A review of machine learning techniques in photoplethysmography for the non-invasive cuff-less measurement of blood pressure

Hypertension or high blood pressure is a leading cause of death throughout the world and a critical factor for increasing the risk of serious diseases, including cardiovascular diseases such as stroke and heart failure. Blood pressure is a primary vital sign that must be monitored regularly for the early detection, prevention and treatment of cardiovascular diseases. Traditional blood pressure measurement techniques are either invasive or cuff-based, which are impractical, intermittent, and uncomfortable for patients. Over the past few decades, several indirect approaches using photoplethysmogram (PPG) have been investigated, namely, pulse transit time, pulse wave velocity, pulse arrival time and pulse wave analysis, in an effort to utilise PPG for estimating blood pressure. Recent advancements in signal processing techniques, including machine learning and artificial intelligence, have also opened up exciting new horizons for PPG-based cuff less and continuous monitoring of blood pressure. Such a device will have a significant and transformative impact in monitoring patients’ vital signs, especially those at risk of cardiovascular disease. This paper provides a comprehensive review for non-invasive cuff-less blood pressure estimation using the PPG approach along with their challenges and limitations

Cuffless and Continuous Blood Pressure Estimation from PPG Signals Using Recurrent Neural Networks

This paper proposes cuffless and continuous blood pressure estimation utilising Photoplethysmography (PPG) signals and state of the art recurrent network models, namely, Long Short Term Memory and Gated Recurrent Units. The models were validated on wide range of varying blood pressure and PPG signals acquired from the Multiparameter Intelligent Monitoring in Intensive Care database. Many features were extracted from the PPG waveform and several machine learning techniques were employed in an attempt to eliminate collinearity and reduce the size of input feature vector. Consequently, the most effective features for blood pressure estimation were selected. Experimental results show that the accuracy of the proposed methods outperform traditional models applied in the literature. The results satisfy the American National Standards of the Association for the Advancement of Medical Instrumentation

Review of Protocols Used in Ultrasound Thrombolysis

Objectives: This paper focuses on the review of protocols used in thrombolysis studies with ultrasound. Materials and methods: Data from peer-review articles were acquired. Results: The protocols of several published reports are summarized in 3 tables (in vitro, in vivo, and clinical), providing detailed information concerning clot model, thrombolytic drug, treatment mode, sonication parameters, evaluation method, thrombolysis outcome, side effects, and conclusions. Conclusions: The aim of this review was to give an overview of the different protocols used so far in the field of sonothrombolysis and investigate the impact of several aspects involved on sonothrombolysis outcome

Within - and between - session reliability of the spider drill test to assess Change of Direction Speed in youth tennis athletes

Agility or Change of Direction Speed (CODS) is a critical physical attribute in a sport such as tennis, which is categorised by frequent and multiple changes of direction. Recently a CODS test called the ‘spider drill’ has been used to assess tennis athletes’ ability to change direction. To the authors’ knowledge, no study has solely assessed its reliability and compared this with other commonly-used CODS tests; thus, this was the aim of the study. Ten nationally ranked youth tennis athletes (age: 15.1 ± 2.6; mass: 66.4 + 17.2 kg; height: 163.0 + 16.2 cm) completed three trials of the spider drill, modified t-test and pro-agility test on two separate testing occasions. All CODS tests had low typical percentage error, both within-sessions (CV = 1.8 - 4.1%), and between session (CV = 1.2 - 3.7%). The SEM was also consistent within tests both within- and between- testing sessions. Within-session test-retest consistency illustrates strong reliability for the spider drill (ICC = 0.93, 0.95), modified t-test (ICC = 0.79, 0.83), however for pro-agility session 2 fell outside of the accepted threshold (ICC = 0.88, 0.69). These trends were similar when assessing between-session consistency, with both the spider drill and modified t-test providing high levels of reliability (ICC = 0.95 and 0.97 respectively). However, the pro-agility fell outside of the accepted threshold (ICC = 0.66), with 95% confidence intervals wide-ranging in nature (95% CI: 0.11 - 0.9). These results suggest that the spider drill and modified t-test are both reliable tests when measuring CODS within youth tennis athletes. Strength and conditioning practitioners could consider changes in excess of ± 1.1% as meaningful (based off the SDD) when assessing CODS through the spider drill or modified t-test within youth tennis athletes

Quantitative MRI Brain Studies in Mild Cognitive Impairment and Alzheimer's disease: A Methodological Review

Classifying and predicting Alzheimer's disease (AD) in individuals with memory disorders through clinical and psychometric assessment is challenging especially in Mild Cognitive Impairment (MCI) subjects. Quantitative structural Magnetic Resonance Imaging (MRI) acquisition methods in combination with Computer-Aided Diagnosis (CAD) are currently being used for the assessment AD. These acquisitions methods include: i) Voxel-based Morphometry (VBM), ii) volumetric measurements in specific Regions of Interest (ROIs), iii) cortical thickness measurements, iv) shape analysis and v) texture analysis. This review evaluates the aforementioned methods in the classification of cases into one of the following 3 groups: Normal Controls (NC), MCI and AD subjects. Furthermore, the performance of the methods is assessed on the prediction of conversion from MCI to AD. In parallel, it is also assessed which ROIs are preferred in both classification and prognosis through the different states of the disease. Structural changes in the early stages of the disease are more pronounced in the Medial Temporal Lobe (MTL) especially in the entorhinal cortex, whereas with disease progression both entorhinal cortex and hippocampus offer similar discriminative power. However, for the conversion from MCI subjects to AD, entorhinal cortex provides better predictive accuracies rather than other structures, such as the hippocampus

Comparison of NIRS, laser Doppler flowmetry, photoplethysmography, and pulse oximetry during vascular occlusion challenges

© 2016 Institute of Physics and Engineering in Medicine. Monitoring changes in blood volume, blood flow, and oxygenation in tissues is of vital importance in fields such as reconstructive surgery and trauma medicine. Near infrared spectroscopy (NIRS), laser Doppler (LDF) flowmetry, photoplethysmography (PPG), and pulse oximetry (PO) contribute to such fields due to their safe and noninvasive nature. However, the techniques have been rarely investigated simultaneously or altogether. The aim of this study was to investigate all the techniques simultaneously on healthy subjects during vascular occlusion challenges. Sensors were attached on the forearm (NIRS and LDF) and fingers (PPG and PO) of 19 healthy volunteers. Different degrees of vascular occlusion were induced by inflating a pressure cuff on the upper arm. The responses of tissue oxygenation index (NIRS), tissue haemoglobin index (NIRS), flux (LDF), perfusion index (PPG), and arterial oxygen saturation (PO) have been recorded and analyzed. Moreover, the optical densities were calculated from slow varying dc PPG, in order to distinguish changes in venous blood volumes. The indexes showed significant changes (p < 0.05) in almost all occlusions, either venous or over-systolic occlusions. However, differentiation between venous and arterial occlusion by LDF may be challenging and the perfusion index (PI) may not be adequate to indicate venous occlusions. Optical densities may be an additional tool to detect venous occlusions by PPG

Evaluation of fast spin echo MRI sequence for an MRI guided high intensity focused ultrasound system for in vivo rabbit liver ablation

The effectiveness of magnetic resonance imaging (MRI) to monitor thermal lesions created by High Intensity Focused Ultrasound (HIFU) in rabbit liver in vivo is investigated. The MRI sequences of T1-weighted, and T2-weighted fast spin echo (FSE) were evaluated. The main goal in this paper was to find the range of repetition time (TR) and range of echo time (TE) which maximizes the contrast to noise ratio (CNR). An ultrasonic transducer operating at 2 MHz was used, which is navigated using a positioning device. With T1W FSE the range of TR under which CNR is maximized ranges from 400 to 900 ms. The maximum contrast measured is approximately 25. With T2W FSE the range of TE that establishes maximum contrast is between 40 ms and 80 ms, with CNR of approximately 14. T1W FSE is much better than T2W FSE in detecting thermal lesions in liver. Both T1W and T2 W FSE were proven successful to image thermal lesions created by HIFU in rabbit liver in vivo

Heart ablation using a planar rectangular high intensity ultrasound transducer and MRI guidance

The aim of this study was to evaluate a flat rectangular (3 × 10 mm2) MRI compatible transducer operating at 5 MHz. The main task was to explore the feasibility of creating deep lesions in heart at a depth of at least 15 mm. The size of thermal necrosis in heart tissue was estimated as a function of power and time using a simulation model. The system was then tested in an excised lamb heart. In this study, we were able to create lesions of 15 mm deep with acoustic power of 6 W for an exposure of approximately 1 min. The contrast to noise ratio (CNR) between lesion and heart tissue was evaluated using fast spin echo (FSE). The CNR value was approximately 22 using T1 W FSE. Maximum CNR was achieved with repetition time (TR) between 300 and 800 ms. Using T2W FSE, the corresponding CNR was approximately 13 for the 14 in vivo experiments. The average lesion depth was 11.93 mm with a standard deviation of 0.62 mm. In vivo irradiation conditions were 6 W for 60 s. The size of the lesion in the other two dimensions was close to 3 × 10 mm2 (size of the transducer element)

Recurrent Neural Network Models for Blood Pressure Monitoring Using PPG Morphological Features

Continuous non-invasive Blood Pressure (BP) monitoring is vital for the early detection and control of hypertension. However, this is yet not possible as all current non-invasive BP devices are cuff-based devices and hence precluding continuous monitoring. Several methods have been proposed to overcome this challenge, one of which utilises the Photoplethysmograph (PPG) signal in an effort to predict reliable BP values from this signal using various computational approaches. Although, good performance has been reported in the literature, it was mainly achieved on a small inadequate sample size using conventional models that are unable to account for the temporal variations in the input vector. To address these limitations, this paper proposes cuff-less and continuous blood pressure estimation using Long Short-term Memory (LSTM) and Gated Recurrent Units (GRU). The models were evaluated on 942 patients acquired from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC II) dataset. The proposed models produced superior results in comparison with conventional artificial neural network. In particular, the best performance was achieved by the GRU, with mean absolute error and standard deviation of 5.77 ± 8.52 mmHg and 3.33±5.02 mmHg for systolic (SBP) and diastolic blood pressure (DBP), respectively. Furthermore, the results comply with the international standards for cuff-less blood pressure estimation

Investigation of oesophageal photoplethysmographic signals and blood oxygen saturation measurements in cardiothoracic surgery patients

Pulse oximeter probes attached to the finger may fail to estimate blood oxygen saturation (SpO2) in patients with compromised peripheral perfusion (e.g. hypothermic cardiopulmonary bypass surgery). The measurement of SpO2 from a central organ such as the oesophagus is suggested as an alternative to overcome this problem. A reflectance oesophageal pulse oximeter probe and a processing system implemented in LabVIEW were developed. The system was evaluated in clinical measurements on 50 cardiothoracic surgery patients. Oesophageal photoplethysmographic (PPG) signals with large amplitudes and high signal-to-noise ratios were measured from various depths within the oesophagus from all the cardiothoracic patients. The oesophageal PPG amplitudes from these patients were in good agreement with previous oesophageal PPG amplitude measurements from healthy anaesthetized patients. The oesophageal pulse oximeter SpO2 results agreed well with the estimated arterial oxygen saturation (SaO2) values inferred from the oxygen tension obtained by blood gas analysis. The mean (+/- SD) of the differences between the oesophageal pulse oximeter SpO2 readings and those from blood gas analysis was 0.02 +/- 0.88%. Also, the oesophageal pulse oximeter was found to be reliable and accurate in five cases of poor peripheral perfusion when a commercial finger pulse oximeter probe failed to estimate oxygen saturation values for at least 10 min. These results suggest that the arterial blood circulation to the oesophagus is less subject to vasoconstriction and decreased PPG amplitudes than are the peripheral sites used for pulse oximetry such as the finger. It is concluded that oesophageal SPO2 monitoring may be of clinical value