Remote Assessment of the Cardiovascular Function Using Camera-Based Photoplethysmography

Camera-based photoplethysmography (cbPPG) is a novel measurement technique that allows the continuous monitoring of vital signs by using common video cameras. In the last decade, the technology has attracted a lot of attention as it is easy to set up, operates remotely, and offers new diagnostic opportunities. Despite the growing interest, cbPPG is not completely established yet and is still primarily the object of research. There are a variety of reasons for this lack of development including that reliable and autonomous hardware setups are missing, that robust processing algorithms are needed, that application fields are still limited, and that it is not completely understood which physiological factors impact the captured signal. In this thesis, these issues will be addressed. A new and innovative measuring system for cbPPG was developed. In the course of three large studies conducted in clinical and non-clinical environments, the system’s great flexibility, autonomy, user-friendliness, and integrability could be successfully proven. Furthermore, it was investigated what value optical polarization filtration adds to cbPPG. The results show that a perpendicular filter setting can significantly enhance the signal quality. In addition, the performed analyses were used to draw conclusions about the origin of cbPPG signals: Blood volume changes are most likely the defining element for the signal's modulation. Besides the hardware-related topics, the software topic was addressed. A new method for the selection of regions of interest (ROIs) in cbPPG videos was developed. Choosing valid ROIs is one of the most important steps in the processing chain of cbPPG software. The new method has the advantage of being fully automated, more independent, and universally applicable. Moreover, it suppresses ballistocardiographic artifacts by utilizing a level-set-based approach. The suitability of the ROI selection method was demonstrated on a large and challenging data set. In the last part of the work, a potentially new application field for cbPPG was explored. It was investigated how cbPPG can be used to assess autonomic reactions of the nervous system at the cutaneous vasculature. The results show that changes in the vasomotor tone, i.e. vasodilation and vasoconstriction, reflect in the pulsation strength of cbPPG signals. These characteristics also shed more light on the origin problem. Similar to the polarization analyses, they support the classic blood volume theory. In conclusion, this thesis tackles relevant issues regarding the application of cbPPG. The proposed solutions pave the way for cbPPG to become an established and widely accepted technology

The military applications of near infrared spectroscopy in trauma

This work examines tissue oxygenation (StO2), as measured by near infrared spectroscopy (NIRS), as tool for assessing trauma patients, with particular emphasis on its use in the deployed military environment. Resting StO2 values were examined and found to vary significantly between monitoring sites. Exercise was associated with a significant increase in StO2. Comparing the sensitivities of different NIRS monitoring sites in detecting simulated hypovolaemia, the forearm and deltoid were found be the most sensitive sites. The thenar eminence and brain were not sensitive to mild degrees of hypovolaemia. The administration of morphine was found to attenuate the StO2 response to hypovolaemia at all sites. In a porcine trauma model changes in StO2 recorded from both injured and uninjured muscle sites phase led those of base excess and lactate by 31–37 minutes, and demonstrate that injured monitoring sites can be used to accurately track patients’ response to resuscitation. In the deployed military setting NIRS was found to be a robust, easy to use technique for the initial assessment of patients. Although StO2 was not demonstrable superior to a combination of pulse rate and blood pressure it has several practical advantages that make it a useful adjunct to contemporary trauma care

Spatial and temporal integration of binocular disparity in the primate brain

Le système visuel du primate s'appuie sur les légères différences entre les deux projections rétiniennes pour percevoir la profondeur. Cependant, on ne sait pas exactement comment ces disparités binoculaires sont traitées et intégrées par le système nerveux. D'un côté, des enregistrements unitaires chez le macaque permettent d'avoir accès au codage neuronal de la disparité à un niveau local. De l'autre côté, la neuroimagerie fonctionnelle (IRMf) chez l'humain met en lumière les réseaux corticaux impliqués dans le traitement de la disparité à un niveau macroscopique mais chez une espèce différente. Dans le cadre de cette thèse, nous proposons d'utiliser la technique de l'IRMf chez le macaque pour permettre de faire le lien entre les enregistrements unitaires chez le macaque et les enregistrements IRMf chez l'humain. Cela, afin de pouvoir faire des comparaisons directes entre les deux espèces. Plus spécifiquement, nous nous sommes intéressés au traitement spatial et temporal des disparités binoculaires au niveau cortical mais aussi au niveau perceptif. En étudiant l'activité corticale en réponse au mouvement tridimensionnel (3D), nous avons pu montrer pour la première fois 1) qu'il existe un réseau dédié chez le macaque qui contient des aires allant au-delà du cluster MT et des aires environnantes et 2) qu'il y a des homologies avec le réseau trouvé chez l'humain en réponse à des stimuli similaires. Dans une deuxième étude, nous avons tenté d'établir un lien entre les biais perceptifs qui reflètent les régularités statistiques 3D ans l'environnement visuel et l'activité corticale. Nous nous sommes demandés si de tels biais existent et peuvent être reliés à des réponses spécifiques au niveau macroscopique. Nous avons trouvé de plus fortes activations pour le stimulus reflétant les statistiques naturelles chez un sujet, démontrant ainsi une possible influence des régularités spatiales sur l'activité corticale. Des analyses supplémentaires sont cependant nécessaires pour conclure de façon définitive. Néanmoins, nous avons pu confirmer de façon robuste l'existence d'un vaste réseau cortical répondant aux disparités corrélées chez le macaque. Pour finir, nous avons pu mesurer pour la première fois les points rétiniens correspondants au niveau du méridien vertical chez un sujet macaque qui réalisait une tâche comportementale (procédure à choix forcé). Nous avons pu comparer les résultats obtenus avec des données également collectées chez des participants humains avec le même protocole. Dans les différentes sections de discussion, nous montrons comment nos différents résultats ouvrent la voie à de nouvelles perspectives.The primate visual system strongly relies on the small differences between the two retinal projections to perceive depth. However, it is not fully understood how those binocular disparities are computed and integrated by the nervous system. On the one hand, single-unit recordings in macaque give access to neuronal encoding of disparity at a very local level. On the other hand, functional neuroimaging (fMRI) studies in human shed light on the cortical networks involved in disparity processing at a macroscopic level but with a different species. In this thesis, we propose to use an fMRI approach in macaque to bridge the gap between single-unit and fMRI recordings conducted in the non-human and human primate brain, respectively, by allowing direct comparisons between the two species. More specifically, we focused on the temporal and spatial processing of binocular disparities at the cortical but also at the perceptual level. Investigating cortical activity in response to motion-in-depth, we could show for the first time that 1) there is a dedicated network in macaque that comprises areas beyond the MT cluster and its surroundings and that 2) there are homologies with the human network involved in processing very similar stimuli. In a second study, we tried to establish a link between perceptual biases that reflect statistical regularities in the three-dimensional visual environment and cortical activity, by investigating whether such biases exist and can be related to specific responses at a macroscopic level. We found stronger activity for the stimulus reflecting natural statistics in one subject, demonstrating a potential influence of spatial regularities on the cortical activity. Further work is needed to firmly conclude about such a link. Nonetheless, we robustly confirmed the existence of a vast cortical network responding to correlated disparities in the macaque brain. Finally, we could measure for the first time retinal corresponding points on the vertical meridian of a macaque subject performing a behavioural task (forced-choice procedure) and compare it to the data we also collected in several human observers with the very same protocol. In the discussion sections, we showed how these findings open the door to varied perspectives

Investigation expérimentale des contraintes hémodynamiques d'un fantôme d'artère sténosée

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal

Extraction and Detection of Fetal Electrocardiograms from Abdominal Recordings

The non-invasive fetal ECG (NIFECG), derived from abdominal surface electrodes, offers novel diagnostic possibilities for prenatal medicine. Despite its straightforward applicability, NIFECG signals are usually corrupted by many interfering sources. Most significantly, by the maternal ECG (MECG), whose amplitude usually exceeds that of the fetal ECG (FECG) by multiple times. The presence of additional noise sources (e.g. muscular/uterine noise, electrode motion, etc.) further affects the signal-to-noise ratio (SNR) of the FECG. These interfering sources, which typically show a strong non-stationary behavior, render the FECG extraction and fetal QRS (FQRS) detection demanding signal processing tasks. In this thesis, several of the challenges regarding NIFECG signal analysis were addressed. In order to improve NIFECG extraction, the dynamic model of a Kalman filter approach was extended, thus, providing a more adequate representation of the mixture of FECG, MECG, and noise. In addition, aiming at the FECG signal quality assessment, novel metrics were proposed and evaluated. Further, these quality metrics were applied in improving FQRS detection and fetal heart rate estimation based on an innovative evolutionary algorithm and Kalman filtering signal fusion, respectively. The elaborated methods were characterized in depth using both simulated and clinical data, produced throughout this thesis. To stress-test extraction algorithms under ideal circumstances, a comprehensive benchmark protocol was created and contributed to an extensively improved NIFECG simulation toolbox. The developed toolbox and a large simulated dataset were released under an open-source license, allowing researchers to compare results in a reproducible manner. Furthermore, to validate the developed approaches under more realistic and challenging situations, a clinical trial was performed in collaboration with the University Hospital of Leipzig. Aside from serving as a test set for the developed algorithms, the clinical trial enabled an exploratory research. This enables a better understanding about the pathophysiological variables and measurement setup configurations that lead to changes in the abdominal signal's SNR. With such broad scope, this dissertation addresses many of the current aspects of NIFECG analysis and provides future suggestions to establish NIFECG in clinical settings.:Abstract Acknowledgment Contents List of Figures List of Tables List of Abbreviations List of Symbols (1)Introduction 1.1)Background and Motivation 1.2)Aim of this Work 1.3)Dissertation Outline 1.4)Collaborators and Conflicts of Interest (2)Clinical Background 2.1)Physiology 2.1.1)Changes in the maternal circulatory system 2.1.2)Intrauterine structures and feto-maternal connection 2.1.3)Fetal growth and presentation 2.1.4)Fetal circulatory system 2.1.5)Fetal autonomic nervous system 2.1.6)Fetal heart activity and underlying factors 2.2)Pathology 2.2.1)Premature rupture of membrane 2.2.2)Intrauterine growth restriction 2.2.3)Fetal anemia 2.3)Interpretation of Fetal Heart Activity 2.3.1)Summary of clinical studies on FHR/FHRV 2.3.2)Summary of studies on heart conduction 2.4)Chapter Summary (3)Technical State of the Art 3.1)Prenatal Diagnostic and Measuring Technique 3.1.1)Fetal heart monitoring 3.1.2)Related metrics 3.2)Non-Invasive Fetal ECG Acquisition 3.2.1)Overview 3.2.2)Commercial equipment 3.2.3)Electrode configurations 3.2.4)Available NIFECG databases 3.2.5)Validity and usability of the non-invasive fetal ECG 3.3)Non-Invasive Fetal ECG Extraction Methods 3.3.1)Overview on the non-invasive fetal ECG extraction methods 3.3.2)Kalman filtering basics 3.3.3)Nonlinear Kalman filtering 3.3.4)Extended Kalman filter for FECG estimation 3.4)Fetal QRS Detection 3.4.1)Merging multichannel fetal QRS detections 3.4.2)Detection performance 3.5)Fetal Heart Rate Estimation 3.5.1)Preprocessing the fetal heart rate 3.5.2)Fetal heart rate statistics 3.6)Fetal ECG Morphological Analysis 3.7)Problem Description 3.8)Chapter Summary (4)Novel Approaches for Fetal ECG Analysis 4.1)Preliminary Considerations 4.2)Fetal ECG Extraction by means of Kalman Filtering 4.2.1)Optimized Gaussian approximation 4.2.2)Time-varying covariance matrices 4.2.3)Extended Kalman filter with unknown inputs 4.2.4)Filter calibration 4.3)Accurate Fetal QRS and Heart Rate Detection 4.3.1)Multichannel evolutionary QRS correction 4.3.2)Multichannel fetal heart rate estimation using Kalman filters 4.4)Chapter Summary (5)Data Material 5.1)Simulated Data 5.1.1)The FECG Synthetic Generator (FECGSYN) 5.1.2)The FECG Synthetic Database (FECGSYNDB) 5.2)Clinical Data 5.2.1)Clinical NIFECG recording 5.2.2)Scope and limitations of this study 5.2.3)Data annotation: signal quality and fetal amplitude 5.2.4)Data annotation: fetal QRS annotation 5.3)Chapter Summary (6)Results for Data Analysis 6.1)Simulated Data 6.1.1)Fetal QRS detection 6.1.2)Morphological analysis 6.2)Own Clinical Data 6.2.1)FQRS correction using the evolutionary algorithm 6.2.2)FHR correction by means of Kalman filtering (7)Discussion and Prospective 7.1)Data Availability 7.1.1)New measurement protocol 7.2)Signal Quality 7.3)Extraction Methods 7.4)FQRS and FHR Correction Algorithms (8)Conclusion References (A)Appendix A - Signal Quality Annotation (B)Appendix B - Fetal QRS Annotation (C)Appendix C - Data Recording GU