Pamela T. Bhatti

A System for Seismocardiography-Based Identification of Quiescent Heart Phases: Implications for Cardiac Imaging

Seismocardiography (SCG), a representation of mechanical heart motion, may more accurately determine periods of cardiac quiescence within a cardiac cycle than the electrically derived electrocardiogram (EKG) and, thus, may have implications for gating in cardiac computed tomography. We designed and implemented a system to synchronously acquire echocardiography, EKG, and SCG data. The device was used to study the variability between EKG and SCG and characterize the relationship between the mechanical and electrical activity of the heart. For each cardiac cycle, the feature of the SCG indicating Aortic Valve Closure was identified and its time position with respect to the EKG was observed. This position was found to vary for different heart rates and between two human subjects. A color map showing the magnitude of the SCG acceleration and computed velocity was derived, allowing for direct visualization of quiescent phases of the cardiac cycle with respect to heart rate.

Integrating Patient Digital Photographs with Medical Imaging Examinations

We introduce the concept, benefits, and general architecture for acquiring, storing, and displaying digital photographs along with medical imaging examinations. We also discuss a specific implementation built around an Android-based system for simultaneously acquiring digital photographs along with portable radiographs. By an innovative application of radiofrequency identification technology to radiographic cassettes, the system is able to maintain a tight relationship between these photographs and the radiographs within the picture archiving and communications system (PACS) environment. We provide a cost analysis demonstrating the economic feasibility of this technology. Since our architecture naturally integrates with patient identification methods, we also address patient privacy issues.

Cochlear Implantation Using Thin-Film Array Electrodes:

Objective. Current limitations in language perception may stem from an inability to provide high-resolution sound input. Thin-film array technology allows for a greater density of stimulating sites within the limited diameter of the scala tympani. This study examines the use of a flexible carrier to achieve adequate depth of insertion. Study Design. A prospective human cadaveric temporal bone insertion analysis. Setting. Academic otolaryngology department and school of electrical and computer engineering collaboration. Methods. A prototype thin-film array electrode coupled with an insertion test device (ITD) was manufactured and inserted into 10 human cadaveric temporal bones. As controls, 2 additional temporal bones were implanted with the ITD only and 2 were unimplanted. Radiologic and histologic data were collected. Results. Ten thin-film array electrodes were successfully implanted into 10 individual temporal bones via round window (5) and cochleostomy (5) approaches. Seventeen millimeters of insertion was noted for each device, with an average angular insertion depth of 292° by radiographic measurements and 392° by histologic sectioning. Electrode distance to the modiolus averaged 0.88 mm by computed tomography and 0.67 mm by histologic measurements. Average percentage trauma was 26% for the ITD-backed arrays compared with 15% and 29% for ITD only and unimplanted temporal bones, respectively. Conclusion. Thin-film array electrodes coupled with an ITD were successfully inserted into the human cochlea with limited trauma. With continued development and testing of this electrode design, the thin-film array may improve the language perception achieved through cochlear implantation.

A Field-Programmable Analog Array Development Platform for Vestibular Prosthesis Signal Processing

We report on a vestibular prosthesis signal processor realized using an experimental field programmable analog array (FPAA). Completing signal processing functions in the analog domain, the processor is designed to help replace a malfunctioning inner ear sensory organ, a semicircular canal. Relying on angular head motion detected by an inertial sensor, the signal processor maps angular velocity into meaningful control signals to drive a current stimulator. To demonstrate biphasic pulse control a 1 k Ω resistive load was placed across an H-bridge circuit. When connected to a 2.4 V supply, a biphasic current of 100 μA was maintained at stimulation frequencies from 50-350 Hz, pulsewidths from 25-400 μ sec, and interphase gaps ranging from 25-250 μsec.

A Cochlear Implant Signal Processing Lab: Exploration of a Problem-Based Learning Exercise

This paper presents an introductory signal processing laboratory and examines this laboratory exercise in the context of problem-based learning (PBL). Centered in a real-world application, a cochlear implant, the exercise challenged students to demonstrate a working software-based signal processor. Partnering in groups of two or three, second-year electrical and computer engineering and biomedical engineering students used MATLAB graphical user interface programs, complemented with their own original MATLAB code, to design filters suitable for achieving a filter bank decomposition of an audio signal. Rather than using the envelope-detected output for direct electrical stimulation of auditory nerve fibers as in an implant, the students reconstructed the signal by modulating sinusoids to yield an acoustic simulation. To appreciate the impact of filter order on sound intelligibility, students were asked to reconstruct signals using 4-16 filter channels for both speech and music and to examine the results critically. The lab served as a substrate upon which to solidify fundamental signal processing concepts such as the distinction between time and frequency domains, constructing and interpreting spectrograms, sampling, spectral decomposition, filtering, and reconstruction. In the spirit of PBL, the students examined engineering tradeoffs and discussed implementations when they were asked to consider realizing a significantly higher channel count (128-channel) device. To determine how the laboratory exercise impacted student learning and comprehension, as well as the level of student engagement achieved with this compelling application, an anonymous online survey was administered at the end of the course. The survey outcomes, as well as the components of the lab, are discussed in the context of PBL pedagogy.

Low-power sensing for vestibular prostheses

This paper describes a novel sensing approach for reducing power requirements of implantable vestibular prostheses. A passive, microfabricated polymeric inertial sensor for detecting angular head rotations based on the biomechanics of the human semicircular canal is described. Angular head motion is coded by deflection of a highly compliant capacitor plate placed in parallel with a rigid reference electrode. This capacitance change serves to detect instantaneous angular velocity along a given axis of rotation. Designed for integration with a microelectromechanical systems-based fully implantable vestibular prosthesis, this sensing method can provide substantial power savings when compared with contemporary gyroscopes.

Current steering and current focusing with a high-density intracochlear electrode array

Creating high-resolution or high-density, intra-cochlear electrode arrays may significantly improve quality of hearing for cochlear implant recipients. Through focused activation of neural populations such arrays may better exploit the cochleas frequency-to-place mapping, thereby improving sound perception. Contemporary electrode arrays approach high-density stimulation by employing multi-polar stimulation techniques such as current steering and current focusing. In our procedure we compared an advanced high-density array with contemporary arrays employing these strategies. We examined focused stimulation of auditory neurons using an activating function and a neural firing probability model that together enable a first-order estimation of an auditory nerve fibers response to electrical stimulation. The results revealed that simple monopolar stimulation with a high-density array is more localized than current steering with a contemporary array and requires 25–30% less current. Current focusing with high-density electrodes is more localized than current focusing with a contemporary array; however, a greater amount of current is required. This work illustrates that advanced high-density electrode arrays may provide a low-power, high-resolution alternative to current steering with contemporary cochlear arrays.

A trimodal system for the acquisition of synchronous echocardiography, electrocardiography, and seismocardiography data

A novel system was developed to acquire synchronous echocardiography, electrocardiography (EKG), and seismocardiography (SCG) data. The system was developed to facilitate the study of the relationship between the mechanical and electrical characteristics of the heart. The system has both a hardware and software component. The hardware component consists of an application-specific device designed and built to acquire both SCG and EKG signals simultaneously. The software component consists of a package developed to record and synchronize data from both the device and a clinical ultrasound machine. A feasibility test was performed by simultaneous acquisition of a synchronous dataset from a human subject.

Seismocardiography-Based Cardiac Computed Tomography Gating Using Patient-Specific Template Identification and Detection

To more accurately trigger cardiac computed tomography angiography (CTA) than electrocardiography (ECG) alone, a sub-system is proposed as an intermediate step toward fusing ECG with seismocardiography (SCG). Accurate prediction of quiescent phases is crucial to prospectively gating CTA, which is susceptible to cardiac motion and, thus, can affect the diagnostic quality of images. The key innovation of this sub-system is that it identifies the SCG waveform corresponding to heart sounds and determines their phases within the cardiac cycles. Furthermore, this relationship is modeled as a linear function with respect to heart rate. For this paper, B-mode echocardiography is used as the gold standard for identifying the quiescent phases. We analyzed synchronous ECG, SCG, and echocardiography data acquired from seven healthy subjects (mean age: 31; age range: 22–48; males: 4) and 11 cardiac patients (mean age: 56; age range: 31–78; males: 6). On average, the proposed algorithm was able to successfully identify 79% of the SCG waveforms in systole and 68% in diastole. The simulated results show that SCG-based prediction produced less average phase error than that of ECG. It was found that the accuracy of ECG-based gating is more susceptible to increases in heart rate variability, while SCG-based gating is susceptible to high cycle to cycle variability in morphology. This pilot work of prediction using SCG waveforms enriches the framework of a comprehensive system with multiple modalities that could potentially, in real time, improve the image quality of CTA.

Echocardiography as an indication of continuous-time cardiac quiescence.

Cardiac computed tomography (CT) angiography using prospective gating requires that data be acquired during intervals of minimal cardiac motion to obtain diagnostic images of the coronary vessels free of motion artifacts. This work is intended to assess B-mode echocardiography as a continuous-time indication of these quiescent periods to determine if echocardiography can be used as a cost-efficient, non-ionizing modality to develop new prospective gating techniques for cardiac CT. These new prospective gating approaches will not be based on echocardiography itself but on CT-compatible modalities derived from the mechanics of the heart (e.g. seismocardiography and impedance cardiography), unlike the current standard electrocardiogram. To this end, echocardiography and retrospectively-gated CT data were obtained from ten patients with varied cardiac conditions. CT reconstructions were made throughout the cardiac cycle. Motion of the interventricular septum (IVS) was calculated from both echocardiography and CT reconstructions using correlation-based, deviation techniques. The IVS was chosen because it (1) is visible in echocardiography images, whereas the coronary vessels generally are not, and (2) has been shown to be a suitable indicator of cardiac quiescence. Quiescent phases were calculated as the minima of IVS motion and CT volumes were reconstructed for these phases. The diagnostic quality of the CT reconstructions from phases calculated from echocardiography and CT data was graded on a four-point Likert scale by a board-certified radiologist fellowship-trained in cardiothoracic radiology. Using a Wilcoxon signed-rank test, no significant difference in the diagnostic quality of the coronary vessels was found between CT volumes reconstructed from echocardiography- and CT-selected phases. Additionally, there was a correlation of 0.956 between the echocardiography- and CT-selected phases. This initial work suggests that B-mode echocardiography can be used as a tool to develop CT-compatible gating techniques based on modalities derived from cardiac mechanics rather than relying on the ECG alone.