Pulse oximetry based on photoplethysmography imaging with red and green light : Calibratability and challenges.

Remotely measuring the arterial blood oxygen saturation (SpO2) in visible light (Vis) involves different probing depths, which may compromise calibratibility. This paper assesses the feasibility of calibrating camera-based SpO2 (SpO2,cam) using red and green light. Camera-based photoplethysmographic (PPG) signals were measured at 46 healthy adults at center wavelengths of 580 nm (green), 675 nm (red), and 840 nm (near-infrared; NIR). Subjects had their faces recorded during normoxia and hypoxia and under gradual cooling. SpO2,cam estimates in Vis were based on the normalized ratio of camera-based PPG amplitudes in red over green light (RoG). SpO2,cam in Vis was validated against contact SpO2 (reference) and compared with SpO2,cam estimated using red-NIR wavelengths. An RoG-based calibration curve for SpO2 was determined based on data with a SpO2 range of 85-100%. We found an [Formula: see text] error of 2.9% (higher than the [Formula: see text] for SpO2,cam in red-NIR). Additional measurements on normoxic subjects under temperature cooling (from [Formula: see text] to [Formula: see text]) evidenced a significant bias of - 1.7, CI [- 2.7, - 0.7]%. It was also noted that SpO[Formula: see text] estimated at the cheeks was significantly biased (- 3.6, CI [- 5.7, - 1.5]%) with respect to forehead estimations. Under controlled conditions, SpO[Formula: see text] can be calibrated with red and green light but the accuracy is less than that of SpO[Formula: see text] estimated in the usual red-NIR window.

Usefulness of Reflection Scanning in Determining Whole-Body Composition in Broadly Built Individuals Using Dual-Energy X-ray Absorptiometry.

Whole-body composition analysis by dual-energy X-ray absorptiometry (DXA) requires subjects to fit within the width limits of the DXA bed. To overcome this limitation, the aim of this study was to validate a partial scanning technique at which the upper left limb is deliberately left unscanned and measurements are "reflected" from the right-side upper limb. A Hologic Explorer-W densitometer was used in a sample of 189 participants, including athletes and nonathletes, ranging from underweight to obese (body mass index: 17.0-40.1 kg/m2). A whole-body scan was analyzed as the reference procedure to determine bone mineral content (BMC), lean soft tissue (LST), and fat mass (FM), and reanalyzed using a partial reflection scanning (RS) technique. RS estimates of BMC were associated with athletic status and differed significantly from reference estimates (p < 0.05). Also, the RS estimates of LST and FM were different (p < 0.05) from those of the reference whole-body scan, although differences were small (0.17 kg, -0.02 kg, and -0.10% for BMC, LST, and FM, respectively). The alternative procedure explained more than 99% of the reference scan variance with low limits of agreement (BMC: -13.8 to 23.9 g [athletes] and -6.3 to 18.0 g [nonathletes]; LST: -0.11 to 0.45 kg; FM: -0.22 to 0.17 kg). Regardless of body mass index, athletic status, and gender, RS is a useful and simple solution to be used in individuals wider than the DXA scan area. However, individual errors for BMC may be higher in athletes engaged in lateral dominant sports practice.

A Model for Waveform Dissimilarities in Dual-Depth Reflectance-PPG.

The pressure wave is attenuated as it travels through the vascular bed of tissue. Consequently, reflectance photoplethysmography (PPG) waveforms probed using dual-penetrating wavelengths, such as green (G) and red R; the deepest) are dissimilar. To unravel the dual-depth aspect of PPG, we modeled the wavelength-dependency of the shape of reflection-PPG signals in G (520-580 nm) and R (625-720nm). Skin compression perturbs the relative contributions of the dermal and subdermal blood volume variations sources (BVVs) to PPG and was used to verify our model. We acquired reflectance-PPG in G and R on the finger of nine subjects (ages, 26-32 yrs). Two parameters were used for describing dual-depth dissimilarities: the phase shift, $\phi $, between the first harmonics of the subdermal and dermal BVVs, and the observed phase shift (PS) between PPG signals in G and R. The average $\phi $ was 37.6, CI 95% [22.0, 53.2] degrees. At uncompressed skin, this corresponds to an average PS of 12.5, [7.8, 17.2] degrees. Our results suggest that phase parameters may enable microvascular characterization and diagnosis.

The Importance of Posture and Skin-Site Selection on Remote Measurements of Neck Pulsations: An Ultrasonographic Study.

Laser Doppler vibrometry (LDV) and camerabased vibrocardiography imaging (cVCGI) systems can sense cardiac-related displacements of the skin. This allows that carotid artery (CA) or jugular vein (JV) wall movements are acquired, non-obtrusively, at the neck and used for assessing cardiovascular health. However, skin-neck measurements are invalid if the CA and JV pulsations overlap. The concern is plausible since these vessels are anatomically close to one another until the carotid sinus. In this paper, we build on ultrasonographic (US) insights to verify whether trunk posture and skin-site variability within the neck influence cVCGI outcomes. Using ultrasound (US), we recorded the wall movements of the CA and JV in 4 subjects (ages, 28-41 yrs) in the supine, recumbent and seated positions at sites in the vicinity of the common CA. Skin-displacement waveforms were subsequently recorded by cVCGI and compared with US recordings. Our results show that CA displacements are dominant at the upper neck in the seated-to-recumbent positions whereas JV pulsations are best probed in recumbent-to-supine positions at the lower neck. These insights help to recognize the possible value of cVCGI in early-stage diagnosis or ambulatory monitoring.

Can the calf-raise senior test predict functional fitness in elderly people? A validation study using electromyography, kinematics and strength tests.

The assessment of the plantar-flexors muscle strength in older adults (OA) is of the utmost importance since they are strongly associated with the performance of fundamental tasks of daily life. The objective was to strengthen the validity of the Calf-Raise-Senior (CRS) test by assessing the biomechanical movement pattern of calf muscles in OA with different levels of functional fitness (FF) and physical activity (PA). Twenty-six OA were assessed with CRS, a FF battery, accelerometry, strength tests, kinematics and electromyography (EMG). OA with the best and worst CRS scores were compared. The association between the scores and EMG pattern of ankle muscles was determined. OA with the best CRS scores presented higher levels of FF, PA, strength, power, speed and range of movement, and a more efficient movement pattern during the test. Subjects who scored more at the CRS test demonstrated the possibility to use a stretch-shortening cycle type of action in the PF muscles to increase power during the movements. OA with different levels of FF can be stratified by the muscular activation pattern of the calf muscles and the scores in CRS test. This study reinforced the validity of CRS for evaluating ankle strength and power in OA.

New insights into the origin of remote PPG signals in visible light and infrared.

Remote photoplethysmography (PPG) is an optical measurement technique with established applications in vital signs monitoring. Recently, the consensual understanding of blood volume variations (BVVs) as the origin of PPG signals was challenged, raising validity concerns about the remote SpO2 methodology. Recognizing the imperative for new opto-physiological evidence, this investigation supports the volumetric hypothesis with living skin experiments and Monte Carlo simulations of remote PPG-amplitude in visible light (VIS) and infrared (IR). Multilayered models of the skin were developed to simulate the separate contributions from skin layers containing pulsatile arterioles to the PPG signal in the 450-1000 nm range. The simulated spectra were qualitatively compared with observations of the resting and compressed finger pad, and complemented with videocapillaroscopy. Our results indicate that remote PPG systems indeed probe arterial blood. Green wavelengths probe dermal arterioles while red-IR wavelengths also reach subcutaneous BVVs. Owing to stable penetration depths, the red-IR diagnostic window promotes the invariance of SpO2 measurements to skin non-homogeneities.

Skin inhomogeneity as a source of error in remote PPG-imaging.

Remote photoplethysmography (rPPG) imaging is an optical technique to remotely assess the local cutaneous microcirculation. Despite its potential for enabling health-related applications, the current understanding of the outcome images/maps remains incomplete. In this paper, we present a model and supporting experiments confirming the contribution of skin inhomogeneity to the morphology of PPG waveforms. Since rPPG imagers rely on the complex inner-product operator and may combine multiple wavelengths, the derived phase measurements reflect morphological heterogeneity of PPG signals to a larger extent than propagation-related phase differences. The influence of light penetration depth on PPG was observed and modeled on the green and red wavelengths at the hand region. We further show how our work contributes to understanding reproducibility issues in recent papers on pulse wave velocity (PWV) estimation.

Motion robust PPG-imaging through color channel mapping.

Photoplethysmography (PPG)-imaging is an emerging noninvasive technique that maps spatial blood-volume variations in living tissue with a video camera. In this paper, we clarify how cardiac-related (i.e., ballistocardiographic; BCG) artifacts occur in this imaging modality and address these using algorithms from the remote-PPG literature. Performance is assessed under stationary conditions at the immobilized hand. Our proposal outperforms the state-of-the-art, blood pulsation imaging [Biomed. Opt. Express5, 3123 (2014). ], even in our best attempt to create diffused illumination. BCG-artifacts are suppressed to an order of magnitude below PPG-signal strength, which is sufficient to prevent interpretation errors.

Video-based respiration monitoring with automatic region of interest detection.

Vital signs monitoring is ubiquitous in clinical environments and emerging in home-based healthcare applications. Still, since current monitoring methods require uncomfortable sensors, respiration rate remains the least measured vital sign. In this paper, we propose a video-based respiration monitoring method that automatically detects a respiratory region of interest (RoI) and signal using a camera. Based on the observation that respiration induced chest/abdomen motion is an independent motion system in a video, our basic idea is to exploit the intrinsic properties of respiration to find the respiratory RoI and extract the respiratory signal via motion factorization. We created a benchmark dataset containing 148 video sequences obtained on adults under challenging conditions and also neonates in the neonatal intensive care unit (NICU). The measurements obtained by the proposed video respiration monitoring (VRM) method are not significantly different from the reference methods (guided breathing or contact-based ECG; p-value = 0.6), and explain more than 99% of the variance of the reference values with low limits of agreement (-2.67 to 2.81 bpm). VRM seems to provide a valid solution to ECG in confined motion scenarios, though precision may be reduced for neonates. More studies are needed to validate VRM under challenging recording conditions, including upper-body motion types.

Ballistocardiographic Artifacts in PPG Imaging.

OBJECTIVE: Photoplethysmography (PPG) is a noninvasive technique to measure the blood-volume pulse and derive various vital signs. Camera-based PPG imaging was recently proposed for clinical microvascular assessment, but motion robustness is still an issue for this technique. Our study aims to quantify cardiac-related, i.e., ballistocardiographic (BCG), motion as a source of artifacts in PPG imaging. METHODS: In this paper, using the human head as a relevant region of interest, the amplitude of BCG-artifacts was modeled for a Lambertian surface illuminated by a light source. To derive peak-to-peak head displacements for the model, we recorded, on 54 subjects, PPG and inertial sensor data at the pulse and cranial vertex. We simulated the effect of light source location at a mesh representation of a human face and conducted additional experiments on a real subject. RESULTS: Under nonorthogonal illumination, the relative strength of the BCG artifacts is strong enough, compared to the amplitude of PPG signals, to compromise PPG imaging in realistic scenarios. Particularly affected are the signals obtained in the nongreen part of the spectrum and/or when the incident angle at the skin surface exceeds 45 (°). CONCLUSION: From the model and an additional experiment conducted on real skin, we were able to prove that homogenous and orthogonal illumination is a means to minimize the problem. SIGNIFICANCE: Our illumination recommendation provides a simple and effective means to improve the validity of remote PPG-imagers. We hope that it helps to prevent mistakes currently seen in many publications on remote PPG.