Multidimensional embedded MEMS motion detectors for wearable mechanocardiography and 4D medical imaging

Background: Cardiovascular diseases are the number one cause of death. Of these deaths, almost 80% are due to coronary artery disease (CAD) and cerebrovascular disease. Multidimensional microelectromechanical systems (MEMS) sensors allow measuring the mechanical movement of the heart muscle offering an entirely new and innovative solution to evaluate cardiac rhythm and function. Recent advances in miniaturized motion sensors present an exciting opportunity to study novel device-driven and functional motion detection systems in the areas of both cardiac monitoring and biomedical imaging, for example, in computed tomography (CT) and positron emission tomography (PET). Methods: This Ph.D. work describes a new cardiac motion detection paradigm and measurement technology based on multimodal measuring tools — by tracking the heart’s kinetic activity using micro-sized MEMS sensors — and novel computational approaches — by deploying signal processing and machine learning techniques—for detecting cardiac pathological disorders. In particular, this study focuses on the capability of joint gyrocardiography (GCG) and seismocardiography (SCG) techniques that constitute the mechanocardiography (MCG) concept representing the mechanical characteristics of the cardiac precordial surface vibrations. Results: Experimental analyses showed that integrating multisource sensory data resulted in precise estimation of heart rate with an accuracy of 99% (healthy, n=29), detection of heart arrhythmia (n=435) with an accuracy of 95-97%, ischemic disease indication with approximately 75% accuracy (n=22), as well as significantly improved quality of four-dimensional (4D) cardiac PET images by eliminating motion related inaccuracies using MEMS dual gating approach. Tissue Doppler imaging (TDI) analysis of GCG (healthy, n=9) showed promising results for measuring the cardiac timing intervals and myocardial deformation changes. Conclusion: The findings of this study demonstrate clinical potential of MEMS motion sensors in cardiology that may facilitate in time diagnosis of cardiac abnormalities. Multidimensional MCG can effectively contribute to detecting atrial fibrillation (AFib), myocardial infarction (MI), and CAD. Additionally, MEMS motion sensing improves the reliability and quality of cardiac PET imaging.Moniulotteisten sulautettujen MEMS-liiketunnistimien käyttö sydänkardiografiassa sekä lääketieteellisessä 4D-kuvantamisessa Tausta: Sydän- ja verisuonitaudit ovat yleisin kuolinsyy. Näistä kuolemantapauksista lähes 80% johtuu sepelvaltimotaudista (CAD) ja aivoverenkierron häiriöistä. Moniulotteiset mikroelektromekaaniset järjestelmät (MEMS) mahdollistavat sydänlihaksen mekaanisen liikkeen mittaamisen, mikä puolestaan tarjoaa täysin uudenlaisen ja innovatiivisen ratkaisun sydämen rytmin ja toiminnan arvioimiseksi. Viimeaikaiset teknologiset edistysaskeleet mahdollistavat uusien pienikokoisten liiketunnistusjärjestelmien käyttämisen sydämen toiminnan tutkimuksessa sekä lääketieteellisen kuvantamisen, kuten esimerkiksi tietokonetomografian (CT) ja positroniemissiotomografian (PET), tarkkuuden parantamisessa. Menetelmät: Tämä väitöskirjatyö esittelee uuden sydämen kineettisen toiminnan mittaustekniikan, joka pohjautuu MEMS-anturien käyttöön. Uudet laskennalliset lähestymistavat, jotka perustuvat signaalinkäsittelyyn ja koneoppimiseen, mahdollistavat sydämen patologisten häiriöiden havaitsemisen MEMS-antureista saatavista signaaleista. Tässä tutkimuksessa keskitytään erityisesti mekanokardiografiaan (MCG), joihin kuuluvat gyrokardiografia (GCG) ja seismokardiografia (SCG). Näiden tekniikoiden avulla voidaan mitata kardiorespiratorisen järjestelmän mekaanisia ominaisuuksia. Tulokset: Kokeelliset analyysit osoittivat, että integroimalla usean sensorin dataa voidaan mitata syketiheyttä 99% (terveillä n=29) tarkkuudella, havaita sydämen rytmihäiriöt (n=435) 95-97%, tarkkuudella, sekä havaita iskeeminen sairaus noin 75% tarkkuudella (n=22). Lisäksi MEMS-kaksoistahdistuksen avulla voidaan parantaa sydämen 4D PET-kuvan laatua, kun liikeepätarkkuudet voidaan eliminoida paremmin. Doppler-kuvantamisessa (TDI, Tissue Doppler Imaging) GCG-analyysi (terveillä, n=9) osoitti lupaavia tuloksia sydänsykkeen ajoituksen ja intervallien sekä sydänlihasmuutosten mittaamisessa. Päätelmä: Tämän tutkimuksen tulokset osoittavat, että kardiologisilla MEMS-liikeantureilla on kliinistä potentiaalia sydämen toiminnallisten poikkeavuuksien diagnostisoinnissa. Moniuloitteinen MCG voi edistää eteisvärinän (AFib), sydäninfarktin (MI) ja CAD:n havaitsemista. Lisäksi MEMS-liiketunnistus parantaa sydämen PET-kuvantamisen luotettavuutta ja laatua

Acoustic sensing as a novel approach for cardiovascular monitoring at the wrist

Cardiovascular diseases are the number one cause of deaths globally. An increased cardiovascular risk can be detected by a regular monitoring of the vital signs including the heart rate, the heart rate variability (HRV) and the blood pressure. For a user to undergo continuous vital sign monitoring, wearable systems prove to be very useful as the device can be integrated into the user's lifestyle without affecting the daily activities. However, the main challenge associated with the monitoring of these cardiovascular parameters is the requirement of different sensing mechanisms at different measurement sites. There is not a single wearable device that can provide sufficient physiological information to track the vital signs from a single site on the body. This thesis proposes a novel concept of using acoustic sensing over the radial artery to extract cardiac parameters for vital sign monitoring. A wearable system consisting of a microphone is designed to allow the detection of the heart sounds together with the pulse wave, an attribute not possible with existing wrist-based sensing methods. Methods: The acoustic signals recorded from the radial artery are a continuous reflection of the instantaneous cardiac activity. These signals are studied and characterised using different algorithms to extract cardiovascular parameters. The validity of the proposed principle is firstly demonstrated using a novel algorithm to extract the heart rate from these signals. The algorithm utilises the power spectral analysis of the acoustic pulse signal to detect the S1 sounds and additionally, the K-means method to remove motion artifacts for an accurate heartbeat detection. The HRV in the short-term acoustic recordings is found by extracting the S1 events using the relative information between the short- and long-term energies of the signal. The S1 events are localised using three different characteristic points and the best representation is found by comparing the instantaneous heart rate profiles. The possibility of measuring the blood pressure using the wearable device is shown by recording the acoustic signal under the influence of external pressure applied on the arterial branch. The temporal and spectral characteristics of the acoustic signal are utilised to extract the feature signals and obtain a relationship with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively. Results: This thesis proposes three different algorithms to find the heart rate, the HRV and the SBP/ DBP readings from the acoustic signals recorded at the wrist. The results obtained by each algorithm are as follows: 1. The heart rate algorithm is validated on a dataset consisting of 12 subjects with a data length of 6 hours. The results demonstrate an accuracy of 98.78%, mean absolute error of 0.28 bpm, limits of agreement between -1.68 and 1.69 bpm, and a correlation coefficient of 0.998 with reference to a state-of-the-art PPG-based commercial device. A high statistical agreement between the heart rate obtained from the acoustic signal and the photoplethysmography (PPG) signal is observed. 2. The HRV algorithm is validated on the short-term acoustic signals of 5-minutes duration recorded from each of the 12 subjects. A comparison is established with the simultaneously recorded electrocardiography (ECG) and PPG signals respectively. The instantaneous heart rate for all the subjects combined together achieves an accuracy of 98.50% and 98.96% with respect to the ECG and PPG signals respectively. The results for the time-domain and frequency-domain HRV parameters also demonstrate high statistical agreement with the ECG and PPG signals respectively. 3. The algorithm proposed for the SBP/ DBP determination is validated on 104 acoustic signals recorded from 40 adult subjects. The experimental outputs when compared with the reference arm- and wrist-based monitors produce a mean error of less than 2 mmHg and a standard deviation of error around 6 mmHg. Based on these results, this thesis shows the potential of this new sensing modality to be used as an alternative, or to complement existing methods, for the continuous monitoring of heart rate and HRV, and spot measurement of the blood pressure at the wrist.Open Acces

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

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

Cuffless Blood Pressure in clinical practice: challenges, opportunities and current limits.

Background: Cuffless blood pressure measurement technologies have attracted significant attention for their potential to transform cardiovascular monitoring.Methods: This updated narrative review thoroughly examines the challenges, opportunities, and limitations associated with the implementation of cuffless blood pressure monitoring systems.Results: Diverse technologies, including photoplethysmography, tonometry, and ECG analysis, enable cuffless blood pressure measurement and are integrated into devices like smartphones and smartwatches. Signal processing emerges as a critical aspect, dictating the accuracy and reliability of readings. Despite its potential, the integration of cuffless technologies into clinical practice faces obstacles, including the need to address concerns related to accuracy, calibration, and standardization across diverse devices and patient populations. The development of robust algorithms to mitigate artifacts and environmental disturbances is essential for extracting clear physiological signals. Based on extensive research, this review emphasizes the necessity for standardized protocols, validation studies, and regulatory frameworks to ensure the reliability and safety of cuffless blood pressure monitoring devices and their implementation in mainstream medical practice. Interdisciplinary collaborations between engineers, clinicians, and regulatory bodies are crucial to address technical, clinical, and regulatory complexities during implementation. In conclusion, while cuffless blood pressure monitoring holds immense potential to transform cardiovascular care. The resolution of existing challenges and the establishment of rigorous standards are imperative for its seamless incorporation into routine clinical practice.Conclusion: The emergence of these new technologies shifts the paradigm of cardiovascular health management, presenting a new possibility for non-invasive continuous and dynamic monitoring. The concept of cuffless blood pressure measurement is viable and more finely tuned devices are expected to enter the market, which could redefine our understanding of blood pressure and hypertension

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

Blind Source Separation for the Processing of Contact-Less Biosignals

(Spatio-temporale) Blind Source Separation (BSS) eignet sich für die Verarbeitung von Multikanal-Messungen im Bereich der kontaktlosen Biosignalerfassung. Ziel der BSS ist dabei die Trennung von (z.B. kardialen) Nutzsignalen und Störsignalen typisch für die kontaktlosen Messtechniken. Das Potential der BSS kann praktisch nur ausgeschöpft werden, wenn (1) ein geeignetes BSS-Modell verwendet wird, welches der Komplexität der Multikanal-Messung gerecht wird und (2) die unbestimmte Permutation unter den BSS-Ausgangssignalen gelöst wird, d.h. das Nutzsignal praktisch automatisiert identifiziert werden kann. Die vorliegende Arbeit entwirft ein Framework, mit dessen Hilfe die Effizienz von BSS-Algorithmen im Kontext des kamera-basierten Photoplethysmogramms bewertet werden kann. Empfehlungen zur Auswahl bestimmter Algorithmen im Zusammenhang mit spezifischen Signal-Charakteristiken werden abgeleitet. Außerdem werden im Rahmen der Arbeit Konzepte für die automatisierte Kanalauswahl nach BSS im Bereich der kontaktlosen Messung des Elektrokardiogramms entwickelt und bewertet. Neuartige Algorithmen basierend auf Sparse Coding erwiesen sich dabei als besonders effizient im Vergleich zu Standard-Methoden.(Spatio-temporal) Blind Source Separation (BSS) provides a large potential to process distorted multichannel biosignal measurements in the context of novel contact-less recording techniques for separating distortions from the cardiac signal of interest. This potential can only be practically utilized (1) if a BSS model is applied that matches the complexity of the measurement, i.e. the signal mixture and (2) if permutation indeterminacy is solved among the BSS output components, i.e the component of interest can be practically selected. The present work, first, designs a framework to assess the efficacy of BSS algorithms in the context of the camera-based photoplethysmogram (cbPPG) and characterizes multiple BSS algorithms, accordingly. Algorithm selection recommendations for certain mixture characteristics are derived. Second, the present work develops and evaluates concepts to solve permutation indeterminacy for BSS outputs of contact-less electrocardiogram (ECG) recordings. The novel approach based on sparse coding is shown to outperform the existing concepts of higher order moments and frequency-domain features

The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology