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Article ; Online: Numerical Analysis of the Localization of Pulmonary Nodules during Thoracoscopic Surgery by Ultra-Wideband Radio Technology

Alberto Battistel / Peter Paul Pott / Knut Möller

Applied Sciences, Vol 11, Iss 4282, p

2021 Volume 4282

Abstract: Worldwide, lung cancer is one of the most common causes of cancer-related death. Detected by computer tomography, it is usually removed through thoracoscopic surgery. During the surgery the lung collapses requiring some strategies to track or localize ... ...

Abstract	Worldwide, lung cancer is one of the most common causes of cancer-related death. Detected by computer tomography, it is usually removed through thoracoscopic surgery. During the surgery the lung collapses requiring some strategies to track or localize the new position of the lesion. This is particularly challenging in the case of minimally invasive surgeries when mechanical palpation is not possible. Here we undertake a preliminary study with numerical analysis of an ultra-wideband (UWB) radio technology which can be employed directly during thoracoscopic surgery to localize deep solitary pulmonary nodules. This study was conducted through Finite Difference Time Domain (FDTD) simulations, where a spherical target mimicking a nodule located between 1 and 6 cm of depth and an UWB pulse at several frequencies between 0.5 and 5 GHz was used for localization. This investigation quantifies the influence of several parameters, such frequency, lesion depth, and number of acquisitions, on the final confocal image used to locate a cancer in the lung tissue. We also provide extensive discussion on several artifacts that appear in the images. The results show that the cancer localization was possible at operational frequencies below 1 GHz and for deep nodules (>5 cm), while at lower depths and higher frequencies several artifacts hindered its detection.
Keywords	lung cancer ; solitary pulmonary nodule (SPN) ; microwave imaging ; ultra-wideband (UWB) ; finite difference time domain (FDTD) ; Technology ; T ; Engineering (General). Civil engineering (General) ; TA1-2040 ; Biology (General) ; QH301-705.5 ; Physics ; QC1-999 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Structural priors represented by discrete cosine transform improve EIT functional imaging.

Rongqing Chen / Sabine Krueger-Ziolek / András Lovas / Balázs Benyó / Stefan J Rupitsch / Knut Moeller

PLoS ONE, Vol 18, Iss 5, p e

2023 Volume 0285619

Abstract: Structural prior information can improve electrical impedance tomography (EIT) reconstruction. In this contribution, we introduce a discrete cosine transformation-based (DCT-based) EIT reconstruction algorithm to demonstrate a way to incorporate the ... ...

Abstract	Structural prior information can improve electrical impedance tomography (EIT) reconstruction. In this contribution, we introduce a discrete cosine transformation-based (DCT-based) EIT reconstruction algorithm to demonstrate a way to incorporate the structural prior with the EIT reconstruction process. Structural prior information is obtained from other available imaging methods, e.g., thorax-CT. The DCT-based approach creates a functional EIT image of regional lung ventilation while preserving the introduced structural information. This leads to an easier interpretation in clinical settings while maintaining the advantages of EIT in terms of bedside monitoring during mechanical ventilation. Structural priors introduced in the DCT-based approach are of two categories in terms of different levels of information included: a contour prior only differentiates lung and non-lung region, while a detail prior includes information, such as atelectasis, within the lung area. To demonstrate the increased interpretability of the EIT image through structural prior in the DCT-based approach, the DCT-based reconstructions were compared with reconstructions from a widely applied one-step Gauss-Newton solver with background prior and from the advanced GREIT algorithm. The comparisons were conducted both on simulation data and retrospective patient data. In the simulation, we used two sets of forward models to simulate different lung conditions. A contour prior and a detail prior were derived from simulation ground truth. With these two structural priors, the reconstructions from the DCT-based approach were compared with the reconstructions from both the one-step Gauss-Newton solver and the GREIT. The difference between the reconstructions and the simulation ground truth is calculated by the ℓ2-norm image difference. In retrospective patient data analysis, datasets from six lung disease patients were included. For each patient, a detail prior was derived from the patient's CT, respectively. The detail prior was used for the ...
Keywords	Medicine ; R ; Science ; Q
Subject code	518
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Analysing multi-perspective patient-related data during laparoscopic gynaecology procedures

Nour Aldeen Jalal / Tamer Abdulbaki Alshirbaji / Bernhard Laufer / Paul D. Docherty / Thomas Neumuth / Knut Moeller

Scientific Reports, Vol 13, Iss 1, Pp 1-

2023 Volume 16

Abstract: Abstract Fusing data from different medical perspectives inside the operating room (OR) sets the stage for developing intelligent context-aware systems. These systems aim to promote better awareness inside the OR by keeping every medical team well ... ...

Abstract	Abstract Fusing data from different medical perspectives inside the operating room (OR) sets the stage for developing intelligent context-aware systems. These systems aim to promote better awareness inside the OR by keeping every medical team well informed about the work of other teams and thus mitigate conflicts resulting from different targets. In this research, a descriptive analysis of data collected from anaesthesiology and surgery was performed to investigate the relationships between the intra-abdominal pressure (IAP) and lung mechanics for patients during laparoscopic procedures. Data of nineteen patients who underwent laparoscopic gynaecology were included. Statistical analysis of all subjects showed a strong relationship between the IAP and dynamic lung compliance (r = 0.91). Additionally, the peak airway pressure was also strongly correlated to the IAP in volume-controlled ventilated patients (r = 0.928). Statistical results obtained by this study demonstrate the importance of analysing the relationship between surgical actions and physiological responses. Moreover, these results form the basis for developing medical decision support models, e.g., automatic compensation of IAP effects on lung function.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The influence of gravity on electrical impedance tomography measurements during upper body position change

Lin Yang / Zhijun Gao / Xinsheng Cao / Feng Fu / Knut Möller / Inéz Frerichs / Meng Dai / Zhanqi Zhao

Heliyon, Vol 9, Iss 5, Pp e15910- (2023)

2023

Abstract: Objective: The aim of the study was to examine the influence of gravity on regional ventilation measured by electrical impedance tomography (EIT) with the standard electrode belt position at the 5th intercostal space during tilting from supine to sitting ...

Abstract	Objective: The aim of the study was to examine the influence of gravity on regional ventilation measured by electrical impedance tomography (EIT) with the standard electrode belt position at the 5th intercostal space during tilting from supine to sitting positions. Methods: A total of 30 healthy volunteers were examined prospectively in supine position during quiet tidal breathing. Subsequently, the bed was tilted so that the upper body of the subjects achieved 30, 60 and 90° every 3 min. Regional ventilation distribution and end-expiratory lung impedance (EELI) were monitored with EIT throughout the whole experiment. Absolute tidal volumes were measured with spirometry and the volume-impedance ratio was calculated for each position. Results: The volume-impedance ratio did not differ statistically between the studied body positions but 11 subjects exhibited a large change in ratio at one of the positions (outside 99.3% coverage). In general, ventilation distribution became more heterogeneous and moved towards dorsal regions as the upper body was tilted to 90-degree position. EELI increased and tidal volume decreased. The lung regions identified at various positions differed significantly. Conclusion: Gravity has non-negligible influence on EIT data, as the upper body tilted from supine to sitting positions. The standard electrode belt position might be reconsidered if ventilation distribution is to be compared between supine and sitting positions.
Keywords	Electrical impedance tomography ; Ventilation distribution ; Upper body position ; Diaphragm ; Gravity ; Science (General) ; Q1-390 ; Social sciences (General) ; H1-99
Subject code	796
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Respiratory monitoring dataset, with rapid expiratory occlusions, over increasing positive airway pressure ventilation

Ella F.S. Guy / Jaimey A. Clifton / Trudy Calje-Van Der Klei / Rongqing Chen / Jennifer L. Knopp / Knut Möller / J. Geoffrey Chase

Data in Brief, Vol 52, Iss , Pp 109874- (2024)

1481

Abstract: Resting breathing data was collected from 80 smokers, vapers, asthmatics, and otherwise healthy people in the low-risk clinical unit at the University of Canterbury. Subjects were asked to breathe normally through a full-face mask connected to a Fisher ... ...

Abstract	Resting breathing data was collected from 80 smokers, vapers, asthmatics, and otherwise healthy people in the low-risk clinical unit at the University of Canterbury. Subjects were asked to breathe normally through a full-face mask connected to a Fisher and Paykel Healthcare SleepStyle SPSCAA CPAP device. PEEP (Positive End-Expiratory Pressure) support was increased from 4 to 12 cmH2O in 0.5 cmH2O increments. Data was also collected during resting breathing at ZEEP (0 cmH2O) before and after the PEEP trial. The trial was conducted under University of Canterbury Human Research Ethics Committee consent (Ref: HREC 2023/04/LR-PS). Data was collected by and Dräeger PulmoVista 500 EIT machine and a custom Venturi-based pressure and flow sensor device connected in series with the CPAP and full-face mask. The outlined dataset includes pressure, flow, volume, dynamic circumference (thoracic and abdominal, and cross-sectional aeration. Subject demographic data was self-reported using a questionnaire given prior to the trial.
Keywords	Pulmonary mechanics ; Venturi ; Spirometry ; Electrical impedance tomography ; Vapers ; Smokers ; Computer applications to medicine. Medical informatics ; R858-859.7 ; Science (General) ; Q1-390
Language	English
Publishing date	2024-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Differentiating Phenotypes of Coronavirus Disease-2019 Pneumonia by Electric Impedance Tomography

András Lovas / Rongqing Chen / Tamás Molnár / Balázs Benyó / Ákos Szlávecz / Fatime Hawchar / Sabine Krüger-Ziolek / Knut Möller

Frontiers in Medicine, Vol

2022 Volume 9

Abstract: IntroductionCoronavirus disease-2019 (COVID-19) pneumonia has different phenotypes. Selecting the patient individualized and optimal respirator settings for the ventilated patient is a challenging process. Electric impedance tomography (EIT) is a real- ... ...

Abstract	IntroductionCoronavirus disease-2019 (COVID-19) pneumonia has different phenotypes. Selecting the patient individualized and optimal respirator settings for the ventilated patient is a challenging process. Electric impedance tomography (EIT) is a real-time, radiation-free functional imaging technique that can aid clinicians in differentiating the “low” (L-) and “high” (H-) phenotypes of COVID-19 pneumonia described previously.MethodsTwo patients (“A” and “B”) underwent a stepwise positive end-expiratory pressure (PEEP) recruitment by 3 cmH2O of steps from PEEP 10 to 25 and back to 10 cmH2O during a pressure control ventilation of 15 cmH2O. Recruitment maneuvers were performed under continuous EIT recording on a daily basis until patients required controlled ventilation mode.ResultsPatients “A” and “B” had a 7- and 12-day long trial, respectively. At the daily baseline, patient “A” had significantly higher compliance: mean ± SD = 53 ± 7 vs. 38 ± 5 ml/cmH2O (p < 0.001) and a significantly higher physiological dead space according to the Bohr–Enghoff equation than patient “B”: mean ± SD = 52 ± 4 vs. 45 ± 6% (p = 0.018). Following recruitment maneuvers, patient “A” had a significantly higher cumulative collapse ratio detected by EIT than patient “B”: mean ± SD = 0.40 ± 0.08 vs. 0.29 ± 0.08 (p = 0.007). In patient “A,” there was a significant linear regression between the cumulative collapse ratios at the end of the recruitment maneuvers (R2 = 0.824, p = 0.005) by moving forward in days, while not for patient “B” (R2 = 0.329, p = 0.5).ConclusionPatient “B” was recognized as H-phenotype with high elastance, low compliance, higher recruitability, and low ventilation-to-perfusion ratio; meanwhile patient “A” was identified as the L-phenotype with low elastance, high compliance, and lower recruitability. Observation by EIT was not just able to differentiate the two phenotypes, but it also could follow the transition from L- to H-type within patient “A.”Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: ...
Keywords	acute lung injury ; compliance ; Coronavirus-COVID-19 ; electric impedance tomography ; recruitment maneuver ; Medicine (General) ; R5-920
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Scoring System to Evaluate the Performance of ICU Ventilators in the Pandemic of COVID-19

Xingshuo Hu / Fei Xie / Kaifei Wang / Hongjun Gu / Guoxin Mo / Ruoxuan Wen / Ying Zhao / Qingyun Yang / Knut Möller / Zhanqi Zhao / Lixin Xie

Frontiers in Medicine, Vol

A Lung Model Study

2021 Volume 8

Abstract: Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of ... ...

Abstract	Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of COVID-19. The scoring system was established by weighting the ventilator performance on five different aspects: the stability of pressurization, response to leaks alteration, performance of reaction, volume delivery, and accuracy in oxygen delivery. The weighting factors were determined with analytic hierarchy process (AHP). Survey was sent out to 66 clinical and mechanical experts. The scoring system was built based on 54 valid replies. A total of 12 commercially available ICU ventilators providing non-invasive ventilation were evaluated using the novel scoring system. A total of eight ICU ventilators with non-invasive ventilation mode and four dedicated non-invasive ventilators were tested according to the scoring system. Four COVID-19 phenotypes were simulated using the ASL5000 lung simulator, namely (1) increased airway resistance (IR) (10 cm H2O/L/s), (2) low compliance (LC) (compliance of 20 ml/cmH2O), (3) low compliance plus increased respiratory effort (LCIE) (respiratory rate of 40 and inspiratory effort of 10 cmH2O), (4) high compliance (HC) (compliance of 50 ml/cmH2O). All of the ventilators were set to three combinations of pressure support and positive end-expiratory pressure levels. The data were collected at baseline and at three customized leak levels. Significant inaccuracies and variations in performance between different non-invasive ventilators were observed, especially in the aspect of leaks alteration, oxygen and volume delivery. Some ventilators have stable performance in different simulated phenotypes whereas the others have over 10% scoring differences. It is feasible to use the proposed scoring system to evaluate the ventilator performance. In the COVID-19 pandemic, clinicians should be aware of possible strengths and weaknesses of ventilators.
Keywords	scoring system ; ventilator performance ; stability of pressurization ; leakage correction ; accuracy in volume delivery ; performance of triggering ; Medicine (General) ; R5-920
Subject code	690
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Model-based PEEP titration versus standard practice in mechanical ventilation

Kyeong Tae Kim / Sophie Morton / Sarah Howe / Yeong Shiong Chiew / Jennifer L. Knopp / Paul Docherty / Christopher Pretty / Thomas Desaive / Balazs Benyo / Akos Szlavecz / Knut Moeller / Geoffrey M. Shaw / J. Geoffrey Chase

Trials, Vol 21, Iss 1, Pp 1-

a randomised controlled trial

2020 Volume 18

Abstract: Abstract Background Positive end-expiratory pressure (PEEP) at minimum respiratory elastance during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) may improve patient care and outcome. The Clinical utilisation of ... ...

Abstract	Abstract Background Positive end-expiratory pressure (PEEP) at minimum respiratory elastance during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) may improve patient care and outcome. The Clinical utilisation of respiratory elastance (CURE) trial is a two-arm, randomised controlled trial (RCT) investigating the performance of PEEP selected at an objective, model-based minimal respiratory system elastance in patients with ARDS. Methods and design The CURE RCT compares two groups of patients requiring invasive MV with a partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio ≤ 200; one criterion of the Berlin consensus definition of moderate (≤ 200) or severe (≤ 100) ARDS. All patients are ventilated using pressure controlled (bi-level) ventilation with tidal volume = 6–8 ml/kg. Patients randomised to the control group will have PEEP selected per standard practice (SPV). Patients randomised to the intervention will have PEEP selected based on a minimal elastance using a model-based computerised method. The CURE RCT is a single-centre trial in the intensive care unit (ICU) of Christchurch hospital, New Zealand, with a target sample size of 320 patients over a maximum of 3 years. The primary outcome is the area under the curve (AUC) ratio of arterial blood oxygenation to the fraction of inspired oxygen over time. Secondary outcomes include length of time of MV, ventilator-free days (VFD) up to 28 days, ICU and hospital length of stay, AUC of oxygen saturation (SpO2)/FiO2 during MV, number of desaturation events (SpO2 < 88%), changes in respiratory mechanics and chest x-ray index scores, rescue therapies (prone positioning, nitric oxide use, extracorporeal membrane oxygenation) and hospital and 90-day mortality. Discussion The CURE RCT is the first trial comparing significant clinical outcomes in patients with ARDS in whom PEEP is selected at minimum elastance using an objective model-based method able to quantify and consider both inter-patient and intra-patient variability. CURE aims to demonstrate the hypothesized benefit of patient-specific PEEP and attest to the significance of real-time monitoring and decision-support for MV in the critical care environment. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN12614001069640. Registered on 22 September 2014. (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366838&isReview=true) The CURE RCT clinical protocol and data usage has been granted by the New Zealand South Regional Ethics Committee (Reference number: 14/STH/132).
Keywords	ARDS ; Mechanical ventilation ; Pulmonary mechanics ; RCT ; PEEP titration ; recruitment manoeuvre ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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