Simulation-based feasibility study of monitoring of intracerebral hemorrhages and detection of secondary hemorrhages using electrical impedance tomography.

Purpose: We present a simulation-based feasibility study of electrical impedance tomography (EIT) for continuous bedside monitoring of intracerebral hemorrhages (ICH) and detection of secondary hemorrhages. Approach: We simulated EIT measurements for six different hemorrhage sizes at two different hemorrhage locations using an anatomically detailed computational head model. Using this dataset, we test the ICH monitoring and detection performance of our tailor-made, patient-specific stroke-monitoring algorithm that utilizes a novel combination of nonlinear region-of-interest difference imaging, parallel level sets regularization and a prior-conditioned least squares algorithm. We compare the results of our algorithm to the results of two reference algorithms, a total variation regularized absolute imaging algorithm and a linear difference imaging algorithm. Results: The tailor-made stroke-monitoring algorithm is capable of indicating smaller changes in the simulated hemorrhages than either of the reference algorithms, indicating better monitoring and detection performance. Conclusions: Our simulation results from the anatomically detailed head model indicate that EIT equipped with a patient-specific stroke-monitoring algorithm is a promising technology for the unmet clinical need of having a technology for continuous bedside monitoring of brain status of acute stroke patients.

Corrections to "Sensitivity Analysis Highlights the Importance of Accurate Head Models for Electrical Impedance Tomography Monitoring of Intracerebral Hemorrhagic Stroke".

In the above paper [1] there are two errors which we correct here. An important reference was omitted.

Sensitivity Analysis Highlights the Importance of Accurate Head Models for Electrical Impedance Tomography Monitoring of Intracerebral Hemorrhagic Stroke.

OBJECTIVE: Electrical impedance tomography (EIT) has been proposed as a novel tool for diagnosing stroke. However, so far, the clinical feasibility is unresolved. In this study, we aim to investigate the need for accurate head modeling in EIT and how the inhomogeneities of the head contribute to the EIT measurement and affect its feasibility in monitoring the progression of a hemorrhagic stroke. METHODS: We compared anatomically detailed six- and three-layer finite element models of a human head and computed the resulting scalp electrode potentials and the lead fields of selected electrode configurations. We visualized the resulting EIT measurement sensitivity distributions, computed the scalp electrode potentials, and examined the inverse imaging with selected cases. The effect of accurate tissue geometry and conductivity values on the EIT measurement is assessed with multiple different hemorrhagic perturbation locations and sizes. RESULTS: Our results show that accurate tissue geometries and conductivity values inside the cranial cavity, especially the highly conductive cerebrospinal fluid, significantly affect EIT measurement sensitivity distribution and measured potentials. CONCLUSIONS: We can conclude that the three-layer head models commonly used in EIT literature cannot depict the current paths correctly in the head. Thus, our study highlights the need to consider the detailed geometry of the cerebrospinal fluid (CSF) in EIT. SIGNIFICANCE: The results clearly show that the CSF should be considered in the head EIT calculations.

A device for measuring sternal bone connectivity using vibration analysis techniques.

OBJECTIVES: Stability of bone splitting sternotomy is essential for normal healing after open cardiac surgery. Mechanical vibration transmittance may offer a means for early detection of separation of bone (diastasis) in the sternotomy and prevent further complications. This article describes the technical implementation and validation of vibration analysis-based prototype device built for measuring sternal bone connectivity after sternotomy. METHODS: An in-house built measurement system, sternal vibration device, consisting of actuator, sensor, and main controller and signal acquisition unit was designed and manufactured. The system was validated, and three different test settings were studied in mockups (polylactide rods in ballistic gel) and in two human sternums: intact, stable wire fixation, and unstable wire fixation with a gap mimicking bone diastasis. The transmittance of vibration stimulus across the median sternotomy was measured. RESULTS: The validation showed that the force produced by the actuator was stable, and the sensor could be calibrated to precisely measure the acceleration values. The vibration transmittance response to material cut and sternotomy was evident and detectable in the 20 Hz to 2 kHz band. The transmittance decreased when the connectivity between the sternal halves became unstable. The trend was visible in all the settings. CONCLUSION: Technical solutions and description of validation process were given. The device was calibrated, and the vibration transmittance analysis differentiated intact and cut polylactide rod. In the sternum, intact bone, wire fixation with exact apposition, and with a gap were identified separately. Although further studies are needed to assess the accuracy of the method to detect different levels of diastases, the method appears to be feasible.