Respiratory rate measurement in children using a thermal camera

Abstract— Respiratory rate is a vital physiological measurement used in the immediate assessment of unwell children. Con-venient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although de-vices which measure respiratory rate exist, none has entered everyday clinical practice. An accurate device which has no physical contact with the child is important to ensure readings are not affected by distress. A thermal imaging camera to moni-tor respiratory rate in children was evaluated. Facial thermal images of 20 children (age: median=6.5 years, range 6 months-17 years) were included in the study. Record-ings were performed while the children slept comfortably on a bed for a duration of two minutes. Values obtained using the thermal imaging camera were compared with those obtained from standard methods: nasal thermistor, respiratory impedance plethysmography and transcutaneous CO2. Median respiratory rate measurements per minute were 21.0 (range 15.5-34.0) using thermal imaging and 19.0 (range 15.3-34.0) using standard methods. A close correlation (r 2 = 0.994) was observed between the thermal imaging and the standard methods. The thermal imaging camera is an accurate, objective non-invasive device which can be used to measure respiratory rate in children

Exploratory study to evaluate respiratory rate using a thermal imaging camera

Background: Respiratory rate is a vital physiological measurement used in the immediate assessment of unwell children and adults. Convenient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although devices which measure respiratory rate exist, none has entered everyday clinical practice for acute assessment of children and adults. An accurate and practical device which has no physical contact with the patient is important to ensure readings are not affected by distress caused by the assessment method. Objective: To evaluate the use of a thermal imaging method to monitor respiratory rate in children and adults. Methods: Facial thermal images of adult volunteers and children undergoing elective polysomnography were included. Respiration was recorded for at least two minutes with the camera positioned one metre from the subject's face. Values obtained using the thermal imaging camera were compared with those obtained from contact methods such as nasal thermistor, respiratory inductance plethysmography, nasal airflow and End Tidal Carbon Dioxide (CO2). Results: A total of 61 subjects, including 41 adults (age range 27 to 46 years) and 20 children (age range 0.5 to 18 years) were enrolled. The correlation between respiratory rate measured using thermal imaging and the contact method was r=0.94. Sequential refinements to the thermal imaging algorithms resulted in the ability to perform real-time measurements and an improvement of the correlation to r=0.995. Conclusion: This exploratory study shows that thermal imaging derived respiratory rates in children and adults correlate closely with the best performing standard method. With further refinements, this method could be implemented in both acute and chronic care in children and adults

Respiratory sound analysis as a diagnosis tool for breathing disorders

This paper provides an overview of respiratory sound analysis (RSA) and its functionality as a diagnostic tool for breathing disorders. A number of respiratory conditions and the techniques used to diagnose them, including sleep apnoea, lung sound analysis (LSA), wheeze detection and phase estimation are discussed. The technologies used, from multi-channel bespoke recording systems to using a smart phone application are explained. A new study that focusses on developing a non-invasive tool for the detection and characterisation of inducible laryngeal obstruction (ILO) is presented. ILO is a debilitating condition, caused by malfunctioning structures of the upper airway, commonly triggered by exertion, leaving children feeling out of breath and unable to exercise normally. In rare cases it can lead to critical laryngeal obstruction and admission to intensive care for endotracheal intubation. The current definitive method of diagnosis is by inserting a camera through the nose while the person is exercising. This approach is invasive, uncomfortable (in particular for young children) subjective and relies on the consultant's expertise. There are only a handful of consultants with the appropriate level of expertise in the UK to diagnose this condition

Non-invasive respiration monitoring by thermal imaging to detect sleep apnoea

Accurate airflow measurements are vital to diagnose apnoeas; respiratory pauses occurring during sleep that interrupt airflow to the lungs. Apnoea diagnosis usually requires an overnight polysomnography during which numerous vital signs are monitored, including respiratory rate and airflow. The current gold standard in respiration monitoring is a nasal pressure sensor which is placed inside the nostrils of the patient and through which the airflow is measured. Due to the contact nature of the sensor, it is often refused or removed during polysomnography, especially in the case of paediatric patients. We have found that around 50% of children refuse the use of nasal prongs due to its in-vasiveness, and of those that accepted it, 64% removed the sensor over the course of the polysomnography. We evaluated a non-contact method to monitor respiration by developing infrared thermal imaging, whereby temperature fluc-tuations associated with respiration are measured and correlated with airflow. A study was carried out on a sample of 11 healthy adult volunteers whose res-piratory signals were recorded over four simulated apnoea scenarios. The res-piratory signal obtained through thermal imaging was compared against the gold standard nasal pressure sensor. In 70% of cases, apnoea related events were well correlated with airflow sensor readings. In 16% of recordings the subject’s head position did not allow correct identification of the region of interest (i.e. the nostrils). For the remaining 14% of cases there was partial agreement between the thermal measurements and airflow sensor readings. These results indicate thermal imaging can be valuable as a detection tool for sleep apnoea, particularly in the case of paediatric patients

Respiration Measurement in a Simulated Setting Incorporating the Internet of Things

The Internet of Things (IoT) in healthcare has gained significant attention in recent years. This study demonstrates an adaptation of IoT in healthcare by illustrating a method of respiration rate measurement from a platform that simulates breathing. Respiration rate is a crucial physiological measure in monitoring critically ill patients. The devised approach, with further development, may be suitable for integration into neonatal intensive care units (NICUs) to measure infants’ respiration rate. A potential advantage of this method is that it monitors respiration using a wireless non-contact method and could add benefits such as preservation of skin integrity. The paper aimed to assess the accuracy of an IoT-integrated ultrasound (US)-based method for measuring respiration rate. Chest movement due to respiration was simulated by a platform with a controllable moving surface. The magnitude and frequency of the movements were accurately controlled by a signal generator. The surface movements were tracked using US as a reliable and cost-effective technology. ESP8266 NodeMCU was used to wirelessly record the US signal and ThingSpeak and Matlab© were used to analyze and visualize the data in the cloud. A close relationship between the measured rate of the simulated respiration and the actual frequency was observed. The study demonstrated a possible adaption of IoT for respiration rate measurement, however further work will be needed to ensure security and reliability of data handling before use of the system in medical environments

Preventing and lessening exacerbations of asthma in school-age children associated with a new term (PLEASANT) : Study protocol for a cluster randomised control trial

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedBackground: Within the UK, during September, there is a pronounced increase in the number of unscheduled medical contacts by school-aged children (4-16 years) with asthma. It is thought that that this might be caused by the return back to school after the summer holidays, suddenly mixing with other children again and picking up viruses which could affect their asthma. There is also a drop in the number of prescriptions administered in August. It is possible therefore that children might not be taking their medication as they should during the summer contributing to them becoming ill when they return to school. It is hoped that a simple intervention from the GP to parents of children with asthma at the start of the summer holiday period, highlighting the importance of maintaining asthma medication can help prevent increased asthma exacerbation, and unscheduled NHS appointments, following return to school in September.Methods/design: PLEASANT is a cluster randomised trial. A total of 140 General Practices (GPs) will be recruited into the trial; 70 GPs randomised to the intervention and 70 control practices of "usual care" An average practice is expected to have approximately 100 children (aged 4-16 with a diagnosis of asthma) hence observational data will be collected on around 14000 children over a 24-month period. The Clinical Practice Research Datalink will collect all data required for the study which includes diagnostic, prescription and referral data.Discussion: The trial will assess whether the intervention can reduce exacerbation of asthma and unscheduled medical contacts in school-aged children associated with the return to school after the summer holidays. It has the potential to benefit the health and quality of life of children with asthma while also improving the effectiveness of NHS services by reducing NHS use in one of the busiest months of the year. An exploratory health economic analysis will gauge any cost saving associated with the intervention and subsequent impacts on quality of life. If results for the intervention are positive it is hoped that this could be adopted as part of routine care management of childhood asthma in general practice. Trial registration: Current controlled trials: ISRCTN03000938 (assigned 19/10/12) http://www.controlled-trials.com/ISRCTN03000938/.UKCRN ID: 13572.Peer reviewe

A Novel, Contactless, Portable “Spot-Check” Device Accurately Measures Respiratory Rate

Respiratory rate (RR) is an important vital sign used in the assessment of acutely ill patients. It is also used as to predict serious deterioration in a patient's clinical condition. Convenient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although devices which measure RR exist, none has entered everyday clinical practice. We developed a contactless portable respiratory rate monitor (CPRM) and evaluated the agreement in respiratory rate measurements between existing methods and our new device. The CPRM uses thermal anemometry to measure breath signals during inspiration and expiration. RR data were collected from 52 healthy adult volunteers using respiratory inductance plethysmography (RIP) bands (established contact method), visual counting of chest movements (established non-contact method) and the CPRM (new method), simultaneously. Two differently shaped funnel attachments were evaluated for each volunteer. Data showed good agreement between measurements from the CPRM and the gold standard RIP, with intra-class correlation coefficient (ICC): 0.836, mean difference 0.46 and 95% limits of agreement of -5.90 to 6.83. When separate air inlet funnels of the CPRM were analysed, stronger agreement was seen with an elliptical air inlet; ICC 0.908, mean difference 0.37 with 95% limits of agreement -4.35 to 5.08. A contactless device for accurately and quickly measuring respiratory rate will be an important triage tool in the clinical assessment of patients. More testing is needed to explore the reasons for outlying measurements and to evaluate in the clinical setting

Noncontact Respiration Rate Monitoring: An Evaluation of Four Methods

Respiratory rate (RR) is an important diagnostic indicator of deterioration in critically ill patients, therefore an accurate method for its measurement is needed. The existing methods for RR measurement are typically contact-based, ie the sensing unit is attached to the patient's body. Some young children do not tolerate contact-based methods. Contact-based methods may also cause stress, affecting RR value. The operations of four non-contact RR measurement methods were compared. These were: infrared thermal imaging; airflow sensing; vision-based chest movement tracking and respiratory airflow sensing. The study showed that all four methods could measure RR. The strengths and limitations of each method are explained

Thermal imaging method for measurement of respiratory rate

Background: Monitoring respiratory rate (RR) is an important task for medical diagnosis that is neglected due to complexities in performing it. Current methods require the sensing device to be attached to the subjects' body thereby constraining or causing them discomfort and thus potentially affecting the breathing rate. We have developed a noncontact method for RR monitoring using a thermal camera.Method: Algorithms to capture images and detect the location of the face in each image were developed. The amount of emitted infrared radiation was then determined and signal processing techniques were then utilised to obtain the respiration rate in real time. A FLIR A40 thermal camera was used in this study. The evaluations were conducted against five existing contact based methods. Results: Tests were conducted on 51 adults (mean age 35.7) and 20 children (mean age 6.4 years). Mean RR (thermal imaging) 14.8 per minute; (chest and abdominal band) 14.8 per minute in adults. The correlation coefficient was 0.88 - 0.998 in adults and 0.578 – 0.999 in children depending on the method used. Figure 1 shows a respiration signal for a child obtained during the evaluation

Environmental benefits of sleep apnoea detection in the home environment

Sleep Apnoea (SA) is a common chronic illness that affects nearly 1 billion people around the world, and the number of patients is rising. SA causes a wide range of psychological and physiological ailments that have detrimental effects on a patient’s wellbeing. The high prevalence and negative health effects make SA a public health problem. Whilst the current gold standard diagnostic procedure, polysomnography (PSG), is reliable, it is resource-expensive and can have a negative impact on sleep quality, as well as the environment. With this study, we focus on the environmental impact that arises from resource utilisation during SA detection, and we propose remote monitoring (RM) as a potential solution that can improve the resource efficiency and reduce travel. By reusing infrastructure technology, such as mobile communication, cloud computing, and artificial intelligence (AI), RM establishes SA detection and diagnosis support services in the home environment. However, there are considerable barriers to a widespread adoption of this technology. To gain a better understanding of the available technology and its associated strength, as well as weaknesses, we reviewed scientific papers that used various strategies for RM-based SA detection. Our review focused on 113 studies that were conducted between 2018 and 2022 and that were listed in Google Scholar. We found that just over 50% of the proposed RM systems incorporated real time signal processing and around 20% of the studies did not report on this important aspect. From an environmental perspective, this is a significant shortcoming, because 30% of the studies were based on measurement devices that must travel whenever the internal buffer is full. The environmental impact of that travel might constitute an additional need for changing from offline to online SA detection in the home environment