D C Barber

Applied potential tomography.

Applied Potential Tomography (APT) is a new method of imaging changes in the distribution of electrical resistivity within the human body. Such changes occur during respiration and, because of the movement of blood within the chest, during the cardiac cycle. Changes can also be observed due to redistribution of fluid within the body during simulated weightlessness. As very low electric currents are used to take measurements the method is safe. The equipment is simple and compact and ideal for use in space based measurement of physiological changes in the human body.

Applied potential tomography: possible clinical applications

Applied potential tomography (APT) or electrical impedance imaging has received considerable attention during the past few years and some in vivo images have been produced. This paper reviews the current situation in terms of what in vivo results have been and are likely to be obtained in the near future. Both static and dynamic imaging are possible and these two areas are dealt with separately. Features of the existing in vivo imaging system are good tissue contrast, high-speed data collection, good sensitivity to resistivity changes, low spatial resolution, low cost and no known hazard. It is concluded that the most promising way forward to clinical application in the short term is to use dynamic as opposed to static imaging. An example of lung imaging is shown and the application to measuring regional ventilation and pulmonary oedema is discussed. Use of APT for the detection of intraventricular bleeding in neonates is discussed as is the proven ability to study gastric physiology by imaging resistivity distribution changes following the ingestion of conducting or insulating fluids. Other areas of possible application which are considered are blood flow measurement, cell counting, measurement of lean-fat ratios and the detection of soft tissue lesions.

The use of principal components in the quantitative analysis of gamma camera dynamic studies

The reduction of the enormous quantity of data in a radionuclide dynamic study to a few diagnostic parameters presents a problem. Conventional methods of data reduction using regions-of-interest or functional images have several defects which potentially limit their usefulness. Using a principal components analysis of the elemental curves representing the change of activity with time in each pixel, followed by a further factor analysis, it is possible to extract the fundamental functional changes of activity which underly the observed variation of activity. An example of this analysis on a dynamic brain scan suggests that the three fundamental phases of activity represent activity in the arterial system, the venous system and diffusion of tracer into the tissues.

Fast reconstruction of resistance images.

Resistance imaging involves the reconstruction of the distribution of electrical resistivity within a conducting object from measurements of the voltages or voltage gradients developed on the boundary of the object while current is flowing within the object. In general, the relationship between the distribution of resistivity in the object and the voltage profile on the object boundary is non-linear and attempts to reconstruct the distribution of resistivity from these profiles usually appear to involve time consuming iterative solutions. If it is assumed that the required resistivity distribution is close to a known reference distribution then it can be shown that there is an approximately linear relationship between the perturbation of the boundary voltage gradient measurements from those of the reference distribution and the logarithm of the resistivity perturbation from the reference distribution. The reconstruction problem then becomes solvable by linear methods. In particular it has proved possible to construct a single-pass back-projection method which can produce images of resistivity from a 16 electrode data collection system. Although the present implementation of this algorithm also assumes that the data is produced from a two-dimensional distribution of resistivity within a circular boundary and that the reference distribution is always uniform it seems capable of reconstructing useful images using data from three dimensional objects, including human subjects.

Applications of applied potential tomography (APT) in respiratory medicine

Impedance pneumography, electrical impedance measurements of the lung, is a technique which has been widely used to monitor respiration non-invasively and more recently, the onset of pulmonary oedema. Attempts have been made to try to localise the changes in impedance using electrode arrays and electrode guarding. These techniques allow localisation to a particular hemithorax, but the resolution of the majority of the systems remains poor. To assess the performance and possible clinical applications of APT, measurements have been made following increases in lung volume and pulmonary blood volume. During inspiration an increase in both the area and the magnitude of the impedance changes over the area of the lungs was observed. Numerical analysis of the impedance changes in normal subjects reveals a consistently high correlation between the volume of air inspired and the magnitude of the impedance changes. The resolution of the system is sufficient to monitor differences in ventilation in the right and left lung and to measure variations in these levels with posture. Preliminary clinical work suggests that APT may be used to detect ventilatory defects in certain types of lung disease. APT measurements show a decrease in resistivity over the area of the lungs when the pulmonary blood volume is increased by the intravenous infusion of 1.5 litres of isotonic saline. Similar changes in the volume of fluid in the lungs are known to occur in pulmonary oedema. APT measurements of lung impedance may detect the onset of pulmonary oedema in high risk patients.

Recent Developments in Applied Potential Tomography-APT

The electrical resistance of various tissues are known to cover a wide range of values. Table 1 shows some typical values taken from the literature and it can be seen that even within the soft tissues differences are quite substantial. Images of the distribution of resistance within the human body should show good contrast between these tissues. It is the aim of resistance imaging to produce such images.

Theoretical limits to sensitivity and resolution in impedance imaging

In any practical impedance imaging system it is important to be able to predict the image quality which can be expected from particular measurements. It is of interest both to establish the smallest object that can be detected for a certain noise level and to determine the maximum resolution for a certain number of electrodes. In impedance imaging this is not straightforward. The reason is that the resolution and the accuracy of an image which represents a conductive region are related to the number of electrodes and to the noise on the measurements. They also vary with position in the image and depend on the particular distribution of conductivity itself. It is therefore not possible, in general, to make quantitative statements about the resolution and accuracy. It is of course possible to make qualitative statements, but they are not of much use in any particular situation. Formulations are presented here which do allow quantitative assessment of the resolution and accuracy in a certain class of conductive regions. The regions to which they apply are two-dimensional and have a circular boundary shape. The details of the approach are included, both mathematically and descriptively. The quantitative improvement in image quality which can be obtained by reducing the noise, is shown both in terms of accuracy and resolution. The limit to the improvement in quality which can be obtained by taking unlimited independent measurements (i.e. using an unlimited number of electrodes) is calculated. It is shown how to predict the smallest sized object that can just be detected by measurements with a known level of noise.

Cardiac and respiratory related electrical impedance changes in the human thorax

Electrical impedance measurements have been made from the human trunk over the frequency range 9.6 kHz to 614 kHz. Measurements have been made from 12 normal subjects and the amplitude of the impedance changes associated with the cardiac and respiratory cycles have been recorded. It was found that the real part of the impedance fell to 64.0% of its low frequency value over the measured range of frequencies and that the changes associated with respiration fell in a similar manner. However, the cardiac related changes fell more rapidly with increasing frequency to 28.2% of the low frequency value. The origin of the measured changes is discussed with a view to understanding why the cardiac related changes fall more rapidly. It is not possible to relate in any simple way the frequency dispersion of a single component to that of the whole trunk. However, the results are consistent with the lungs being the major origin of both the cardiac and respiratory related components. The origin of the cardiac related impedance changes could be the pulsatile volume changes in the pulmonary tree. These could be shunted by nonpulsatile lung tissue that has decreasing impedance at high frequency and thus decreases the relative magnitude of the cardiac related changes. This hypothesis needs to be tested using localized measurements from the thorax and 3D modeling of the trunk.<<ETX>>

A review of image reconstruction techniques for electrical impedance tomography

There has recently been an increasing interest in the possibility of producing images of electrical impedance within the human body. When an electric current is applied to the body of a voltage distribution is developed across the body surface. This distribution is in part dependent on the internal impedance distribution within the body and it is possible to estimate this distribution from a suitable set of voltage measurements. Because of the nonlinear relationship between the impedance distribution and the voltage distribution at the surface of the body, the reconstruction problem is much more difficult than for other tomographic imaging techniques, but a significant amount of progress has been made, and it is now possible to produce tomographic images of in vivo distributions of impedance, albeit with low spatial resolution. Future developments should improve image quality.

In vivo imaging of cardiac related impedance changes

Electrical impedance tomography (EIT) produces cross-sectional images of the electrical resistivity distribution within the body, made from voltage or current measurements through electrodes attached around the body. The authors describe a gated EIT system to image the cardiogenic electrical resistivity variations and the results of in vivo studies on human subjects. It is shown that the sensitivity of EIT to tissue resistivity variations due to blood perfusion is good enough to image blood flow to the lungs; hence, abnormalities in pulmonary perfusion, such as pulmonary embolism, should appear in EIT images. In addition, more valuable information related to the cardiac activity can be gained from EIT images than from impedance cardiography. It is thus likely that a cardiac output index may be calculable from the average resistivity variations over the ventricles, but considerable research is required before the images can be understood in detail.<<ETX>>