with wireless communication modules such as Bluetooth, radio frequency identification, and near-field communication. In smart healthcare applications, designing ergonomic and intuitive human–computer interfaces is crucial because a system that is not easy to use will create a huge obstacle to adoption and may significantly reduce the efficacy of the solution. Signal and data processing is another important consideration in smart healthcare applications because it must ensure high accuracy with a high level of confidence in order for the applications to be useful for clinicians in making diagnosis and treatment decisions. This Special Issue is a collection of 10 articles selected from a total of 26 contributions. These contributions span the areas of signal processing and smart healthcare systems mostly contributed by authors from Europe, including Italy, Spain, France, Portugal, Romania, Sweden, and Netherlands. Authors from China, Korea, Taiwan, Indonesia, and Ecuador are also included