Parameter-Invariant Design of Medical Alarms

The recent explosion of low-power low-cost communication, sensing, and actuation technologies has ignited the automation of medical diagnostics and care in the form of medical cyber physical systems (MCPS). MCPS are poised to revolutionize patient care by providing smarter alarm systems, clinical decision support, advanced diagnostics, minimally invasive surgical care, improved patient drug delivery, and safety and performance guarantees. With the MCPS revolution emerges a new era in medical alarm systems, where measurements gathered via multiple devices are fused to provide early detection of critical conditions. The alarms generated by these next generation monitors can be exploited by MCPS to further improve performance, reliability, and safety. Currently, there exist several approaches to designing medical monitors ranging from simple sensor thresholding techniques to more complex machine learning approaches. While all the current design approaches have different strengths and weaknesses, their performance degrades when underlying models contain unknown parameters and training data is scarce. Under this scenario, an alternative approach that performs well is the parameter-invariant detector, which utilizes sufficient statistics that are invariant to unknown parameters to achieve a constant false alarm rate across different systems. Parameter-invariant detectors have been successfully applied in other cyber physical systems (CPS) applications with structured dynamics and unknown parameters such as networked systems, smart buildings, and smart grids; most recently, the parameter-invariant approach has been recently extended to medical alarms in the form of a critical shunt detector for infants undergoing a lung lobectomy. The clinical success of this case study application of the parameter-invariant approach is paving the way for a range of other medical monitors. In this tutorial, we present a design methodology for medical parameter-invariant monitors. We begin by providing a motivational review of currently employed medical alarm techniques, followed by the introduction of the parameter-invariant design approach. Finally, we present a case study example to demonstrate the design of a parameter-invariant alarm for critical shunt detection in infants during surgical procedures

Context-Aware Detection in Medical Cyber-Physical Systems

This paper considers the problem of incorporating context in medical cyber-physical systems (MCPS) applications for the purpose of improving the performance of MCPS detectors. In particular, in many applications additional data could be used to conclude that actual measurements might be noisy or wrong (e.g., machine settings might indicate that the machine is improperly attached to the patient); we call such data context. The first contribution of this work is the formal definition of context, namely additional information whose presence is associated with a change in the measurement model (e.g., higher variance). Given this formulation, we developed the context-aware parameter-invariant (CA-PAIN) detector; the CA-PAIN detector improves upon the original PAIN detector by recognizing events with noisy measurements and not raising unnecessary false alarms. We evaluate the CA-PAIN detector both in simulation and on real-patient data; in both cases, the CA-PAIN detector achieves roughly a 20-percent reduction of false alarm rates over the PAIN detector, thus indicating that formalizing context and using it in a rigorous way is a promising direction for future work

Towards Non-Invasive Monitoring of Hypovolemia in Intensive Care Patients

Hypovolemia caused by internal hemorrhage is a major cause of death in critical care patients. However, hypovolemia is difficult to diagnose in a timely fashion, as obvious symptoms do not manifest until patients are already nearing a critical state of shock. Novel non-invasive methods for detecting hypovolemia in the literature utilize the photoplethysmogram (PPG) waveform generated by the pulse-oximeter attached to a finger or ear. Until now, PPG-based alarms have been evaluated only on healthy patients under ideal testing scenarios (e.g., motionless patients); however, the PPG is sensitive to patient health and significant artifacts manifest when patients move. Since patient health varies within the intensive care unit (ICU) and ICU patients typically do not remain motionless, this work introduces a PPG-based monitor designed to be robust to waveform artifacts and health variability in the underlying patient population. To demonstrate the promise of our approach, we evaluate the proposed monitor on a small sample of intensive care patients from the Physionet database. The monitor detects hypovolemia within a twelve hour window of nurse documentation of hypovolemia when it is present, and achieves a low false alarm rate over patients without documented hypovolemia

Robust Monitoring of Hypovolemia in Intensive Care Patients Using Photoplethysmogram Signals

The paper presents a fingertip photoplethysmography based technique to assess patient fluid status that is robust to waveform artifacts and health variability in the underlying patient population. The technique is intended for use in intensive care units, where patients are at risk for hypovolemia, and signal artifacts and inter-patient variations in health are common. Input signals are preprocessed to remove artifact, then a parameter-invariant statistic is calculated to remove effects of patient-specific physiology. Patient data from the Physionet MIMICII database was used to evaluate the performance of this technique. The proposed method was able to detect hypovolemia within 24 hours of onset in all hypovolemic patients tested, while producing minimal false alarms over non-hypovolemic patients

Early Detection of Critical Pulmonary Shunts in Infants

This paper aims to improve the design of modern Medical Cyber Physical Systems through the addition of supplemental noninvasive monitors. Specifically, we focus on monitoring the arterial blood oxygen content (CaO2), one of the most closely observed vital signs in operating rooms, currently measured by a proxy - peripheral hemoglobin oxygen saturation (SpO2). While SpO2 is a good estimate of O2 content in the finger where it is measured, it is a delayed measure of its content in the arteries. In addition, it does not incorporate system dynamics and is a poor predictor of future CaO2 values. Therefore, as a first step towards supplementing the usage of SpO2, this work introduces a predictive monitor designed to provide early detection of critical drops in CaO2 caused by a pulmonary shunt in infants. To this end, we develop a formal model of the circulation of oxygen and carbon dioxide in the body, characterized by unknown patient-unique parameters. Employing the model, we design a matched subspace detector to provide a near constant false alarm rate invariant to these parameters and modeling uncertainties. Finally, we validate our approach on real-patient data from lung lobectomy surgeries performed at the Children\u27s Hospital of Philadelphia. Given 198 infants, the detector predicted 81% of the critical drops in CaO2 at an average of about 65 seconds earlier than the SpO2-based monitor, while achieving a 0:9% false alarm rate (representing about 2 false alarms per hour)

Towards a Model-Based Meal Detector for Type I Diabetics

Blood glucose management systems are an important class of Medical Cyber-Physical Systems that provide vital everyday decision support service to diabetics. An artificial pancreas, which integrates a continuous glucose monitor, a wearable insulin pump, and control algorithms running on embedded computing devices, can significantly improve the quality of life for millions of Type 1 diabetics. A primary problem in the development of an artificial pancreas is the accurate detection and estimation of meal carbohydrates, which cause significant glucose system disturbances. Meal carbohydrate detection is challenging since post-meal glucose responses greatly depend on patient-specific physiology and meal composition. In this paper, we develop a novel meal-time detector that leverages a linearized physiological model to realize a (nearly) constant false alarm rate (CFAR) performance despite unknown model parameters and uncertain meal inputs. Insilico evaluations using 10, 000 virtual subjects on an FDA-accepted maximal physiological model illustrate that the proposed CFAR meal detector significantly outperforms a current state-of-the-art meal detector that utilizes a voting scheme based on rate-of-change (RoC) measures. The proposed detector achieves 99.6% correct detection rate while averaging one false alarm every 24 days (a 1.4% false alarm rate), which represents an 84% reduction in false alarms and a 95% reduction in missed alarms when compared to the RoC approach

Parameter-Invariant Monitor Design for Cyber Physical Systems

The tight interaction between information technology and the physical world inherent in Cyber-Physical Systems (CPS) can challenge traditional approaches for monitoring safety and security. Data collected for robust CPS monitoring is often sparse and may lack rich training data describing critical events/attacks. Moreover, CPS often operate in diverse environments that can have significant inter/intra-system variability. Furthermore, CPS monitors that are not robust to data sparsity and inter/intra-system variability may result in inconsistent performance and may not be trusted for monitoring safety and security. Towards overcoming these challenges, this paper presents recent work on the design of parameter-invariant (PAIN) monitors for CPS. PAIN monitors are designed such that unknown events and system variability minimally affect the monitor performance. This work describes how PAIN designs can achieve a constant false alarm rate (CFAR) in the presence of data sparsity and intra/inter system variance in real-world CPS. To demonstrate the design of PAIN monitors for safety monitoring in CPS with different types of dynamics, we consider systems with networked dynamics, linear-time invariant dynamics, and hybrid dynamics that are discussed through case studies for building actuator fault detection, meal detection in type I diabetes, and detecting hypoxia caused by pulmonary shunts in infants. In all applications, the PAIN monitor is shown to have (significantly) less variance in monitoring performance and (often) outperforms other competing approaches in the literature. Finally, an initial application of PAIN monitoring for CPS security is presented along with challenges and research directions for future security monitoring deployments

Particle detection and tracking in fluorescence time-lapse imaging: a contrario approach

This paper proposes a probabilistic approach for the detection and the tracking of particles in fluorescent time-lapse imaging. In the presence of a very noised and poor-quality data, particles and trajectories can be characterized by an a contrario model, that estimates the probability of observing the structures of interest in random data. This approach, first introduced in the modeling of human visual perception and then successfully applied in many image processing tasks, leads to algorithms that neither require a previous learning stage, nor a tedious parameter tuning and are very robust to noise. Comparative evaluations against a well-established baseline show that the proposed approach outperforms the state of the art.Comment: Published in Journal of Machine Vision and Application