Data-driven methods for analyzing ballistocardiograms in longitudinal cardiovascular monitoring

Cardiovascular disease (CVD) is the leading cause of death in the US; about 48% of American adults have one or more types of CVD. The importance of continuous monitoring of the older population, for early detection of changes in health conditions, has been shown in the literature, as the key to a successful clinical intervention. We have been investigating environmentally-embedded in-home networks of non-invasive sensing modalities. This dissertation concentrates on the signal processing techniques required for the robust extraction of morphological features from the ballistocardiographs (BCG), and machine learning approaches to utilize these features in non-invasive monitoring of cardiovascular conditions. At first, enhancements in the time domain detection of the cardiac cycle are addressed due to its importance in the estimation of heart rate variability (HRV) and sleep stages. The proposed enhancements in the energy-based algorithm for BCG beat detection have shown at least 50% improvement in the root mean square error (RMSE) of the beat to beat heart rate estimations compared to the reference estimations from the electrocardiogram (ECG) R to R intervals. These results are still subject to some errors, primarily due to the contamination of noise and motion artifacts caused by floor vibration, unconstrained subject movements, or even the respiratory activities. Aging, diseases, breathing, and sleep disorders can also affect the quality of estimation as they slightly modify the morphology of the BCG waveform.Includes bibliographical reference

새로운 심탄도 계측 시스템의 응용 -연속혈압 추정과 생체인식

학위논문 (박사)-- 서울대학교 대학원 : 협동과정 바이오엔지니어링전공, 2014. 8. 김희찬.심탄도 (Ballistocardiogram)는 심박에 동기되어 발생하는 우리 몸의 미세한 진동을 측정한 신호이다. 비침습적으로 심혈관계의 활동을 관찰할 수 있다는 장점 때문에, 20세기 초반에 심탄도의 해석에 대한 많은 연구가 이루어졌다. 그러나 초음파 기기 등 심혈관계 관련 질병들을 진단할 수 있는 새로운 기술들이 개발되면서 상대적으로 실용적이지 못한 특성을 가진 심탄도에 대한 관심은 1970년대 이후에 급격히 줄어들었다. 새로운 센서들의 등장과 마이크로프로세서, 신호처리 기술들의 발전에 힘입어 심탄도 연구는 다시 활기를 띠고 있다. 그러나 이러한 발전들에도 불구하고 심탄도는 의자나 침대 등 상당한 부피를 차지하는 사물을 이용하여 계측되고, 분석을 위해서는 동기화 된 심전도가 동시에 측정되어야 하는 등 측정상의 번거로움이 있다. 또한, 심탄도는 개인 간에는 물론 한 개인에게서도 파형에 많은 변이를 보여 신호의 일관된 해석에 어려움이 있다. 본 학위논문에서는, 이러한 측정 측면과 신호처리 측면에서 현 심탄도 응용의 한계점을 극복할 수 있는 방안을 마련하여, 심탄도의 실질적인 활용 범위를 더욱 확장할 수 있는 방안에 대해 연구하였다. 우선, 심탄도를 심전도와 동시에 무구속적으로 잴 수 있는 필름기반의 패치타입 센서를 개발하였다. 압전소자의 양면에 복수개의 전극을 패터닝하고 각각의 전극에 독립된 기능을 부여해 회로에 연결함으로써 필름 한 장으로 물리적인 신호 (심탄도)와 전기적인 신호(심전도)의 동시 측정이 가능하게 하였다. 센서를 가슴에 부착하였을 때 심전도의 특징적인 R 피크과 심탄도의 특징적인 J 피크를 확인하여 기능을 확인할 수 있었으며, 추가적으로 R-J 간격이 수축기 혈압과 음의 상관관계를 가짐을 이용하여 개발된 센서로 혈압을 추정할 수 있었다. 센서를 통해 예측한 수축기 혈압 오차의 평균값과 표준편차는 각각 -0.16 mmHg와 4.12mmHg으로, 미국과 영국의 혈압계 가이드라인을 모두 만족시킬 수 있었다. 다음으로, 심탄도의 변이적 특성을 새로운 생체인식 기법으로 발전시키는 방안에 대한 연구를 진행하였다. 이를 위하여 심탄도 한 파형 내의 특이점들을 기반으로 특징 벡터를 추출하고 기계학습을 통해 특징들의 변이를 개인들 간의 변이와 한 개인 내에서의 변이로 구분 하였다. 추출된 특징들을 이용하여 35명의 피험자들에게 실험해 본 결과, 단일 심박신호로는 90.20%의 확률로 개개인을 구분할 수 있었으며 7개의 연속된 심박신호로는 98%이상의 성능을 낼 수 있었다. 또한 약 일주일 간격을 두고 반복하여 측정한 데이터와 운동을 통해 심박수가 변화된 데이터의 적용을 통해서 심탄도를 이용한 생체인식 방법의 재현성을 확인할 수 있었다.Ballistocardiogram (BCG) is a recording of body movement, which is generated in synchronous with the heartbeats. Studies on BCG were a field of intense research in the past decades, since it could provide a non-invasive means to monitor cardiovascular activities. However, such interests have slowly diminished after 1970s due to its impractical characteristics compared to the new technologies (i.e. echocardiography) that diagnose cardiovascular system. Studies on BCG are now on its resurgence era, with advent of new sensors, microprocessor, and the signal processing techniques. Notable differences of todays BCG researches, compared to the past ones, are on the emergence of non-diagnostic applications of BCG. Sleep analysis, heartbeat detection and the estimation of pre-ejection time are the few examples of BCG applications that were previously non-existent. Despite these advancements, however, practical usage of BCG has yet to become reality. One reason for this is in its difficulties in instrumentation. In a number of researches, BCGs are often recorded with a sensor attached to bulky objects, for example bed or chair. Also, a synchronously measured electrocardiogram (ECG) is required for the accurate analysis of BCG, therefore, increases the system complexity. Morphological variability of BCG is another limiting factor. Waveforms of BCG are reported to vary among subjects and even in a same person. Such characteristics of BCG impose difficulties in its consistent interpretation and in drawing meaningful information. In this dissertation, we first propose a sensor, namely BE-patch, which can record both the BCG and ECG using a ferro-electret film. As the sensor is thin and flexible and features reduced complexity, it suits for wearable applications in terms both of user compliance and power consumption. The fabrication method of BE-patch and its application in blood pressure estimation is reported in Chapter 2. Using the time delay of R-peak of ECG and J-peak of BCG (so-called, R-J interval), which showed the negative relationship with changes in blood pressure, the beat-by-beat systolic blood pressure (SBP) is estimated. The mean error of the estimated SBP and its standard deviation were ?0.16 and 4.12 mm Hg, respectively and their performance met both the Association for the Advancement of Medical Instrumentation and the British Hypertension Society guidelines. In Chapter 3, the variable aspect of BCG is re-analyzed to develop a biometric application. Waveforms of BCG were described using features and their variability was separated to the inter-individual and the intra-individual variations by applying supervised learning algorithms. The result showed the potential utility of BCG as biometric signal, by achieving identification accuracy of 90.20% using only a cycle of BCG. Then identification increased to 98% when multiple beats were used, and reproducible with time and changes in heart-rates. In Chapter 4, the thesis work is summarized, and future directions to further develop the proposed sensor and applications are discussed.Abstract i List of Tables v List of Figures vi 1. Introduction １ 1.1. History of BCG Research １ 1.2. Recent Advances ７ 1.3. Goal of Thesis Work ９ 2. Blood Pressure Estimation １３ 2.1. Introduction １３ 2.2. Principles of BP Estimation １６ 2.3. Methods ２１ 2.4. Results and Discussions ２６ 2.5. Conclusion ２８ 3. Biometric Application ２９ 3.1. Introduction ２９ 3.2. Methods ３９ 3.3. Results and Discussions ４８ 3.4. Conclusion ５６ 4. Conclusions and Discussions ５７ Bibliography ６５ 국문초록 ７１Docto

Development of a bed-based nighttime monitoring toolset

Doctor of PhilosophyDepartment of Electrical and Computer EngineeringSteven WarrenA movement is occurring within the healthcare field towards evidence-based or preventative care-based medicine, which requires personalized monitoring solutions. For medical technologies to fit within this framework, they need to adapt. Reduced cost of operation, ease-of-use, durability, and acceptance will be critical design considerations that will determine their success. Wearable technologies have shown the capability to monitor physiological signals at a reduced cost, but they require consistent effort from the user. Innovative unobtrusive and autonomous monitoring technologies will be needed to make personalized healthcare a reality. Ballistocardiography, a nearly forgotten field, has reemerged as a promising alternative for unobtrusive physiological monitoring. Heart rate, heart rate variability, respiration rate, movement, and additional hemodynamic features can be estimated from the ballistocardiogram (BCG). This dissertation presents a bed-based nighttime monitoring toolset designed to monitor BCG, respiration, and movement data motivated by the need to quantify the sleep of children with severe disabilities and autism – a capability currently unmet by commercial systems. A review of ballistocardiography instrumentation techniques (Chapter 2) is presented to 1) build an understanding of how the forces generated by the heart are coupled to the measurement apparatus and 2) provide a background of the field. The choice of sensing modalities and acquisition hardware and software for developing the unobtrusive bed-based nighttime monitoring platform is outlined in Chapters 3 and 4. Preliminary results illustrating the system’s ability to track physiological signals are presented in Chapter 5. Analyses were conducted on overnight data acquired from three lower-functioning children with autism (Chapters 6 and 9) who reside at Heartspring, Wichita, KS, where results justified the platform’s multi-sensor architecture and demonstrated the system’s ability to track physiological signals from this sensitive population over many months. Further, this dissertation presents novel BCG signal processing techniques – a signal quality index (Chapter 7) and a preprocessing inverse filter (Chapter 8) that are applicable to any ballistocardiograph. The bed-based nighttime monitoring toolset outlined in this dissertation presents an unobtrusive, autonomous, robust physiological monitoring system that could be used in hospital-based or personalized, home-based medical applications that consist of short or long-term monitoring scenarios

Advanced Signal Processing in Wearable Sensors for Health Monitoring

Smart, wearables devices on a miniature scale are becoming increasingly widely available, typically in the form of smart watches and other connected devices. Consequently, devices to assist in measurements such as electroencephalography (EEG), electrocardiogram (ECG), electromyography (EMG), blood pressure (BP), photoplethysmography (PPG), heart rhythm, respiration rate, apnoea, and motion detection are becoming more available, and play a significant role in healthcare monitoring. The industry is placing great emphasis on making these devices and technologies available on smart devices such as phones and watches. Such measurements are clinically and scientifically useful for real-time monitoring, long-term care, and diagnosis and therapeutic techniques. However, a pertaining issue is that recorded data are usually noisy, contain many artefacts, and are affected by external factors such as movements and physical conditions. In order to obtain accurate and meaningful indicators, the signal has to be processed and conditioned such that the measurements are accurate and free from noise and disturbances. In this context, many researchers have utilized recent technological advances in wearable sensors and signal processing to develop smart and accurate wearable devices for clinical applications. The processing and analysis of physiological signals is a key issue for these smart wearable devices. Consequently, ongoing work in this field of study includes research on filtration, quality checking, signal transformation and decomposition, feature extraction and, most recently, machine learning-based methods

Physiological Information Analysis Using Unobtrusive Sensors: BCG from Load-Cell Based Infants' Bed and ECG from Patch Electrode

학위논문 (박사)-- 서울대학교 대학원 : 바이오엔지니어링전공, 2016. 8. 박광석.The aging population, chronic diseases, and infectious diseases are major challenges for our current healthcare system. To address these unmet healthcare needs, especially for the early prediction and treatment of major diseases, acquiring physiological information of different types has emerged as a promising interdisciplinary research area. Unobtrusive sensing techniques are instrumental in constructing a routine health management system, because they can be incorporated in daily life without confining individuals or causing any discomfort. This dissertation is dedicated to summarizing our research on monitoring of cardiorespiratory activities by means of unobtrusive sensing methods. Ballistocardiography and electrocardiography, which record the activity of the cardiorespiratory system with respect to mechanical or electrical characteristics, are both being actively investigated as important physiological signal measurement that provide the information required to monitor human health states. This research was carried out to evaluate the feasibility of new application methods of unobtrusive sensing that not been investigated significantly in previous investigations. We also tried to incorporate improvement essential for bringing these technologies to practical use. Our first device is a non-confining system for monitoring the physiological information of infants using ballistocardiography technology. Techniques to observe continuous biological signals without confinement may be even more important for infants since they could be used effectively to detect respiratory distress and cardiac abnormalities. We also expect to find extensive applications in the field of sleep research for analyzing sleep efficiency and sleep patterns of infants. Specifically, the sleep of infants is closely related to their health, growth, and development. Children who experience abnormal sleep and activity rhythms during their early infantile period are more prone to developing sleep-related disorders in late childhood, which are also more difficult to overcome. Therefore, studying their sleep characteristics is extremely important. Although ballistocardiography technology seems to represent a possible solution to overcome the limitations of conventional physiological signal monitoring, most studies investigating the application of these methods have focused on adults, and few have been focused on infants. To verify the usefulness of ballistocardiogram (BCG)-based physiological measurement in infants, we describe a load-cell based signal monitoring bed and assess an algorithm to estimate heartbeat and respiratory information. Four infants participated in 13 experiments. As a reference signal, electrocardiogram (ECG) and respiration signals were simultaneously measured using a commercial device. The proposed automatic algorithm then selected the optimal sensor from which to estimate the heartbeat and respiratory information. The results from the load-cell sensor signals were compared with those of the reference signals, and the heartbeat and respiratory information were found to have average performance errors of 2.55% and 2.66%, respectively. We believe that our experimental results verify the feasibility of BCG-based measurements in infants. Next, we developed a small, light, ECG monitoring device with enhanced portability and wearability, with software that contains a peak detection algorithm for analyzing heart rate variability (HRV). A mobile ECG monitoring system, which can assess an individuals condition efficiently during daily life activities, could be beneficial for management of their health care. A portable ECG monitoring patch with a minimized electrode array pad, easily attached to a persons chest, was developed. To validate the devices performance and efficacy, signal quality analysis in terms of robustness under motion, and HRV results obtained under stressful conditions were assessed by comparing the developed device with a commercially available ECG device. The R-peak detection results obtained with the device exhibited a sensitivity of 99.29%, a positive predictive value of 100.00%, and an error of 0.71%. The device also exhibited less motional noise than conventional ECG recording, being stable up to a walking speed of 5 km/h. When applied to mental stress analysis, the device evaluated the variation in HRV parameters in the same way as a reference ECG signal, with very little difference. Thus, our portable ECG device with its integrated minimized electrode patch carries promise as a form of ECG measurement technology that can be used for daily health monitoring. There is currently an increased demand for continuous health monitoring systems with unobtrusive sensors. All of the experimental results in this dissertation verify the feasibility of our unobtrusive cardiorespiratory activity monitoring system. We believe that the proposed device and algorithm presented here are essential prerequisites toward substantiating the utility of unobtrusive physiological measurements. We also expect this system can help users better understand their state of health and provide physicians with more reliable data for objective diagnosis.Chapter 1. Introduction 1 1.1. Cardiorespiratory signal and its related physiological information 2 1.1.1. Electrocardiogram 2 1.1.2. Ballistocardiogram 3 1.1.3. Respiration 4 1.1.4. Heart rate and breathing rate 5 1.1.5. Variability analysis of heart and respiratory rate 5 1.2. Unobtrusive sensing methods for continuous physiological monitoring 6 1.3. Outline of the dissertation 9 Chapter 2. Development of sensor device for unobtrusive physiological signal measurement 13 2.1. Unobtrusive BCG measurement device for infants health monitoring 13 2.1.1. Specifications of the device 17 2.1.2. Signal processing in hardware 18 2.1.3. Performance of the device 21 2.2. Unobtrusive ECG measurement device for health monitoring in daily life 25 2.2.1. Specifications of the device 26 2.2.2. Signal processing in hardware 28 2.2.3. Performance of the device 30 Chapter 3. Development of algorithm for physiological information analysis from unobtrusively measured signal 35 3.1. Algorithm for automatically analyzing unobtrusively measured BCG signal 35 3.1.1. Process flow of the algorithm 36 3.1.2. Performance evaluation 47 3.2. Algorithm for automatically analyzing unobtrusively measured ECG signal 57 3.2.1. Process flow of the algorithm 57 3.2.2. Performance evaluation 60 3.3. HRV analysis for processing unobtrusively measured signals 63 3.3.1. Optimum HRV algorithm selection in data missing simulation 64 3.3.2. Stress assessment using HRV parameters 67 Chapter 4. Discussion 71 Chapter 5. Conclusion 79 Reference 81 Abstract in Korean 89 Appendix 93Docto

Continuous Cardiorespiratory Monitoring Using Ballistocardiography From Load Cells Embedded in a Hospital Bed

The objective of this research is to explore signal processing and machine learning techniques to allow continuous monitoring of cardiorespiratory parameters using the ballistocardiogram (BCG) signals recorded with sensors embedded in a hospital bed. First, the heart rate (HR) estimation algorithms were presented. The first is signal processing-based HR estimation with array processing for multi-channel combination. The second uses a deep learning (DL) model that transforms BCG signals into an interpretable triangular waveform, from which heartbeat locations can be estimated. Second part of the work focuses on estimating respiratory rate (RR) and respiratory volume (RV) using the respiration waveforms derived from the low-frequency components of the load cell signals. Lastly, this work presents two models for blood pressure (BP) estimation -- 1) Conventional pulse transit time (PTT)-based model and 2) DL-based model, both using multi-channel BCG and the photoplethysmogram (PPG) signals to extract features. Overall, this work established methods to enable non-invasive and continuous monitoring of standard vital signs utilizing the sensors already embedded in commonly-deployed commercially available hospital beds. Such technologies could potentially improve the continuous assessment of the patients' physiologic state without adding an extra burden on the caregivers.Ph.D

Sensores de fibra ótica para arquiteturas e-Health

In this work, optical fiber sensors were developed and optimized for biomedical applications in wearable and non-intrusive and/or invisible solutions. As it was intended that the developed devices would not interfere with the user's movements and their daily life, the fibre optic sensors presented several advantages when compared to conventional electronic sensors, among others, the following stand out: size and reduced weight, biocompatibility, safety, immunity to electromagnetic interference and high sensitivity. In a first step, wearable devices with fibre optic sensors based in Fiber Bragg gratings (FBG) were developed to be incorporated into insoles to monitor different walking parameters based on the analysis of the pressure exerted on several areas of the insole. Still within this theme, other sensors were developed using the same sensing technology, but capable of monitoring pressure and shear forces simultaneously. This work was pioneering and allowed monitoring one of the main causes of foot ulceration in people with diabetes: shear. At a later stage, the study focused on the issue related with the appearance of ulcers in people with reduced mobility and wheelchair users. In order to contribute to the mitigation of this scourge, a system was developed composed of a network of fibre optic sensors capable of monitoring the pressure at various points of the wheelchair. It not only measures the pressure at each point, but also monitors the posture of the wheelchair user and advises him/her to change posture regularly to reduce the probability of this pathology occurring. Still within this application, another work was developed where the sensor not only monitored the pressure but also the temperature in each of the analysis points, thus indirectly measuring shear. In another phase, plastic fibre optic sensors were studied and developed to monitor the body posture of an office chair user. Simultaneously, software was developed capable of monitoring and showing the user all the acquired data in real time and warning for incorrect postures, as well as advising for work breaks. In a fourth phase, the study focused on the development of highly sensitive sensors embedded in materials printed by a 3D printer. The sensor was composed of an optical fibre with a FBG and the sensor body of a flexible polymeric material called "Flexible". This material was printed on a 3D printer and during its printing the optical fibre was incorporated. The sensor proved to be highly sensitive and was able to monitor respiratory and cardiac rate, both in wearable solutions (chest and wrist) and in "invisible" solutions (office chair).Neste trabalho foram desenvolvidos e otimizados sensores em fibra ótica para aplicações biomédicas em soluções vestíveis e não intrusivas/ou invisíveis. Tendo em conta que se pretende que os dispositivos desenvolvidos não interfiram com os movimentos e o dia-a-dia do utilizador, os sensores de fibra ótica apresentam inúmeras vantagens quando comparados com os sensores eletrónicos convencionais, de entre várias, destacam-se: tamanho e peso reduzido, biocompatibilidade, segurança, imunidade a interferências eletromagnéticas e elevada sensibilidade. Numa primeira etapa, foram desenvolvidos dispositivos vestíveis com sensores de fibra ótica baseados em redes de Bragg (FBG) para incorporar em palmilhas de modo a monitorizar diferentes parâmetros da marcha com base na análise da pressão exercida em várias zonas da palmilha. Ainda no âmbito deste tema, adicionalmente, foram desenvolvidos sensores utilizando a mesma tecnologia de sensoriamento, mas capazes de monitorizar simultaneamente pressão e forças de cisalhamento. Este trabalho foi pioneiro e permitiu monitorizar um dos principais responsáveis pela ulceração dos pés em pessoas com diabetes: o cisalhamento. Numa fase posterior, o estudo centrou-se na temática relacionada com o aparecimento de úlceras em pessoas com mobilidade reduzida e utilizadores de cadeiras de rodas. De modo a contribuir para a mitigação deste flagelo, procurou-se desenvolver um sistema composto por uma rede de sensores de fibra ótica capaz de monitorizar a pressão em vários pontos de uma cadeira de rodas e não só aferir a pressão em cada ponto, mas monitorizar a postura do cadeirante e aconselhá-lo a mudar de postura com regularidade, de modo a diminuir a probabilidade de ocorrência desta patologia. Ainda dentro desta aplicação, foi publicado um outro trabalho onde o sensor não só monitoriza a pressão como também a temperatura em cada um dos pontos de análise, conseguindo aferir assim indiretamente o cisalhamento. Numa outra fase, foi realizado o estudo e desenvolvimento de sensores de fibra ótica de plástico para monitorizar a postura corporal de um utilizador de uma cadeira de escritório. Simultaneamente, foi desenvolvido um software capaz de monitorizar e mostrar ao utilizador todos os dados adquiridos em tempo real e advertir o utilizador de posturas incorretas, bem como aconselhar para pausas no trabalho. Numa quarta fase, o estudo centrou-se no desenvolvimento de sensores altamente sensíveis embebidos em materiais impressos 3D. O sensor é composto por uma fibra ótica com uma FBG e o corpo do sensor por um material polimérico flexível, denominado “Flexible”. O sensor foi impresso numa impressora 3D e durante a sua impressão foi incorporada a fibra ótica. O sensor demonstrou ser altamente sensível e foi capaz de monitorizar frequência respiratória e cardíaca, tanto em soluções vestíveis (peito e pulso) como em soluções “invisíveis” (cadeira de escritório).Programa Doutoral em Engenharia Físic

DICOM for EIT

With EIT starting to be used in routine clinical practice [1], it important that the clinically relevant information is portable between hospital data management systems. DICOM formats are widely used clinically and cover many imaging modalities, though not specifically EIT. We describe how existing DICOM specifications, can be repurposed as an interim solution, and basis from which a consensus EIT DICOM ‘Supplement’ (an extension to the standard) can be writte

Estimation of thorax shape for forward modelling in lungs EIT

The thorax models for pre-term babies are developed based on the CT scans from new-borns and their effect on image reconstruction is evaluated in comparison with other available models

Rapid generation of subject-specific thorax forward models

For real-time monitoring of lung function using accurate patient geometry, shape information needs to be acquired and a forward model generated rapidly. This paper shows that warping a cylindrical model to an acquired shape results in meshes of acceptable mesh quality, in terms of stretch and aspect ratio