Electrical impedance tomography is clinically used to trace ventilation related changes in electrical conductivity of lung tissue. Estimating regional pulmonary perfusion using electrical impedance tomography is still a matter of research. To support clinical decision making, reliable bedside information of pulmonary perfusion is needed. We introduce a method to robustly detect pulmonary perfusion based on indicator-enhanced electrical impedance tomography and validate it by dynamic multidetector computed tomography in two experimental models of acute respiratory distress syndrome. The acute injury was induced in a sublobar segment of the right lung by saline lavage or endotoxin instillation in eight anesthetized mechanically ventilated pigs. For electrical impedance tomography measurements, a conductive bolus (10% saline solution) was injected into the right ventricle during breath hold. Electrical impedance tomography perfusion images were reconstructed by linear and normalized Gauss-Newton reconstruction on a finite element mesh with subsequent element-wise signal and feature analysis. An iodinated contrast agent was used to compute pulmonary blood flow via dynamic multidetector computed tomography. Spatial perfusion was estimated based on first-pass indicator dilution for both electrical impedance and multidetector computed tomography and compared by Pearson correlation and Bland-Altman analysis. Strong correlation was found in dorsoventral (r = 0.92) and in right-to-left directions (r = 0.85) with good limits of agreement of 8.74% in eight lung segments. With a robust electrical impedance tomography perfusion estimation method, we found strong agreement between multidetector computed and electrical impedance tomography perfusion in healthy and regionally injured lungs and demonstrated feasibility of electrical impedance tomography perfusion imaging.

Abstract One challenge in central hemodynamic monitoring based on electrical impedance tomography (EIT) is to robustly detect ventricular signal components and the corresponding EIT image region without external monitoring information. Current stimulation and voltage measurement of EIT were simulated with finite element porcine torso models in presence of a multitude of thoracic blood volume shifts. The simulated measurement data was examined for linear dependence on changes in stroke volume. Based on the results the EIT measurement information regarding stroke volume changes is sparse

Arterial blood pressure is one of the most often measured vital parameters in clinical practice. State-of-the-art noninvasive ABP measurement technologies have noticeable limitations and are mainly based on uncomfortable techniques of complete or partial arterial occlusion by cuffs. Most commonplace devices provide only intermittent measurements, and continuous systems are bulky and difficult to apply correctly for nonprofessionals. Continuous cuffless ABP measurements are still an unmet clinical need and a topic of ongoing research, with only few commercially available devices. This paper discusses surrogate-based noninvasive blood pressure measurement techniques. It covers measurement methods of continuously and noninvasively inferring BP from surrogate signals without applying external pressures, except for reference or initialization purposes. The BP is estimated by processing signal features, so called surrogates, which are modulated by variations of BP. Discussed techniques include well-known approaches such as pulse transit time and pulse arrival time techniques, pulse wave analysis or combinations thereof. Despite a long research history, these methods have not found widespread use in clinical and ambulatory practice, in part due to technical limitations and the lack of a standardized regulatory framework. This work summarizes findings from an invited workshop of experts in the fields covering clinical expertise, engineering aspects, commercialization and standardization issues. The goal is to provide an application driven outlook, starting with clinical needs, and extending to technical actuality. It provides an outline of recommended research directions and includes a detailed overview of clinical use case scenarios for these technologies, opportunities, and limitations.

Background In acute respiratory distress syndrome (ARDS), non-ventilated perfused regions coexist with non-perfused ventilated regions within lungs. The number of unmatched regions might reflect ARDS severity and affect the risk of ventilation-induced lung injury. Despite pathophysiological relevance, unmatched ventilation and perfusion are not routinely assessed at the bedside. The aims of this study were to quantify unmatched ventilation and perfusion at the bedside by electrical impedance tomography (EIT) investigating their association with mortality in patients with ARDS and to explore the effects of positive end-expiratory pressure (PEEP) on unmatched ventilation and perfusion in subgroups of patients with different ARDS severity based on PaO 2 /FiO 2 and compliance. Methods Prospective observational study in 50 patients with mild (36%), moderate (46%), and severe (18%) ARDS under clinical ventilation settings. EIT was applied to measure the regional distribution of ventilation and perfusion using central venous bolus of saline 5% during end-inspiratory pause. We defined unmatched units as the percentage of only ventilated units plus the percentage of only perfused units. Results Percentage of unmatched units was significantly higher in non-survivors compared to survivors (32[27–47]% vs. 21[17–27]%, p < 0.001). Percentage of unmatched units was an independent predictor of mortality (OR 1.22, 95% CI 1.07–1.39, p = 0.004) with an area under the ROC curve of 0.88 (95% CI 0.79–0.97, p < 0.001). The percentage of ventilation to the ventral region of the lung was higher than the percentage of ventilation to the dorsal region (32 [27–38]% vs. 18 [13–21]%, p < 0.001), while the opposite was true for perfusion (28 [22–38]% vs. 36 [32–44]%, p < 0.001). Higher percentage of only perfused units was correlated with lower dorsal ventilation ( r = − 0.486, p < 0.001) and with lower PaO 2 /FiO 2 ratio ( r = − 0.293, p = 0.039). Conclusions EIT allows bedside assessment of unmatched ventilation and perfusion in mechanically ventilated patients with ARDS. Measurement of unmatched units could identify patients at higher risk of death and could guide personalized treatment.

Abstract The indicator dilution method (IDM) is one approach to measure pulmonary perfusion using Electrical Impedance Tomography (EIT). To be able to calculate perfusion parameters and to increase robustnes, it is necessary to approximate and then to separate the components of the measured signals. The component referring to the passage of the injected bolus through the pixels can be modeled as a gamma variate function, its parameters are often determined using nonlinear optimization algorithms. In this paper, we introduce a linear approach that enables higher robustnes and faster computation, and compare the linear and nonlinear fitting approach on data of an animal study.

Abstract Electrical Impedance Tomography (EIT) is a clinically used tool for bed-side monitoring of ventilation. Previous work also showed a high potential for lung perfusion monitoring with indicator-enhanced EIT. However, many research questions have yet to be answered before it can be broadly applied in clinical everyday life. The goal of this work is to evaluate a new method to improve EIT perfusion measurements. Pulmonary hemodynamic transfer functions were estimated using regularized deconvolution with Tikhonov regularization to estimate spatial perfusion parameters. The final comparison between EIT images and PET scans showed a median correlation of 0.897 for the images which were reconstructed using the regularized deconvolution. In comparison the previously used maximum slope method led to a median correlation of 0.868.

In this study a physiological closed-loop system for arterial CO2 partial pressure control was designed and comprehensively tested using a set of models of the respiratory CO2 gas exchange. The underlying preclinical data were collected from 12 pigs in presence of severe changes in hemodynamic and pulmonary condition. A minimally complex nonlinear state space model of CO2 gas exchange was identified post hoc in different lung conditions. The control variable was measured noninvasively using the endtidal CO2 partial pressure. For the simulation study the output signal of the controller was defined as the alveolar minute volume set value of an underlying adaptive lung protective ventilation mode. A linearisation of the two-compartment CO2 gas exchange model was used for the design of a model predictive controller (MPC). It was augmented by a tube based controller suppressing prediction errors due to model uncertainties. The controller was subject to comparative testing in interaction with each of the CO2 gas exchange models previously identified on the preclinical study data. The performance was evaluated for the system response towards the following five tests in comparison to a PID controller: recruitment maneuver, PEEP titration maneuver, stepwise change in the CO2 production, breath-hold maneuver and a step in the reference signal. A root mean square error of 2.69 mmHg between arterial CO2 partial pressure and the reference signal was achieved throughout the trial. The reference-variable response of the model predictive controller was superior regarding overshoot and settling time.

The fabrication of optical interconnects has been widely investigated for the generation of optical circuit boards. Twophoton absorption (TPA) lithography (or high-precision 3D printing) as an innovative production method for direct manufacture of individual 3D photonic structures gains more and more attention when optical polymers are employed. In this regard, we have evaluated novel ORMOCER-based hybrid polymers tailored for the manufacture of optical waveguides by means of high-precision 3D printing. In order to facilitate future industrial implementation, the processability was evaluated and the optical performance of embedded waveguides was assessed. The results illustrate that hybrid polymers are not only viable consumables for industrial manufacture of polymeric micro-optics using generic processes such as UV molding. They also are potential candidates to fabricate optical waveguide systems down to the chip level where TPA-based emerging manufacturing techniques are engaged. Hence, it is shown that hybrid polymers continue to meet the increasing expectations of dynamically growing markets of micro-optics and optical interconnects due to the flexibility of the employed polymer material concept.

Eikonal models are useful to compute approximate solutions of cardiac excitation propagation in a computationally efficient way. In this work the underlying conduction velocities for different cell types were computed solving the classical bidomain model equations for planar wavefront propagation. It was further investigated how changes in the conductivity tensors within the bidomain model analytically correspond to changes in the conduction velocity. The error in the presence of local front curvature for the derived eikonal model parametrization were analyzed. The conduction velocity simulated based on the bidomain model was overestimated by a maximum of 10%.

We address the feasibility of free-form laser-printed 3D structures for sub-μm to large area fabrication. The impact of material and process parameters for different applications in photonics, micro- and organic electronics and life-science is discussed.

This dataset is associated with the Left Atrial Segmentation Challenge 2013 (LASC'13). For a detailed report on the challenge, please refer to: Tobon-Gomez C, Geers AJ, Peters, J, Weese J, Pinto K, Karim R, Ammar M, Daoudi A, Margeta J, Sandoval Z, Stender B, Zheng Y, Zuluaga, MA, Betancur J, Ayache N, Chikh MA, Dillenseger J-L, Kelm BM, Mahmoudi S, Ourselin S, Schlaefer A, Schaeffter T, Razavi R, Rhode KS. Benchmark for Algorithms Segmenting the Left Atrium From 3D CT and MRI Datasets. IEEE Transactions on Medical Imaging, 34(7):1460–1473, 2015. The data and code of the challenge have been made publicly available to serve as a benchmark for left atrial segmentation algorithms. Code is hosted on github.com/catactg/lasc

Knowledge of left atrial (LA) anatomy is important for atrial fibrillation ablation guidance, fibrosis quantification and biophysical modelling. Segmentation of the LA from Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) images is a complex problem. This manuscript presents a benchmark to evaluate algorithms that address LA segmentation. The datasets, ground truth and evaluation code have been made publicly available through the http://www.cardiacatlas.org website. This manuscript also reports the results of the Left Atrial Segmentation Challenge (LASC) carried out at the STACOM'13 workshop, in conjunction with MICCAI'13. Thirty CT and 30 MRI datasets were provided to participants for segmentation. Each participant segmented the LA including a short part of the LA appendage trunk and proximal sections of the pulmonary veins (PVs). We present results for nine algorithms for CT and eight algorithms for MRI. Results showed that methodologies combining statistical models with region growing approaches were the most appropriate to handle the proposed task. The ground truth and automatic segmentations were standardised to reduce the influence of inconsistently defined regions (e.g., mitral plane, PVs end points, LA appendage). This standardisation framework, which is a contribution of this work, can be used to label and further analyse anatomical regions of the LA. By performing the standardisation directly on the left atrial surface, we can process multiple input data, including meshes exported from different electroanatomical mapping systems.

Ablation is a minimal invasive interventional method used in cardiac electrophysiology. It is one option for the treatment of patients suffering from paroxysmal or persistent atrial fibrillation through pulmonary vein isolation. During the intervention endocardial surface potentials from a tracked mapping catheter are recorded with respect to a static patient specific surface geometry. The purpose of the presented work is to compare two different automatic segmentation methods working on both CT and MRI volumes. Segmentation of the left atrium is challenging because the shape variability is high. The use of statistical shape models initialized by means of affine image registration was explored as first method. The second method was non-parametric and based on atlas registration and statistical region growing. Segmentation results were validated and compared using a leave-one-out cross validation on the volumes provided with segmentation results achieved manually by experts. The Dice's coefficient was used as error measure. The method based on statistical region growing performed better than statistical shape models. A Dice's coefficient of 0.87 was achieved on both imaging modalities.

Because the electrical and mechanical properties of myocardial tissue are strongly anisotropic the local fiber direction is an important parameter for realistic computational models of cardiac excitation and motion. Within the last years Diffusion Tensor Imaging has been established as a noninvasive measuring technique for fiber directions from whole hearts ex vivo. X-ray microtomography offers a much higher spatial resolution than Diffusion Tensor Imaging and could scan a whole heart as well. The inherently low soft-tissue contrast can be enhanced through staining with iodine. We recorded a volumetric scan of a rat heart and filtered the imaging data with a coherence-enhancing anisotropic diffusion filter to enhance its microstructure. The filtering was performed in three dimensions. From the structure tensor of the filtered volumes scalar measurements and fiber tracts were calculated and used for visualization and further analysis.

Planning aortic valve reconstruction requires a model of the aortic root geometry. One image modality available in the clinic is transesophageal ultrasound. We present a setup to obtain ultrasound images of porcine valves in different states, i.e., mimicking the dilatation and reconstruction of the aortic root. We studied whether key geometry parameters can be obtained from the ultrasound images. Our preliminary results indicate that the location of the commissures, the diameter of the annulus and the coaptation height can be estimated from the images and the setup can help validate the fitting of the prosthesis.

Optical mapping is a well established technique for recording monophasic action potential traces either within myocardial slices or on the epicardial surface of isolated hearts. This measuring technique offers a high spatial and sufficient temporal resolution but it is sensitive towards myocardial motion. Motion artifacts occur because the mapping between a certain tissue portion sending out fluorescent light and a pixel of the photodetector changes over time. So far this problem has been adressed in two different ways: Suppressing the motion or ratiometric imaging. Working with beating rat heart slices we developed a different approach to noninvasively record simultaneously optical mapping data and motion of the slices. Our approach is based on image registration. We use the background fluorescent light to perform first a rigid transformation to detect translational and and rotational motion. The contractive motion is recovered using a non-rigid demons registration algorithm afterwards. The investigation is based on recordings of four different slices stained with Di-4-ANEPPS.

Within the last years some segmentation algorithms working on 3D echocardiography data have been published. Usually such algorithms have been validated against contours manually drawn within the acquired imaging data. This praxis requires considerable expert knowledge and is time-consuming. We propose a different workflow based on synthetic ultrasound volumes. These volumes can be generated from computed tomography (CT) volumes or a surface models. The echocardiography simulation includes reflection, attenuation, speckle and interference between adjacent receiver elements. Based the synthetic echocardiography volumes we present a tool to validate segmentation algorithms. We illustrate the use of our tool in quantifying the segmentation result for a 3D region-based active contour approach.