Andrew Tizzard

GREIT: A unified approach to 2D linear EIT reconstruction of lung images

Electrical impedance tomography (EIT) is an attractive method for clinically monitoring patients during mechanical ventilation, because it can provide a non-invasive continuous image of pulmonary impedance which indicates the distribution of ventilation. However, most clinical and physiological research in lung EIT is done using older and proprietary algorithms; this is an obstacle to interpretation of EIT images because the reconstructed images are not well characterized. To address this issue, we develop a consensus linear reconstruction algorithm for lung EIT, called GREIT (Graz consensus Reconstruction algorithm for EIT). This paper describes the unified approach to linear image reconstruction developed for GREIT. The framework for the linear reconstruction algorithm consists of (1) detailed finite element models of a representative adult and neonatal thorax, (2) consensus on the performance figures of merit for EIT image reconstruction and (3) a systematic approach to optimize a linear reconstruction matrix to desired performance measures. Consensus figures of merit, in order of importance, are (a) uniform amplitude response, (b) small and uniform position error, (c) small ringing artefacts, (d) uniform resolution, (e) limited shape deformation and (f) high resolution. Such figures of merit must be attained while maintaining small noise amplification and small sensitivity to electrode and boundary movement. This approach represents the consensus of a large and representative group of experts in EIT algorithm design and clinical applications for pulmonary monitoring. All software and data to implement and test the algorithm have been made available under an open source license which allows free research and commercial use.

Electrical impedance tomography of human brain function using reconstruction algorithms based on the finite element method

Electrical impedance tomography (EIT) is a recently developed technique which enables the internal conductivity of an object to be imaged using rings of external electrodes. In a recent study, EIT during cortical evoked responses showed encouraging changes in the raw impedance measurements, but reconstructed images were noisy. A simplified reconstruction algorithm was used which modelled the head as a homogeneous sphere. In the current study, the development and validation of an improved reconstruction algorithm are described in which realistic geometry and conductivity distributions have been incorporated using the finite element method. Data from computer simulations and spherical or head-shaped saline-filled tank phantoms, in which the skull was represented by a concentric shell of plaster of Paris or a real human skull, have been reconstructed into images. There were significant improvements in image quality as a result of the incorporation of accurate geometry and extracerebral layers in the reconstruction algorithm. Image quality, assessed by blinded subjective expert observers, also improved significantly when data from the previous evoked response study were reanalysed with the new algorithm. In preliminary images collected during epileptic seizures, the new algorithm generated EIT conductivity changes which were consistent with the electrographic ictal activity. Incorporation of realistic geometry and conductivity into the reconstruction algorithm significantly improves the quality of EIT images and lends encouragement to the belief that EIT may provide a low-cost, portable functional neuroimaging system in the foreseeable future.

Depth sensitivity and image reconstruction analysis of dense imaging arrays for mapping brain function with diffuse optical tomography

The development of diffuse optical tomography (DOT) instrumentation for neuroimaging of humans is challenging due to the large size and the geometry of the head and the desire to distinguish signals at different depths. One approach to this problem is to use dense imaging arrays that incorporate measurements at different source-detector distances. We previously developed a high-density DOT system that is able to obtain retinotopic measurements in agreement with functional magnetic resonance imaging and positron emission tomography. Further extension of high-density DOT neuroimaging necessitates a thorough study of the measurement and imaging sensitivity that incorporates the complex geometry of the head--including the head curvature and layered tissue structure. We present numerical simulations using a finite element model of the adult head to study the sensitivity of the measured signal as a function of the imaging array and data sampling strategy. Specifically, we quantify the imaging sensitivity available within the brain (including depths beyond superficial cortical gyri) as a function of increasing the maximum source-detector separation included in the data. Through the use of depth related sensitivity analysis, it is shown that for a rectangular grid [with 1.3 cm first nearest neighbor (NN) spacing], second NN measurements are sufficient to record absorption changes along the surface of the brains cortical gyri (brain tissue depth <5 mm). The use of fourth and fifth NN measurements would permit imaging down into the cortical sulci (brain tissue depth >15 mm).

Generating accurate finite element meshes for the forward model of the human head in EIT

The use of realistic anatomy in the model used for image reconstruction in EIT of brain function appears to confer significant improvements compared to geometric shapes such as a sphere. Accurate model geometry may be achieved by numerical models based on magnetic resonance images (MRIs) of the head, and this group has elected to use finite element meshing (FEM) as it enables detailed internal anatomy to be modelled and has the capability to incorporate information about tissue anisotropy. In this paper a method for generating accurate FEMs of the human head is presented where MRI images are manually segmented using custom adaptation of industry standard commercial design software packages. This is illustrated with example surface models and meshes from adult epilepsy patients, a neonatal baby and a phantom latex tank incorporating a real skull. Mesh quality is assessed in terms of element stretch and hence distortion.

Solving the forward problem in electrical impedance tomography for the human head using IDEAS (integrated design engineering analysis software), a finite element modelling tool

If electrical impedance tomography is to be used as a clinical tool, the image reconstruction algorithms must yield accurate images of impedance changes. One of the keys to producing an accurate reconstructed image is the inclusion of prior information regarding the physical geometry of the object. To achieve this, many researchers have created tools for solving the forward problem by means of finite element methods (FEMs). These tools are limited, allowing only a set number of meshes to be produced from the geometric information of the object. There is a clear need for geometrical accurate FEM models to improve the quality of the reconstructed images. We present a commercial tool called IDEAS, which can be used to create FEM meshes for these models. The application of this tool is demonstrated by using segmented data from the human head to model impedance changes inside the head.

Bioimpedance imaging: an overview of potential clinical applications

Electrical Impedance Tomography (EIT) is an imaging technique based on multiple bio impedance measurements to produce a map (image) of impedance or changes in impedance across a region. Its origins lay in geophysics where it is still used to today. This review highlights potential clinical applications of EIT. Beginning with a brief overview of the underlying principles behind the modality, it describes the background research leading towards the development of the application of EIT for monitoring pulmonary function, detecting and localising tumours and monitoring brain function.

Development of a neonate lung reconstruction algorithm using a wavelet AMG and estimated boundary form

Objective, non-invasive measures of lung maturity and development, oxygen requirements and lung function, suitable for use in small, unsedated infants, are urgently required to define the nature and severity of persisting lung disease, and to identify risk factors for developing chronic lung problems. Disorders of lung growth, maturation and control of breathing are among the most important problems faced by the neonatologists. At present, no system for continuous monitoring of neonate lung function to reduce the risk of chronic lung disease in infancy in intensive care units exists. We are in the process of developing a new integrated electrical impedance tomography (EIT) system based on wearable technology to integrate measures of the boundary diameter from the boundary form for neonates into the reconstruction algorithm. In principle, this approach could provide a reduction of image artefacts in the reconstructed image associated with incorrect boundary form assumptions. In this paper, we investigate the required accuracy of the boundary form that would be suitable to minimize artefacts in the reconstruction for neonate lung function. The number of data points needed to create the required boundary form is automatically determined using genetic algorithms. The approach presented in this paper is to assist quality of the reconstruction using different approximations to the ideal boundary form. We also investigate the use of a wavelet algebraic multi-grid (WAMG) preconditioner to reduce the reconstruction computation requirements. Results are presented that demonstrate a full 3D model is required to minimize artefact in the reconstructed image and the implementation of a WAMG for EIT.

Improving the finite element forward model of the human head by warping using elastic deformation

As the use of realistic geometry in the forward model of electrical impedance tomography (EIT) of brain function appears to improve image reconstruction, the generation of patient-specific finite element meshes has been the subject of much recent work. This paper presents a more rapid method of generating more geometrically accurate finite element meshes of the human head by warping existing meshes such that the surface boundary beneath the electrodes closely matches that of the subject with minimal degradation to the quality of the mesh. Pre-existing meshes of spheres and adult head models incorporating key internal anatomical features are warped, using elastic deformation, to match a phantom latex tank incorporating a real skull. The algorithm is described and tests are carried out to optimize the key parameters to ensure minimal degradation of mesh quality and distortion of internal features. Results show that the algorithm operating with the optimum parameters produces meshes of sound quality and could represent an important step in the timely and productive creation of forward models in clinical applications.

Wearable sensors for patient-specific boundary shape estimation to improve the forward model for electrical impedance tomography (EIT) of neonatal lung function

Electrical impedance tomography (EIT) could be significantly advantageous to continuous monitoring of lung development in newborn and, in particular, preterm infants as it is non-invasive and safe to use within the intensive care unit. It has been demonstrated that accurate boundary form of the forward model is important to minimize artefacts in reconstructed electrical impedance images. This paper presents the outcomes of initial investigations for acquiring patient-specific thorax boundary information using a network of flexible sensors that imposes no restrictions on the patients normal breathing and movements. The investigations include: (1) description of the basis of the reconstruction algorithms, (2) tests to determine a minimum number of bend sensors, (3) validation of two approaches to reconstruction and (4) an example of a commercially available bend sensor and its performance. Simulation results using ideal sensors show that, in the worst case, a total shape error of less than 6% with respect to its total perimeter can be achieved.

Generation and performance of patient-specific forward models for breast imaging with EIT

It has now been well established that accurate geometric conformity of the forward model for EIT reconstruction has significant benefits for artefact reduction and localisation of conductivity changes within the domain. The problems of generation of patient specific forward models need to be addressed as segmentation of volumetric data from CT or MRI is inadequate for time-critical clinical use. This group has pioneered methods of generating patient-specific surface models from known landmarks and electrode positions and have used this data to warp finite element models for EIT reconstruction. This paper presents a further application of these methods to use known electrode positions for breast imaging to generate an accurate B-Spline surface model of a subject and to warp an existing finite element model to the surface using elastic deformation. Results will show that a forward model can be generated, conforming more realistically to actual subject geometry, that will further enhance the performance of the reconstruction algorithm offering significant benefits to clinical EIT breast imaging.