G. Hahn

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.

Changes in the thoracic impedance distribution under different ventilatory conditions.

The present study was performed with the aim of checking the suitability of EIT in imaging regional thoracic impedance variations during lung ventilation under predefined conditions and to compare EIT with established reference techniques. A new technique of functional EIT imaging designed to visualize physiologically relevant information from the sequentially registered series of thoracic distributions was introduced. Experiments were performed on five spontaneously breathing healthy subjects and on 12 anaesthetized supine pigs. 16 electrodes were placed around the thorax and consecutive transthoracic impedance distributions were measured at a rate of 1 Hz (Sheffield APT system mark I, IBEES, Sheffield, UK). Several voluntary breathing manoeuvres were performed in human subjects and the tracings of local impedance were compared with standard spirometry. In animal experiments EIT was applied during artificial ventilation at different ventilation rates and during stepwise passive emptying and filling of either one or both lungs while the respiratory muscles were relaxes. Further, selective blockade of lung regions resulting in regionally reduced ventilation was performed and the capability of EIT to follow and differentiate local ventilatory disturbances was checked by reference techniques (x-ray and staining methods). The experiments revealed an overall agreement between the spirometric and impedance data in all breathing patterns performed. A linear relationship between changes of the air content of the lungs and the regional thoracic impedance was shown (intraindividual correlation coefficient range, 0.986-0.999; n = 12 animals). The functional images of the impedance distribution across the thorax reproduced adequately the typical anatomical characteristics of the pig and the human thorax. The spatial resolution of EIT functional images was sufficient to differentiate lung areas corresponding to approximately 20 ml tissue volume. EIT with the additional evaluation procedure of functional imaging was shown to be a suitable and reliable method of imaging different ventilatory conditions with the potential to become a useful tool for monitoring respiratory function.

Regional lung perfusion as determined by electrical impedance tomography in comparison with electron beam CT imaging

The aim of the experiments was to check the feasibility of pulmonary perfusion imaging by functional electrical impedance tomography (EIT) and to compare the EIT findings with electron beam computed tomography (EBCT) scans. In three pigs, a Swan-Ganz catheter was positioned in a pulmonary artery branch and hypertonic saline solution or a radiographic contrast agent were administered as boli through the distal or proximal openings of the catheter. During the administration through the proximal opening, the balloon at the tip of the catheter was either deflated or inflated. The latter case represented a perfusion defect. The series of EIT scans of the momentary distribution of electrical impedance within the chest were obtained during each saline bolus administration at a rate of 13/s. EBCT scans were acquired at a rate of 3.3/s during bolus administrations of the radiopaque contrast material under the same steady-state conditions. The EIT data were used to generate local time-impedance curves and functional EIT images showing the perfusion of a small lung region, both lungs with a perfusion defect and complete both lungs during bolus administration through the distal and proximal catheter opening with an inflated or deflated balloon, respectively. The results indicate that EIT imaging of lung perfusion is feasible when an electrical impedance contrast agent is used.

Thoracic electrical impedance tomographic measurements during volume controlled ventilation-effects of tidal volume and positive end-expiratory pressure

The aim of the study was to analyze thoracic electrical impedance tomographic (EIT) measurements accomplished under conditions comparable with clinical situations during artificial ventilation. Multiple EIT measurements were performed in pigs in three transverse thoracic planes during the volume controlled mode of mechanical ventilation at various tidal volumes (V/sub T/) and positive end-expiratory pressures (PEEP). The protocol comprised following ventilatory patterns: (1) V/sub T/ (400, 500, 600, 700 ml) was varied in a random order at various constant PEEP levels and (2) PEEP (2, 5, 8, 11, 14 cm H/sub 2/O) was randomly modified during ventilation with a constant V/sub T/. The EIT technique was used to generate cross-sectional images of (1) regional lung ventilation and (2) regional shifts in lung volume with PEEP. The quantitative analysis was performed in terms of the tidal amplitude of the impedance change, reflecting the volume of delivered gas at various preset V/sub T/ and the end-expiratory impedance change, revealing the variation of the lung volume at various PEEP levels. The results showed: (1) an increase in the tidal amplitude of the impedance change, proportional to the delivered V/sub T/ at all constant PEEP levels, (2) a rising end-expiratory impedance change, with PEEP reflecting an increase in gas volume, and (3) a PEEP-dependent redistribution of the ventilated gas between the planes. The generated images and the quantitative results indicate the ability of EIT to identify regional changes in V/sub T/ and lung volume during mechanical ventilation.

Electrical impedance tomography in monitoring experimental lung injury

ObjectiveTo apply electrical impedance tomography (EIT) and the new evaluation approach (the functional EIT) in monitoring the development of artificial lung injury.DesignAcute experimental trial.SettingOperating room for animal experimental studies at a university hospital.SubjectsFive pigs (41.3 ± 4.1 kg, mean body weight ± SD).InterventionsThe animals were anaesthetised and mechanically ventilated. Sixteen electrodes were attached on the thoracic circumference and used for electrical current injection and surface voltage measurement. Oleic acid was applied sequentially (total dose 0.05 ml/kg body weight) into the left pulmonary artery to produce selective unilateral lung injury.Measurements and resultsThe presence of lung injury was documented by significant changes of PaCO2 (40.1 mmHg vs control 37.1 mmHg), PaO2 (112.3 mmHg vs 187.5 mmHg), pH (7.35 vs 7.42), mean pulmonary arterial pressure (29.2 mmHg vs 20.8 mmHg) and chest radiography. EIT detected 1) a regional decrease in mean impedance variation over the affected left lung (−41.4% vs control) and an increase over the intact right lung (+ 20.4 % vs control) indicating reduced ventilation of the affected, and a compensatory augmented ventilation of the unaffected lung and 2) a pronounced fall in local baseline electrical impedance over the injured lung (−20.6 % vs control) with a moderate fall over the intact lung (−10.0% vs control) indicating the development of lung oedema in the injured lung with a probable atelectasis formation in the contralateral one.ConclusionThe development of the local impairment of pulmonary ventilation and the formation of lung oedema could be followed by EIT in an experimental model of lung injury. This technique may become a useful tool for monitoring local pulmonary ventilation in intensive care patients suffering from pulmonary disorders associated with regionally reduced ventilation, fluid accumulation and/or cell membrane changes.

Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography

Background: Electrical impedance tomography (EIT) is a noninvasive technique providing cross‐sectional images of the thorax. We have tested an extended evaluation procedure, the functional EIT (f‐EIT), to identify the local shifts of ventilation known to occur during the transition between spontaneous, controlled and assisted ventilation modes.

Imaging pathologic pulmonary air and fluid accumulation by functional and absolute EIT

The increasing use of EIT in clinical research on severely ill lung patients requires a clarification of the influence of pathologic impedance distributions on the validity of the resulting tomograms. Significant accumulation of low-conducting air (e.g. pneumothorax or emphysema) or well-conducting liquid (e.g. haematothorax or atelectases) may conflict with treating the imaging problem as purely linear. First, we investigated the influence of stepwise inflation and deflation by up to 300 ml of air and 300 ml of Ringer solution into the pleural space of five pigs on the resulting tomograms during ventilation at constant tidal volume. Series of EIT images representing relative impedance changes were generated on the basis of a modified Sheffield back projection algorithm and ventilation distribution was displayed as functional (f-EIT) tomograms. In addition, a modified simultaneous iterative reconstruction technique (SIRT) was applied to quantify the resistivity distribution on an absolute level scaled in Omega m (a-EIT). Second, we applied these two EIT techniques on four intensive care patients with inhomogeneous air and fluid distribution and compared the EIT results to computed tomography (CT) and to a reference set of intrathoracic resistivity data of 20 healthy volunteers calculated by SIRT. The results of the animal model show that f-EIT based on back projection is not disturbed by the artificial pneumo- or haematothorax. Application of SIRT allows reliable discrimination and detection of the location and amplitude of pneumo- or haematothorax. These results were supported by the good agreement between the electrical impedance tomograms and CT scans on patients and by the significant differences of regional resistivity data between patients and healthy volunteers.

Regional filling characteristics of the lungs in mechanically ventilated patients with acute lung injury

Objectives: The objective of the study was to determine regional pulmonary filling characteristics in 20 mechanically ventilated patients with acute lung injury. Methods: Regional filling characteristics were calculated from tracings of regional tidal volumes vs. global tidal volumes measured by electrical impedance tomography (EIT). These plots were fitted to a polynomial function of the second degree. Regional polynomial coefficients of the second degree characterized the curve linearity of the plots. Near‐zero values of the polynomial coefficient indicated a homogeneous increase in regional tidal volumes during the whole inspiration. Positive values hinted at initial low regional tidal volume change suggesting lung volume recruitment. Negative values indicated late low regional tidal volume change implying hyperinflation of this lung region. Results: We found a broad heterogeneity of regional lung filling characteristics. The minimal regional polynomial coefficients varied from −2.80 to −0.56 (median −1.16), while the maximal regional polynomial coefficients varied from 0.58 to 3.65 (median 1.41). Conclusions: Measurements of regional filling characteristics by EIT may be a helpful tool to adjust the respiratory settings during mechanical ventilation to optimize lung recruitment and to avoid overdistension. It applies a non‐pressure‐related assessment to the mechanics of lung inflation and gives a view of the real problems underlying ventilatory strategies dependent on global characteristics.

Distribution of ventilation in young and elderly adults determined by electrical impedance tomography

To determine the effect of age and posture on regional lung ventilation, eight young (26 +/- 1 years, mean +/- S.D.) and eight old (73 +/- 5 years) healthy men were studied by electrical impedance tomography in four body positions (sitting, supine, right and left lateral). The distribution of gas into the right and left lung regions was determined in the chest cross-section during tidal breathing at the resting lung volume, near residual volume and total lung capacity, as well as forced and slow vital capacity maneuvers. In the young, significant posture-dependent changes in gas distribution occurred during resting tidal breathing whereas they were absent in the elderly. In the older subjects, the contribution of the right lung to global ventilation fell with the transition from sitting to supine posture during both full expiration maneuvers. During forced vital capacity, the high flow rate and early airway closure in the dependent lung, occurring at higher volumes in the elderly, minimized the posture-dependency in gas distribution which was present during the slow maneuver. Our study revealed the significant effect of age on posture-dependent changes in ventilation distribution.

Gravity-dependent phenomena in lung ventilation determined by functional EIT.

Gravity exerts an effect on the distribution of intrapulmonary ventilation. A study on the detection of gravity-dependent inhomogeneity of ventilation by a functional EIT technique is presented. The study was performed on five human subjects, whose ventilation distribution was modified by changes in body position. The subjects were studied during spontaneous tidal breathing. The qualitative and quantitative analysis of the functional EIT images revealed that the ventilation is higher in the dependent lung regions when compared with the non-dependent ones. These EIT findings correspond to current knowledge of the physiological behaviour of the lungs as derived from the radioactive-gas methods and raise the possibility of applying the less complicated functional EIT in future studies on ventilation distribution in the lungs. This may be of major interest in the monitoring of intensive care patients with severe pulmonary disorders.