Carlo Massaroni

Flow measurement in mechanical ventilation: A review

Accurate monitoring of flow rate and volume exchanges is essential to minimize ventilator-induced lung injury. Mechanical ventilators employ flowmeters to estimate the amount of gases delivered to patients and use the flow signal as a feedback to adjust the desired amount of gas to be delivered. Since flowmeters play a crucial role in this field, they are required to fulfill strict criteria in terms of dynamic and static characteristics. Therefore, mechanical ventilators are equipped with only the following kinds of flowmeters: linear pneumotachographs, fixed and variable orifice meters, hot wire anemometers, and ultrasonic flowmeters. This paper provides an overview of these sensors. Their working principles are described together with their relevant advantages and disadvantages. Furthermore, the most promising emerging approaches for flowmeters design (i.e., fiber optic technology and three dimensional micro-fabrication) are briefly reviewed showing their potential for this application.

Medical smart textiles based on fiber optic technology: an overview.

The growing interest in the development of smart textiles for medical applications is driven by the aim to increase the mobility of patients who need a continuous monitoring of such physiological parameters. At the same time, the use of fiber optic sensors (FOSs) is gaining large acceptance as an alternative to traditional electrical and mechanical sensors for the monitoring of thermal and mechanical parameters. The potential impact of FOSs is related to their good metrological properties, their small size and their flexibility, as well as to their immunity from electromagnetic field. Their main advantage is the possibility to use textile based on fiber optic in a magnetic resonance imaging environment, where standard electronic sensors cannot be employed. This last feature makes FOSs suitable for monitoring biological parameters (e.g., respiratory and heartbeat monitoring) during magnetic resonance procedures. Research interest in combining FOSs and textiles into a single structure to develop wearable sensors is rapidly growing. In this review we provide an overview of the state-of-the-art of textiles, which use FOSs for monitoring of mechanical parameters of physiological interest. In particular we briefly describe the working principle of FOSs employed in this field and their relevant advantages and disadvantages. Also reviewed are their applications for the monitoring of mechanical parameters of physiological interest.

Smart Textile Based on Fiber Bragg Grating Sensors for Respiratory Monitoring: Design and Preliminary Trials

Continuous respiratory monitoring is important to assess adequate ventilation. We present a fiber optic-based smart textile for respiratory monitoring able to work during Magnetic Resonance (MR) examinations. The system is based on the conversion of chest wall movements into strain of two fiber Bragg grating (FBG) sensors, placed on the upper thorax (UT). FBGs are glued on the textile by an adhesive silicon rubber. To increase the system sensitivity, the FBGs positioning was led by preliminary experiments performed using an optoelectronic system: FBGs placed on the chest surface experienced the largest strain during breathing. System performances, in terms of respiratory period (TR), duration of inspiratory (TI) and expiratory (TE) phases, as well as left and right UT volumes, were assessed on four healthy volunteers. The comparison of results obtained by the proposed system and an optoelectronic plethysmography highlights the high accuracy in the estimation of TR, TI, and TE: Bland-Altman analysis shows mean of difference values lower than 0.045 s, 0.33 s, and 0.35 s for TR, TI, and TE, respectively. The mean difference of UT volumes between the two systems is about 8.3%. The promising results foster further development of the system to allow routine use during MR examinations.

Temperature monitoring during microwave ablation in ex vivo porcine livers

OBJECTIVE The aim of the present study was to assess the temperature map and its reproducibility while applying two different MWA systems (915 MHz vs 2.45 GHz) in ex vivo porcine livers. MATERIALS AND METHODS Fifteen fresh pig livers were treated using the two antennae at three different settings: treatment time of 10 min and power of 45 W for both systems; 4 min and 100 W for the 2.45 GHz system. Trends of temperature were recorded during all procedures by means of fiber optic-based probes located at five fixed distances from the antenna, ranging between 10 mm and 30 mm. Each trial was repeated twice to assess the reproducibility of temperature distribution. RESULTS Temperature as function of distance from the antenna can be modeled by a decreasing exponential trend. At the same settings, temperature obtained with the 2.45 GHz system was higher than that obtained with the 915 MHz thus resulting into a wider area of ablation (diameter 17 mm vs 15 mm). Both systems showed good reproducibility in terms of temperature distribution (root mean squared difference for both systems ranged between 2.8 °C and 3.4 °C). CONCLUSIONS When both MWA systems are applied, a decreasing exponential model can predict the temperature map. The 2.45 GHz antenna causes higher temperatures as compared to the 915 MHz thus, resulting into larger areas of ablation. Both systems showed good reproducibility although better results were achieved with the 2.45 GHz antenna.

Error of a Temperature Probe for Cancer Ablation Monitoring Caused by Respiratory Movements: Ex Vivo and In Vivo Analysis

Hyperthermal techniques are spreading as an alternative to conventional surgery for cancer removal. A real-time temperature feedback can be used to adjust the treatment settings, in order to improve the clinical outcomes. In this paper, we experimentally assessed the feasibility for distributed temperature monitoring of a custom probe, which consists of a needle embedding six fiber Bragg gratings (FBGs). Since FBGs are also sensitive to strain, we focused on the analysis of the measurement error (artifact) caused by respiratory movements. We assessed the artifact both on ex vivo pig liver and lung (by mimicking the movement of these organs caused by respiration) and on in vivo trial on pig liver. Lastly, we proposed an algorithm to detect and minimize the artifact during ex vivo liver laser ablation. During both ex vivo and in vivo trials, the probe insertion within the organ was easy and safe. The artifact was significant (up to 3 °C), but the correction algorithm allows minimizing the error. The main advantages of the proposed probe are: 1) spatially resolved temperature monitoring (in six points of the tissue by inserting a single needle) and 2) the needle is magnetic resonance (MR)-compatible, hence can be used during MR-guided procedure. Even if the model is close to humans, further trials are required to investigate the feasibility of the probe for clinical applications.

Design and Feasibility Assessment of a Magnetic Resonance-Compatible Smart Textile Based on Fiber Bragg Grating Sensors for Respiratory Monitoring

Comfortable and easy to wear systems are gaining popularity for monitoring physiological parameters. Among others, smart textiles based on fiber optic sensors have shown promising results for respiratory monitoring and applications in magnetic resonance (MR) environment. The aim of this paper was to design, fabricate, and assess on healthy volunteers a smart textile based on fiber Bragg grating (FBG) sensors for respiratory monitoring. The new design was driven by the chest wall kinematics analysis performed by a marked-based motion capture system. The proposed textile shows promising performances for the non-intrusive monitoring of both compartmental and global volumetric parameters over time. Moreover, the use of FBGs makes the system MR-compatible. This feature was tested on two volunteers. The system did neither cause any image artifacts nor discomfort to the volunteers. This promising result encourages future developments to investigate the feasibility of the proposed smart textile for long-term observation of respiratory parameters, for patients monitoring during MR scan, and during sport activities in athletes.

Optoelectronic Plethysmography in Clinical Practice and Research: A Review

Background: Optoelectronic plethysmography (OEP) is a non-invasive motion capture method to measure chest wall movements and estimate lung volumes. Objectives: To provide an overview of the clinical findings and research applications of OEP in the assessment of breathing mechanics across populations of healthy and diseased individuals. Methods: A bibliographic research was performed with the terms “opto-electronic plethysmography,” “optoelectronic plethysmography,” and “optoelectronic plethysmograph” in 50 digital library and bibliographic search databases resulting in the selection of 170 studies. Results: OEP has been extensively employed in studies looking at chest wall kinematics and volume changes in chest wall compartments in healthy subjects in relation to age, gender, weight, posture, and different physiological conditions. In infants, OEP has been demonstrated to be a tool to assess disease severity and the response to pharmacological interventions. In chronic obstructive pulmonary disease patients, OEP has been used to test if patients can dynamically hyperinflate or deflate their lungs during exercise. In neuromuscular patients, respiratory muscle strength and chest kinematics have been analyzed. A widespread application of OEP is in tailoring post-operative pulmonary rehabilitation as well as in monitoring volume increases and muscle contributions during exercise. Conclusions: OEP is an accurate and validated method of measuring lung volumes and chest wall movements. OEP is an appropriate alternative method to monitor and analyze respiratory patterns in children, adults, and patients with respiratory diseases. OEP may be used in the future to contribute to improvements in the therapeutic strategies for respiratory conditions.

Feedforward Neural Network for Force Coding of an MRI-Compatible Tactile Sensor Array Based on Fiber Bragg Grating

This work shows the development and characterization of a fiber optic tactile sensor based on Fiber Bragg Grating (FBG) technology. The sensor is a 3 3 array of FBGs encapsulated in a PDMS compliant polymer. The strain experienced by each FBG is transduced into a Bragg wavelength shift and the inverse characteristics of the sensor were computed by means of a feedforward neural network. A 21 mN RMSE error was achieved in estimating the force over the 8 N experimented load range while including all probing sites in the neural network training procedure, whereas the median force RMSE was 199 mN across the 200 instances of a Monte Carlo randomized selection of experimental sessions to evaluate the calibration under generalized probing conditions. The static metrological properties and the possibility to fabricate sensors with relatively high spatial resolution make the proposed design attractive for the sensorization of robotic hands. Furthermore, the proved MRI-compatibility of the sensor opens other application scenarios, such as the possibility to employ the array for force measurement during functional MRI-measured brain activation.

Experimental Assessment of a Variable Orifice Flowmeter for Respiratory Monitoring

Accurate measurement of gas exchanges is essential in mechanical ventilation and in respiratory monitoring. Among the large number of commercial flowmeters, only few kinds of sensors are used in these fields. Among them, variable orifice meters (VOMs) show some valuable characteristics, such as linearity, good dynamic response, and low cost. This paper presents the characterization of a commercial VOM intended for application in respiratory monitoring. Firstly, two nominally identical VOMs were calibrated within ±10 L·min−1, to assess their metrological properties. Furthermore, experiments were performed by humidifying the air, to evaluate the influence of vapor condensation on sensor’s performances. The condensation influence was investigated during two long lasting trials (i.e., 4 hours) by delivering 4 L·min−1 and 8 L·min−1. Data show that the two VOMs’ responses are linear and their response is comparable (sensitivity difference of 1.4%, RMSE of 1.50 Pa); their discrimination threshold is <0.5 L·min−1, and the settling time is about 66 ms. The condensation within the VOM causes a negligible change in sensor sensitivity and a very slight deterioration of precision. The good static and dynamic properties and the low influence of condensation on sensor’s response make this VOM suitable for applications in respiratory function monitoring.

Evaluation of optoelectronic Plethysmography accuracy and precision in recording displacements during quiet breathing simulation.

Opto-electronic Plethysmography (OEP) is a motion analysis system used to measure chest wall kinematics and to indirectly evaluate respiratory volumes during breathing. Its working principle is based on the computation of marker displacements placed on the chest wall. This work aims at evaluating the accuracy and precision of OEP in measuring displacement in the range of human chest wall displacement during quiet breathing. OEP performances were investigated by the use of a fully programmable chest wall simulator (CWS). CWS was programmed to move 10 times its eight shafts in the range of physiological displacement (i.e., between 1 mm and 8 mm) at three different frequencies (i.e., 0.17 Hz, 0.25 Hz, 0.33 Hz). Experiments were performed with the aim to: (i) evaluate OEP accuracy and precision error in recording displacement in the overall calibrated volume and in three sub-volumes, (ii) evaluate the OEP volume measurement accuracy due to the measurement accuracy of linear displacements. OEP showed an accuracy better than 0.08 mm in all trials, considering the whole 2m3 calibrated volume. The mean measurement discrepancy was 0.017 mm. The precision error, expressed as the ratio between measurement uncertainty and the recorded displacement by OEP, was always lower than 0.55%. Volume overestimation due to OEP linear measurement accuracy was always <; 12 mL (<; 3.2% of total volume), considering all settings.