New algorithm for fetal QRS detection in surface abdominal records

The proposed method detects fetal R waves on abdominal non-invasive records. An exponentially averaged pattern of the mother PQRST segment is obtained and subtracted. Subsequently the fetal R detector based on a Smoothed Nonlinear Energy Operator (SNEO) is applied to the residual signal. Finally, criteria about amplitude, heart rate and backward search are settled to correct false detections. To evaluate the fetal R detector, 10 multichannel records were used, acquired between gestation week 22 and 40. The position of the fetal R waves were manually marked (N=1490), and these reference marks were compared with the ones from the detector. It was obtained a 88.83% of sensitivity and a 91.32% of positive prediction value. The application of the detector to all the abdominal channels will probably allow improving the obtained results

Fog Computing in Medical Internet-of-Things: Architecture, Implementation, and Applications

In the era when the market segment of Internet of Things (IoT) tops the chart in various business reports, it is apparently envisioned that the field of medicine expects to gain a large benefit from the explosion of wearables and internet-connected sensors that surround us to acquire and communicate unprecedented data on symptoms, medication, food intake, and daily-life activities impacting one's health and wellness. However, IoT-driven healthcare would have to overcome many barriers, such as: 1) There is an increasing demand for data storage on cloud servers where the analysis of the medical big data becomes increasingly complex, 2) The data, when communicated, are vulnerable to security and privacy issues, 3) The communication of the continuously collected data is not only costly but also energy hungry, 4) Operating and maintaining the sensors directly from the cloud servers are non-trial tasks. This book chapter defined Fog Computing in the context of medical IoT. Conceptually, Fog Computing is a service-oriented intermediate layer in IoT, providing the interfaces between the sensors and cloud servers for facilitating connectivity, data transfer, and queryable local database. The centerpiece of Fog computing is a low-power, intelligent, wireless, embedded computing node that carries out signal conditioning and data analytics on raw data collected from wearables or other medical sensors and offers efficient means to serve telehealth interventions. We implemented and tested an fog computing system using the Intel Edison and Raspberry Pi that allows acquisition, computing, storage and communication of the various medical data such as pathological speech data of individuals with speech disorders, Phonocardiogram (PCG) signal for heart rate estimation, and Electrocardiogram (ECG)-based Q, R, S detection.Comment: 29 pages, 30 figures, 5 tables. Keywords: Big Data, Body Area Network, Body Sensor Network, Edge Computing, Fog Computing, Medical Cyberphysical Systems, Medical Internet-of-Things, Telecare, Tele-treatment, Wearable Devices, Chapter in Handbook of Large-Scale Distributed Computing in Smart Healthcare (2017), Springe

P and R Wave Detection in Complete Congenital Atrioventricular Block

Complete atrioventricular block (type III AVB) is characterized by an absence of P wave transmission to ventricles. This implies that QRS complexes are generated in an autonomous way and are not coordinated with P waves. This work introduces a new algorithm for the detection of P waves for this type of pathology using non-invasive electrocardiographic surface leads. The proposed algorithm is divided into three stages. In the first stage, the R waves located by a QRS detector are used to generate the RR series and time references for the other stages of the algorithm. In the second stage, the ventricular activity (QT segment) is removed by using an adaptive filter that obtains an averaged pattern of the QT segment. In the third stage, a new P wave detector is applied to the residual signal obtained after QT cancellation in order to detect P wave locations and get the PP time series. Eight Holter records from patients with congenital type III AVB were used to verify the proposed algorithm. Although further improvements should be made to improve the algorithm¿s performance, the results obtained show high average values of sensitivity (90.52 %) and positive prediction (90.98%)

Revisiting QRS detection methodologies for portable, wearable, battery-operated, and wireless ECG systems

Cardiovascular diseases are the number one cause of death worldwide. Currently, portable battery-operated systems such as mobile phones with wireless ECG sensors have the potential to be used in continuous cardiac function assessment that can be easily integrated into daily life. These portable point-of-care diagnostic systems can therefore help unveil and treat cardiovascular diseases. The basis for ECG analysis is a robust detection of the prominent QRS complex, as well as other ECG signal characteristics. However, it is not clear from the literature which ECG analysis algorithms are suited for an implementation on a mobile device. We investigate current QRS detection algorithms based on three assessment criteria: 1) robustness to noise, 2) parameter choice, and 3) numerical efficiency, in order to target a universal fast-robust detector. Furthermore, existing QRS detection algorithms may provide an acceptable solution only on small segments of ECG signals, within a certain amplitude range, or amid particular types of arrhythmia and/or noise. These issues are discussed in the context of a comparison with the most conventional algorithms, followed by future recommendations for developing reliable QRS detection schemes suitable for implementation on battery-operated mobile devices.Mohamed Elgendi, Björn Eskofier, Socrates Dokos, Derek Abbot

A Machine Learning Model for the Prognosis of Pulseless Electrical Activity during Out-of-Hospital Cardiac Arrest

Pulseless electrical activity (PEA) is characterized by the disassociation of the mechanical and electrical activity of the heart and appears as the initial rhythm in 20–30% of out-of-hospital cardiac arrest (OHCA) cases. Predicting whether a patient in PEA will convert to return of spontaneous circulation (ROSC) is important because different therapeutic strategies are needed depending on the type of PEA. The aim of this study was to develop a machine learning model to differentiate PEA with unfavorable (unPEA) and favorable (faPEA) evolution to ROSC. An OHCA dataset of 1921 5s PEA signal segments from defibrillator files was used, 703 faPEA segments from 107 patients with ROSC and 1218 unPEA segments from 153 patients with no ROSC. The solution consisted of a signal-processing stage of the ECG and the thoracic impedance (TI) and the extraction of the TI circulation component (ICC), which is associated with ventricular wall movement. Then, a set of 17 features was obtained from the ECG and ICC signals, and a random forest classifier was used to differentiate faPEA from unPEA. All models were trained and tested using patientwise and stratified 10-fold cross-validation partitions. The best model showed a median (interquartile range) area under the curve (AUC) of 85.7(9.8)% and a balance accuracy of 78.8(9.8)% , improving the previously available solutions at more than four points in the AUC and three points in balanced accuracy. It was demonstrated that the evolution of PEA can be predicted using the ECG and TI signals, opening the possibility of targeted PEA treatment in OHCA.This work was supported by the Spanish Ministerio de Ciencia, Innovacion y Universidades through Grant RTI2018-101475-BI00, jointly with the Fondo Europeo de Desarrollo Regional (FEDER), by the Basque Government through Grant IT1229-19 and Grant PRE2020_1_0177, and by the university of the Basque Country (UPV/EHU) under Grant COLAB20/01

Analysis of Image Sequence Data with Applications to Two-Dimensional Echocardiography

Digital two-dimensional echocardiography is an ultrasonic imaging technique that is used as an increasingly important noninvasive technique in the comprehensive characterization of the left ventricular structure and function. Quantitative analysis often uses heart wall motion and other shape attributes such as the heart wall thickness, heart chamber area, and the variation of these attributes throughout the cardiac cycle. These analyses require the complete determination of the heart wall boundaries. Poor image quality and large amount of noise makes computer detection of the boundaries difficult. An algorithm to detect both the inner and outer heart wall boundaries is presented. The algorithm was applied to images acquired from animal studies and from a tissue equivalent phantom to verify the performance. Different approaches to exploiting the temporal redundancy of the image data without making use of results from image segmentation and scene interpretation are explored. A new approach to perform image flow analysis is developed based on the Total Least Squares method. The result of this processing is an estimate of the velocities in the image plane. In an image understanding system, information acquired from related domains by other sensors are often useful to the analysis of images. Electrocardiogram signals measure the change of electrical potential changes in the heart muscle an d provide important information such as the timing data for image sequence analysis. These signals are frequently plagued by impulsive muscle noise and background drift due to patient movement. A new approach to solving these problems is presented using mathematical morphology. Experiments addressing various aspects of the problem, such as algorithm performance, choice of operator parameters, and response to sinusoidal inputs, are reported

Poisson relationships with applications to digital signal processing

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Novel Low Complexity Biomedical Signal Processing Techniques for Online Applications

Biomedical signal processing has become a very active domain of research nowadays. With the advent of portable monitoring devices, from accelerometer-enabled bracelets and smart-phones to more advanced vital sign tracking body area networks, this field has been receiving unprecedented attention. Indeed, portable health monitoring can help uncover the underlying dynamics of human health in a way that has not been possible before. Several challenges have emerged however, as these devices present key differences in terms of signal acquisition and processing in comparison with conventional methods. Hardware constraints such as processing power and limited battery capacity make most established techniques unsuitable and therefore, the need for low-complexity yet robust signal processing methods has appeared. Another issue that needs to be addressed is the quality of the signals captured by these devices. Unlike in clinical scenarios, in portable health monitoring subjects are constantly performing their daily activities. Moreover, signals maybe captured from unconventional locations and subsequently, be prone to perturbations. In order to obtain reliable measures from these monitoring devices, one needs to acquire dependable signal quality measures, to avoid false alarms. Indeed, hardware limitations and low-quality signals can greatly influence the performance of portable monitoring devices. Nevertheless, most devices offer simultaneous acquisition of multiple physiological parameters, such as electrocardiogram (ECG) and photoplethysmogram (PPG). Through multi-modal signal processing the overall performance can be improved, for instance by deriving parameters such as heart rate estimation from the most reliable and uncontaminated source. This thesis is therefore, dedicated to propose novel low-complexity biomedical processing techniques for real-time/online applications. Throughout this dissertation, several bio-signals such as the ECG, PPG, and electroencephalogram (EEG) are investigated. %There is an emphasis on ECG processing techniques, as most of the bio-signals recorded today reflect information about the heart. The main contribution of this dissertation consists in two signal processing techniques: 1) a novel ECG QRS-complex detection and delineation technique, and 2) a short-term event extraction technique for biomedical signals. The former is based on a processing technique called mathematical morphology (MM), and adaptively uses subject QRS-complex amplitude- and morphological attributes for a robust detection and delineation. This method is generalized to intra-cardiac electrograms for atrial activation detection during atrial fibrillation. The second method, called the Relative-Energy algorithm, uses short- and long-term signal energies to highlight events of interest and discard unwanted activities. Collectively, the results obtained by these methods suggest that while presenting low-computational costs, they can efficiently and robustly extract biomedical events of interest. Using the relative energy algorithm, a continuous non-binary ECG signal quality index is presented. The ECG quality is determined by creating a cleaned-up version of the input ECG and calculating the correlation coefficient between the cleaned-up and the original ECG. The proposed quality index is fast and can be implemented online, making it suitable for portable monitoring scenarios