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基於血管彈力波及脈衝傳遞時間之多變參數建立血 壓估算法 Development of a Blood Pressure Estimation Based on Femoral Artery Elasticity Wave and Pulse Transit Time Parameters Adviser:

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Presentation on theme: "基於血管彈力波及脈衝傳遞時間之多變參數建立血 壓估算法 Development of a Blood Pressure Estimation Based on Femoral Artery Elasticity Wave and Pulse Transit Time Parameters Adviser:"— Presentation transcript:

1 基於血管彈力波及脈衝傳遞時間之多變參數建立血 壓估算法 Development of a Blood Pressure Estimation Based on Femoral Artery Elasticity Wave and Pulse Transit Time Parameters Adviser: Huang Ji-Jer Presenter:Syu Hao-Yi Date:2014/03/12

2 1.Introduction 1.Brief introduction 2.ECG, PPG,FET background and principles 3.Research on motivation and purpose 2.Paper Review 3.Materials and Methods 1.Sensor application 2.Analog circuits 3.Signal processing 4.Digital Circuits 5.GUI 6.Parameter definition 7.Software flowchart 8.Regression analysis and estimation of blood pressure OUTLINE

3 4.Results and Discussion 1.Analog circuit analysis and measurement 2.Digital filtering assessment and actual measurements 3.Digital filtering results built on firmware 4. Verification system 5.NI/LabWindows GUI 6.Auto gain control setting 7.Experiments 5.Conclusions and Future Work OUTLINE

4 Brief introduction – Health promotion and fertility decline in mainly reason for the problem of an aging population – An international reach 7% of the population aged 65 is an aging, 14% called for aged, 20% called for super-aged INTRODUCTION1.INTRODUCTION 出處 : 行政院經濟建設委員會人力規劃處 101 年 7 月 23 日

5 Brief introduction – Cardiovascular defects and disease caused by diet on life INTRODUCTION1.INTRODUCTION 出處 : 行政院衛生署

6 Brief introduction – Growing population, chronic diseases and functional disorders are increasing, except for medical services,the home care services have been our needs INTRODUCTION1.INTRODUCTION Photo Source : http://www.2cm.com.tw/zoomin_content.asp?sn=0912020016

7 ECG, PPG,FET background and principles – ECG records the heart in nerve conduction arising from potential changes graphics – Potential change of the heart begins with the rhythm generator of sinoatrial node (SA node) INTRODUCTION1.INTRODUCTION Photo Source : http://www.bostonscientific.com/lifebeat-online/heart-smart/electrical-system.html

8 INTRODUCTION ECG, PPG,FET background and principles – The electrocardiogram (ECG) or elektrokardiogramm (EKG) is a medical standard for testing the human heart for defects and diseases – The typical amplitude of the R wave of the ECG signal is approximately 1 mV 1.INTRODUCTION

9 ECG, PPG,FET background and principles – A photoplethysmograph (PPG) the use of light source to measure the blood volume change of the blood vessel – Each ECG signal cycle corresponds to a PPG signal INTRODUCTION1.INTRODUCTION Photo Source : INVESTIGATION OF NEW ELECTRO - OPTICAL TECHNIQUES FOR MONITORING PATIENTS WITH COMPROMISED PERIPHERAL PERFUSION IN ANAESTHESIA

10 ECG, PPG,FET background and principles – PPG signal amplitude with the blood out of the tissue will be directly proportional to the change INTRODUCTION1.INTRODUCTION Photo Source : INVESTIGATION OF NEW ELECTRO - OPTICAL TECHNIQUES FOR MONITORING PATIENTS WITH COMPROMISED PERIPHERAL PERFUSION IN ANAESTHESIA

11 ECG, PPG,FET background and principles – FET(Femoral artery elasticity wave) 1.INTRODUCTION

12 Research on motivation and purpose – Capture ECG 、 PPG 、 FET signal characteristics(PAT 、 HR 、 TDB 、 FET) estimate blood pressure 1.INTRODUCTION The Circuits of Amp. Gain Offset and ADC Regression analysis and estimation of blood pressure ECG PPG FET NI/LabWindows GUI and AGC setting 、 data save

13 Continuous and non-invasive blood pressure measurement methods – Tonometric Method – Vascular Unloading Method – Pulse Transit Time 2.PAPER REVIEW

14 壓張式血 壓量測 血管無 負載法 脈衝到 達時間 脈衝到達時間 間歇性校正 恆壓 低壓 血壓之動 態低壓量 測 動作雜 訊 ● ◎◎ ●●● 收縮壓 ●●●●●● 舒張壓 ●●●●● 平均壓 ●●●●● 動態連 續 ●●●● 操作方 便 ●● 2.PAPER REVIEW Comparison of continuous blood pressure measurement ● : 符合 ◎ : 部分符合

15 Long-term monitoring topics for various applications about unconstrained or non- contact measurement of physiological signals – Mobile – Bed – Chair – Toilet 2.PAPER REVIEW

16 A Preliminary Study for Unconstrained Pulse Arrival Time (PAT) Measurement on a Chair – Proceedings of the 2005 IEEEEngineering in Medicine and Biology 27th Annual Conference Shanghai, China, September 1-4, 2005 – Ko Keun Kim1, Youngjoon Chee1, Juwan Park1, Jungsoo Kim1, Yong Kyu Lim1, and Kwang Suk Park2 2.PAPER REVIEW

17 In this paper, the correlation between the typical PAT and the unconstrained PATs (A- PATs) are compared A-PATs: A-PATs were measured from the pressure pulse of the air cushion (APP ) 2.PAPER REVIEW

18 To validate the correlation with typical PAT, the three feature points was used for the A-PAT as follows: 1) the first minimum point of the APP, 2) the zero crossing point of the APP, and 3) the steepest descent point of the APP 2.PAPER REVIEW

19 A Smart Health Monitoring Chair for Nonintrusive Measurement of Biological Signals – Hyun Jae Baek, Gih Sung Chung, Ko Keun Kim, and Kwang Suk Park, Senior Member, IEEE – IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 16, NO. 1, JANUARY 2012 2.PAPER REVIEW

20 PAT was substituted by RJ interval(RJI), defined as the time interval from ECG R peak to BCG J peak 2.PAPER REVIEW

21 Effect of confounding factors on blood pressure estimation using pulse arrival time – This article has been downloaded from IOPscience. Please scroll down to see the full text article.2008 Physiol. Meas. 29 615 – (http://iopscience.iop.org/0967-3334/29/5/007)http://iopscience.iop.org/0967-3334/29/5/007 – Jung Soo Kim, Ko Keun Kim, Hyun Jae Baek and Kwang Suk Park PAPER REVIEW1 2.PAPER REVIEW

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23 Enhancing the estimation of blood pressure using pulse arrival time and two confounding factors – This article has been downloaded from IOPscience. Please scroll down to see the full text article.2010 Physiol. Meas. 31 145 – (http://iopscience.iop.org/0967-3334/31/2/002)http://iopscience.iop.org/0967-3334/31/2/002 – Hyun Jae Baek, Ko Keun Kim, Jung Soo Kim, Boreom Lee and Kwang Suk Park 2.PAPER REVIEW

24 Methods – Clinical data from dental anesthesia – Data from unconstrained biological signal measurement systems a)Application on a toilet seat b)Application in a vehicle c)Application at a computer 2.PAPER REVIEW

25 Performance enhancement for BP estimation by inclusion of confounding factors in the unconstrained data. Results() – BP=a+b*PAT – BP=a+b*PAT+c*HR*d*TDB Performance enhancement for BP estimation by inclusion of confounding factors in clinical data under dental anesthesia. 2.PAPER REVIEW2 2.PAPER REVIEW

26 PPG sensor – Reflective Optical Sensor with Transistor Output – The CNY70 is a reflective sensor that includes an infrared emitter and phototransistor in a leaded package which blocks visible light 3.Materials and Methods Detector type: phototransistor Dimensions (L x W x H in mm): 7 x 7 x 6 Peak operating distance: < 0.5 mm Typical output current under test: IC = 1 mA Emitter wavelength: 950 nm Daylight blocking filter

27 ECG&FET Sensor – SCC Series pressure sensors – 0...5 to 0...100 psi – Low cost sensor element – Internal temperature compensation – Differential, gage and absolute – Disposable ECG electrodes pads 3.Materials and Methods

28 Analog circuits – ECG,PPG and FET block diagram of the measurement circuit 3.Materials and Methods

29 ECG-RL FET PPG&ECG -LA ECG-RA Microprocessor LP Filter(100Hz) HP Filter(0.5Hz) Notch(60Hz) AGC ECG LP Filter(22Hz) Notch(60Hz) AGC PPG LP Filter(100Hz) HP Filter(0.5Hz) Notch(60Hz) AGC FET

30 Analog circuit – ECG 、 FET second-order high-pass circuit 3.Materials and Methods

31 Analog circuit – ECG 、 PPG 、 FET second-order low-pass circuit 3.Materials and Methods

32 Analog circuit – ECG 、 PPG 、 FET notch filter circuit 3.Materials and Methods

33 Analog circuits – Auto gain control block diagram 3.Materials and Methods

34 R50 R49 4bit MSP 430 OffsetGain Analog Signal Latch 8bit ………… Rm 0 1 2 3 4 5 6 7 R47 Differential Amplifier Vin Vf Voffset G2 G1 G0 G3 ………… OP inverting amplifier 0 1 2 3 4 5 6 7 G6 G5 G4 G7 Rg Output OP Offset Gain 4051 R48 R61 R51 R24 R25 R60

35 3.Materials and Methods Analog circuits – Offset circuits 式1式1 式3式3 式2式2 式4式4 式6式6 式5式5

36 3.Materials and Methods Rm/ ohm 準位調整 24k0.4347 30k0.2631 36k0.1020 40k0.0000 47k-0.1690 51k-0.2606 56k-0.3703 62k-0.4954 Analog circuits – Offset circuits

37 3.Materials and Methods Analog circuits – Gain circuits

38 Signal processing – Type Cascade form and Direct form Butterworth design a five order low-pass filter five order high- pass filter and notch filter – High-pass cut-off frequency (fc) of 0.5Hz to eliminate baseline drift – 60Hz stop-band filter (Notch) to filter out noise in utility power 3.Materials and Methods

39 Signal processing – Filter system transfer function 3.Materials and Methods

40 Signal processing – Direct form structure diagram 3.Materials and Methods

41 Signal processing – Cascade form – Signal processing sub-process calculates its output into the relationship 3.Materials and Methods

42 Signal processing – Cascade form structure diagram 3.Materials and Methods

43 Signal processing – High pass and low pass 5 order 、 notch in Matlab 3.Materials and Methods filter before in Matlab filter after in Matlab

44 Signal processing – Multi-scale Mathematical Morphology (3M filter), based on set operations, provides a way to analyze signals using nonlinear signal processing operators that incorporate the geometry information of the signal 3.Materials and Methods

45 Signal processing – The shape information of the signal is extracted by using a structure element to operate on the signal, such operators serve two purposes, i.e. extracting the useful signal and removing the artifacts 3.Materials and Methods

46 Signal processing – 3M Filter related equations

47 Signal processing – In this stage, the 3M filter used to eliminate baseline drift and reduce interference noises (motion artifacts, muscle contraction) 3.Materials and Methods

48 Signal processing – PPG signal, PPG 1st derivative, PPG 2nd derivative, and the process of peak detection 3.Materials and Methods

49 Signal processing – Find out 1st derivative local maxima – To find zero-crossing point PPG derivative local maxima PPG derivative local maxima,crossing zero

50 Digital Circuits – BP estimates System Architecture 3.Materials and Methods AGC Physiological signal MSP430F5438A A/D 12bit DSP(Filter 、 AGC) UART DSPAGC Matlab GUI& Analysis , SPSS NI/LabWindows GUI

51 Digital Circuits – Firmware Flowchart 3.Materials and Methods Stat Intialization a.Port b.timer c.ADC AGC Notch HP 5 order LP 5 order Interface END

52 GUI – National Instruments/LabWindow CVI 9.0 3.Materials and Methods 訊號顯示 增益與準位調整 RS232 設定 資料儲存

53 Blood pressure parameter definition – PAT:Pulse arrive time – HR:RRinterval – TDB:Arterial stiffness index – FET: femoral artery elastic wave time parameters 3.Materials and Methods HR PAT TDB FET

54 Software flowchart – Matlab GUI Regression analysis and estimation of blood pressure – SPSS – About the correlation between the legs – BP = a + b * PAT + c * HR + d * TDB + e * FET 3.Materials and Methods Stat Detrend Filter(LP 、 HP 、 Notch) Normalize Peak detector END

55 Analog circuit analysis and measurement – ECG High pass filter – PSpice circuit simulation frequency response 4. Results and Discussion

56 Analog circuit analysis and measurement – ECG Actual measuring high-pass circuit Bode fch:0.58Hz

57 Analog circuit analysis and measurement – ECG Low pass filter – PSpice circuit simulation frequency response 4. Results and Discussion

58 Analog circuit analysis and measurement – ECG Actual measuring low-pass circuit Bode 4. Results and Discussion fcl:86.7Hz

59 Analog circuit analysis and measurement – ECG Notch filter – PSpice circuit simulation frequency response 4. Results and Discussion

60 Analog circuit analysis and measurement – ECG Actual measuring notch circuit Bode 4. Results and Discussion

61 Analog circuit analysis and measurement – PPG Low pass filter – PSpice circuit simulation frequency response 4. Results and Discussion

62 Analog circuit analysis and measurement – PPG Actual measuring low-pass circuit Bode 4. Results and Discussion fcl:27.1Hz

63 Analog circuit analysis and measurement – PPGG Notch filter – PSpice circuit simulation frequency response 4. Results and Discussion

64 Analog circuit analysis and measurement – PPG Actual measuring notch circuit Bode 4. Results and Discussion

65 Analog circuit analysis and measurement – The actual circuit diagram ECG FET(R) FET(L) PPG Main board

66 Determine structural elements Digital filtering assessment and actual measurements – In the rear of the system analyzed using 3M filter to eliminate baseline measurements obtained with ECG and PPG signals 4. Results and Discussion

67 Signal filtering results with R-wave detection

68 0Hz (watts/he rtz) 0~0.5Hz (watts/hertz) 0.5~45Hz (watts/her tz) IIR Filter 0.00073 23 0.16600000.690046 6 3M Filter 0.30950 00 0.04800000.052909 3 4. Results and Discussion 式5式5 Digital filtering assessment and actual measurements – In the better than part of 3M filter eliminates baseline IIR filter

69 Digital filtering results built on firmware 4. Results and Discussion 1ms

70 4. Results and Discussion Digital filtering results built on firmware Filter before in Matlab Filter after in Matlab Filter after in MCU

71 4. Results and Discussion Verification system – Contact measurement ECG compared with commercially available instruments

72 4. Results and Discussion NI/LabWindows GUI

73 Auto gain control setting – Gain and offset adjustment 4. Results and Discussion 0.1x 0.3x 0.6x 1.0x

74 Summary – Sensors application and analog circuit design – Filter circuit – Offset and Gain – AGC circuit – Signal processing and firmware build – IIR Filter – 3M Filter – NI/LabWindows GUI – Waveform display – AGC Adjustment – Data storage 4. Results and Discussion

75 Experiments – Four waveform measurement system – Signal feature extraction

76 4. Results and Discussion Experiments – BP estimation parameters analysis

77 System Initial 系統量測 (R-peak 、 FET(R)-peak 、 FET(L)-peak) 3min Over 4. Results and Discussion Experiments(FET correlation between the legs) – About the correlation between the legs – FET accounted for HR time proportion

78 Experiments(FET correlation between the legs) – Total : ECG 、 FET(R) 、 FET(L) peak number – Se : success rate – Corr : FET correlation between left and right legs Time Total(bea ts) True(b eats) SeCorrFET(R )/RRI FET(L) /RRI A3min 1981940.9797980.8022930.4402730.443683 B3min 3323220.969880.9110030.4673190.451698 C3min 2252230.9911110.8436150.4240770.411738 D3min 2632580.9809890.8146340.4821050.460597 E3min 2522490.9880950.8633840.4370470.456417 4. Results and Discussion

79 Experiments (estimation blood pressure) – System Initialization – Cuff pressure measuring – Contact system and finomerter simultaneous measurement – Cuff pressure measuring – Over t 5min System Initial Cuff 量測 系統量測 / 動態式 血壓儀器量測 Cuff 量測 Rest 2min 3min Over T:17min 取標準差 取平均值 4. Results and Discussion

80 Experiments(estimation blood pressure) – Finometer is a noninvasive hemodynamic cardiovascular monitor based on the measurement of finger arterial pressure

81 Experiments(estimation blood pressure) – The actual figure 4. Results and Discussion Finometer Contact system Cuff pressure

82 Experiments(estimation blood pressure) – Blue: Finometer pressure signal – Black: ECG Signal – Red: PPG Signal – Green: Right leg femoral artery pressure – Yellow: Left femoral artery pressure 4. Results and Discussion

83 Experiments (estimation blood pressure) – Single- and multiple-regression analysis – BP=a+b*PAT+c*HR+d*TDB+e*FAP

84 4. Results and Discussion

85 Experiments (estimation blood pressure) – Performance of cuffless BP estimation with regard to combinations of parameters used in regression analysis 4. Results and Discussion SBPDBP VariableRR^2Adj.R^2RR^2Adj.R^2 PAT0.935440.875370.874780.595390.370190.36708 PAT+HR0.936190.876780.875610.754560.571620.56751 PAT+TDB0.937170.878570.877410.625610.402570.39664 PAT+FET0.936870.878030.876860.607880.385670.37956 PAT+HR+TDB0.937960.880050.878320.773450.600760.59499 PAT+HR+FET0.937560.879320.877580.761680.582080.57602 PAT+HR+TDB+FET0.939510.882920.880660.779990.610770.6032

86 Experiments (estimation blood pressure) – SBP Scatter plot 4. Results and Discussion 5mmHg

87 Experiments (estimation blood pressure) – DBP Scatter plot 4. Results and Discussion 5mmHg

88 Experiments(estimation blood pressure) – Boxplots 4. Results and Discussion

89 Experiments(estimation blood pressure) – Reproducibility of multiple regression analysis for BP estimation 4. Results and Discussion

90 Experiments(estimation blood pressure) – Reproducibility of multiple regression analysis for BP estimation 4. Results and Discussion t 5min System Initial Cuff 量測 系統量測 / 動態式 血壓儀器量測 Cuff 量測 Rest 2min 3min Over T:17min 取標準差 取平均值

91 4. Results and Discussion Experiments(estimation blood pressure) – Reproducibility of multiple regression analysis for BP estimation

92 Conclusions – 3M Filter remove baseline drift better than IIR filter – FET high correlation between the legs average of 0.844 – Multiple regression analysis for SBP and DBP estimation,r and r^2 of SBP was 0.939 0.882,r and r^2 of DBP was 0.779 0.610 – The estimated BP was compared with the measured BP simultaneously,the performance results of this test set decrease a little 4. Conclusions and Future Work

93 Future work – PPG to be more stable – Build different filters in MCU – Analyze more subjects – FET possibility to replace the TDB parameters – Unconstrained system for BP estimation and application to home care system or firmware development 4. Conclusions and Future Work

94 中華民國 2012 年至 2060 年人口推計,行政院經濟建設委員會人力規劃處, 2012 http://www.bostonscientific.com/lifebeat-online/heart-smart/electrical-system.html P. Kyriacou, “Investigation of new clectro-optical techniques for monitoring patients with compromised peripheral perfusion in anaesthesia,” 2001 http://zh.scribd.com/doc/73084909/Differential-Auscultatory-Technique 徐大川,連續血壓系統的改良與驗證,國立中央大學電機工程學系碩士論 文, 2008 游生益,非接觸式心搏率量測系統應用於心跳變益率監測,南台科技大學電 機工程研究所碩士論文, 2012 J. S. Kim, K. K. Kim, H. J. Baek and K. S. Park "Effect of confounding factors on blood pressure estimation using pulse arrival time", Physiol. Meas., vol. 29, pp.615 -624 2008 H. J. Baek, K. K. Kim, J. S. Kim, B. Lee and K. S. Park "Enhancing the estimation of blood pressure using pulse arrival time and two confounding factors", Physiol. Meas., vol. 31, pp.145 -157 2010 References

95 Κ. L. Kim, Y. Chee, J. Park, J. Kim, Y. Κ. Lim and Κ. S. Park "A preliminary study for unconstrained pulse arrival time (PAT) measurements on a chair", 27th Annual International Conference of IEEE Engineering in Medicine and Biology Society, 2005 Hyun, J.B.; Gih, S.C.; Ko, K.K.; Kwang, S.P. A Smart health monitoring chair for nonintrusive measurement of biological signals. IEEE Trans. Inform. Technol. Biomed. 2012, 16, 150–158. 101 年死因統計結果分析,行政院衛生署, 2012 http://www.2cm.com.tw/zoomin_content.asp?sn=0912020016 Abe, H., Chen, W., Togawa, T., Maeda, T., & Arai, R. (2007, November). Development of a mobile phone based beat-by-beat sphygmomanometer. InInformation Technology Applications in Biomedicine, 2007. ITAB 2007. 6th International Special Topic Conference on (pp. 285-287). IEEE. References

96 Lee, J. S., Chung, G. S., Beak, H. J., Lim, Y. G., Lee, J. S., Jeong, D. U., & Park, K. S. (2009, November). A new approach of unconstrained sleep monitoring and pulse arrival time extraction using PPG pillow and CC-ECG electrode system. In Information Technology and Applications in Biomedicine, 2009. ITAB 2009. 9th International Conference on (pp. 1-3). IEEE. References

97 Thank you for your attention


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