IN VIVO BLOOD SPECTROMETRY
A process and apparatus for determining the arterial and venous oxygenation of blood in vivo with improved precision. The optical properties of tissue are measured by determination of differential and total attenuations of light at a set of wavelengths. By choosing distinct wavelengths and using the measured attenuations, the influence of variables such as light scattering, absorption and other optical tissue properties is canceled out or minimized.
The present application is a continuation of U.S. patent application Ser. No. 12/946,506, filed Nov. 15, 2010, which is a continuation of U.S. patent application Ser. No. 11/078,399, filed Mar. 14, 2005, now U.S. Pat. No. 7,865,223, issued on Jan. 4, 2011, which are incorporated herein by reference in their entireties.
BACKGROUND OF THE INVENTION1. Field of the Invention
The invention relates to a process and apparatus for increasing the accuracy of optical in vivo measurements of blood constituents in tissue, such as arterial oxygenation.
2. Description of Related Art
A standard method to measure the arterial oxygenation of blood is known as pulse oximetry.
Pulse oximeters function on the basis that at differing wavelengths, blood attenuates light very differently depending upon the level of oxygenation. Pulse waves starting from the heart cause in the arterial blood vessel system a periodic fluctuation in the arterial blood content in the tissue. As a consequence, a periodic change in the light absorption (
The light intensities described in the formula represent the light intensities received in the receiver of the sensors used in pulse oximetry. The measured variable R serves as a measurement for the oxygen saturation. The formation of a quotient in order to form the measured variable is intended to compensate for any possible influences the haemoglobin content of the tissue, the pigmentation of the skin or the pilosity may have on the measurement of the oxygen saturation of arterial blood. The difference of the light attenuations at a minimum and maximum value is the delta of the light attenuations for each of both wavelengths.
Measuring oxygen saturation of arterial blood in the tissue in a range of 70 to 100% using light of wavelength 940 nm and 660 nm most often produces for one single application site sufficiently accurate measured values. However, in order to measure lower oxygen saturation of arterial blood it is necessary to assume a strong influence on the measured variable R in particular caused by perfusion (i.e. blood content) (see: IEEE; Photon Diffusion Analysis of the Effects of Multiple Scattering on Pulse Oximetry by J. M. Schmitt; 1991) and other optical parameters of tissue.
Rall, U.S. Pat. No. 5,529,064, describes a fetal pulse oximetry sensor. For this kind of application, a higher measurement precision is desirable because a fetus has a physiological lower oxygenation than adult human beings and measurement error of SaO2 increases at low oxygenations.
U.S. Pat. No. 6,226,540 to Bernreuter, incorporated by reference herein, improves the precision of pulse oximetry. However, in order to measure on different body sites with the same high resolution for the arterial oxygenation, additional precision to measure optical tissue properties is necessary. Another problem is that pulse oximetry alone does not provide sufficient diagnostic information to monitor critically ill patients (See: When Pulse Oximetry Monitoring of the Critically III is Not Enough by Brian F. Keogh in Anesth Analg (2002), 94: 96-99).
Because of this it would be highly desirable to be able to additionally measure the mixed venous oxygenation of blood SVO2. Methods to measure SvO2 with NIR were described by Jobsis in U.S. Pat. No. 4,223,680 and by Hirano et al in U.S. Pat. No. 5,057,695. A problem of those disclosed solutions is that hair, dirt or other optically non-transparent material on the surface of tissue can influence the measured results for SvO2.
To measure the metabolism of blood oxygenation, Anderson et al in U.S. Pat. No. 5,879,294 disclose an instrument in which the second derivative of the light spectrum used delivers information about the oxygenation. Hereby, the influence of light scattering in tissue is minimized, which can result in higher measurement precision. A disadvantage of this solution that the calibration of the optical instruments is complicated and expensive, which makes it impractical to use such devices for sports activity applications, where light weight wearable devices would be of interest. Similar problems are known for frequency domain spectroscopy disclosed for example in Gratton, U.S. Pat. No. 4,840,485. Oximetry devices, which are described in the present specification and which simply measure light attenuations of tissue at different wavelengths, are more feasible, flexible and reliable in practice than complex time resolved methods.
SUMMARY OF THE INVENTIONAccordingly, several objects and advantages of the invention are:
a) to provide a device that measures the arterial oxygenation of blood in tissue at a certain application site with improved precision;
b) to provide a device that measures the arterial oxygenation blood in tissue at different application sites with improved precision;
c) to provide a device that measures the mixed venous or venous oxygenation blood in tissue with improved precision;
d) to provide a device that measures the mixed venous or venous and arterial oxygenation blood in tissue with improved precision with only one sensor;
e) to provide a device that measures the mixed venous or venous oxygenation blood in tissue with improved precision without complicated empirical calibration;
f) to provide an inexpensive device that measures the mixed venous or venous oxygenation blood in tissue with improved precision;
g) to provide an inexpensive device that can directly measure oxygen extraction of tissue at the application site; and
h) to provide an inexpensive, wearable device that measures oxygenation of tissue.
There are various fields of application where the invention can be used with benefit. For example for sports activity applications, a light weight, small and inexpensive device to track the oxygen metabolism would be of interest.
Critically ill persons would benefit by continuous and more detailed diagnostic information of their physiological condition.
Newborns would benefit from better care if arterial oxygenation could be measured e.g. on the back instead on the feet where unintentional alarms more often occur due to motion effects. A higher precision of pulse oximetry could improve ventilation of newborns, and precision of fetal pulse oximetry where a high resolution of the arterial oxygenation is needed, could be improved as well (See U.S. Pat. No. 6,226,540).
In accordance with invention, a device utilizes a combination of light emitters and detectors with:
a light wavelength combination with more than two wavelengths, where the peak spectrum of a third wavelength is about the geometric mean value of the first and second wavelengths;
multiple detectors and emitters which eliminate influences on calibration by subtracting and adding measured light attenuations;
a model-based calibration calculation, which improves precision of measured output variables.
As a result, influences on the calibration of different issue properties can be minimized in order to measure arterial or venous or the combination of arterial and venous oxygenation. It has been discovered that by choosing one of the wavelengths as a geometric mean value of two other wavelengths, variations due to scattering can be reduced. Additional determination of light attenuation can reduce measurement errors because of variations of light absorption due to different tissue composition, i.e., variations of relative amounts of muscle, skin, fat, bone, etc.
It is noted that as used in the present specification, “venous” and “mixed venous” are synonyms, “attenuation” refers to absolute or differential attenuation, “tissue oxygenation” refers to arterial, mixed venous, or venous oxygenation or a combination thereof, and the phrase “about” in reference to wavelengths quantifies in a range of +/−80 nm, and in reference to distance quantifies in a range of +/−2 cm.
The diagram of
The second variation of sensor 32S also applied on the forehead is shown in
By using three instead of two wavelengths to measure the arterial oxygenation, the following approximation can be derived with the help of diffusion theory. The result of this operation is:
where Rw2, w1 and Rw1, w0 are calculated according to equation (1) using wavelengths w0, w1, and w2 and Q is a correction parameter.
Light attenuation LAwx can be calculated in the following or similar manner:
Lawx=ln(Iwx/Iwxo) (3)
LAwx corresponds to the logarithm of the ratio of light intensity Iwxo which is the emitted and light intensity Iwx the received light passing through tissue at wavelength wx. The index following suffix wx indicates the selected wavelength. Graaff et al showed that scattering in tissue decreases for higher wavelengths according to exponential functions (see: Applied Optics; Reduced Light-Scattering Properties for Mixtures of Spherical Particles: A Simple Approximation Derived from Mie Calculations by R. Graaffi; 1992). Absorption variation may also be taken from other measures or approximations such as the ac/dc ratio. The amplitude may be any measure such as peak-to-peak, RMS, average, or cross correlation coefficient. It may also be derived from other techniques such as Kalman filtering or a measure of the time derivative of the signal. Also, while calculations utilizing ratios of absorptions at different wavelengths are shown, alternate calculations may be used to give the same or approximately the same results. For instance the absorptions could be used directly, without calculating the ratios.
A preferred selection of the wavelengths combination to reduce the influence of scattering is defined by the following equation, with wavelength w1 as the geometrical mean value of wavelength w0 and wavelength w2, defined as:
w1=√(w0*w2) (4)
This combination minimizes the variation band of correction parameter Q, which has a default value of about one. The measurement variable R′ of equation (2) has minimized error related to variation of scattering and blood content of tissue.
EXAMPLES Example 1The sensor 31S shown in
Law1=LA(A3w1)+LA(A2w1)−LA(A1w1)−LA(A4w1) (5)
LAw2=LA(A3w2)+LA(A2w2)−LA(A1w2)−LA(A4w2) (6)
LAw3=LA(A3w3)+LA(A2w3)−LA(A1w3)−LA(A4w3) (7)
where LA (Axwy) is the logarithm of received light intensity in the detector related to light arrow Ax at wavelength wy. Each LA (Axwy) here is weighted with the factor 1. The suffix x for light arrows Ax represents the number of the selected light arrow and y the suffix for the selected wavelength. Instead of the logarithm of light intensities, light intensity itself can be used in (5)-(7) and “+” is replaced by “*” and “−” is replaced by “1”.
In the next step, Rw2, w1 and Rw1, w0 are calculated according to equation (1). As a result R′ can be determined using equation (2) with Q as a correction factor which can be dependant on Rw2, w1 or Rw1, w0. The measured arterial oxygenation which is dependant on R′ has minimized influence of scattering, blood content or other optical absorbing constituents in tissue.
The quotient in (8) which is part of (2) delivers a measurement variable Rv′:
Rv′ is a measure of optical absorption of tissue with decreased influence of scattering. Therefore it can be used as a signal for mixed venous oxygenation SvO2
A mathematically identical form of (2) is:
According to (9) the following equation can also be used to determine a measurement variable R1′ for SaO2:
where f is an empirical function of optical tissue parameters with variables defined above.
An empirical calibration which reduces influence of absorption and scattering of tissue on the measured variables with the variables LAw1, LAw2, LAw3, Rw1, w2 and Rw2, w3 for the whole saturation range of blood is complex.
An pure empirical calibration based on these parameters additionally for different application sites is probably impossible. The proposed model-based method reduces complexity of calibration SaO2 can be determined with improved accuracy being only dependent on R′.
It is also possible to use this method for other light absorbing or scattering constituents of blood like carboxyhemoglobin, methemoglobin, bilirubin or glucose dissolved in blood. Light wavelength in the range from 600 nm-1000 nm can be used for carboxyhemoglobin and methemoglobin. Glucose shows an absorption peek dissolved in blood at 1100 nm and bilirubin in the lower wavelengths range from 300 nm-800 nm. For every additional constituent an additional wavelengths has to be chosen. That means that to measure SaO2 and methemoglobin at a time, four wavelength have to be selected and two different measurement variables R′1 and R′2 according equation (9) have to be defined. Accordingly, the resulting output for SaO2 is dependent on R′1 and methemoglobin on R′2.
As a result sensor 31S is able to measure arterial and mixed venous oxygenation and other blood constituents at a time with reduced influence of measurement errors due to scattering and absorption of tissue.
Example 2In
A variant of a multidimensional calibration (
In
A brain oximeter is shown in
The ratio Rvb of the resulting light attentions LAwb2 and LAwb3 is used as a measure for the mixed venous oxygenation. The resulting light attenuation at wavelength wb3=810 nm can be used to eliminate the dependency of blood content in tissue of Rvb with a multidimensional calibration of SvO2 vs. Rvb and LAwb3.
A preferred emitter-detector distance between emitter 32E and detector 31D is greater than 2 cm. The longer the emitter-detector distance is, the deeper the penetration depth into the brain. In order to achieve maximum penetration depth at a minimum of sensor outline, the distance between an emitter and a detector should be the maximum distance between all emitters and detectors.
Referring to Example 5, a brain oximetry sensor was described which is able to determine arterial and mixed venous oxygenation of tissue. These two parameters can be used to calculate the oxygen extraction of tissue. A measure therefor can be the difference of arterial and mixed venous oxygenation. Oxygen extraction reflects how well tissue is supplied with oxygen, and can additionally be used to calculate the cardiac output or the trend of the cardiac output CaOut non-invasively.
Knowledge of oxygenation of tissue of parts of the body is of high interest for sports activity monitoring. The oxygenation the muscles of the upper leg or upper arm can reflect the training level for different activities of sport
Less influence of light scattering and absorption of tissue can be achieved for the determination of mixed venous oxygenation in this way.
A further improvement for better measurement precision can be achieved by generating an output value for the mixed venous oxygenation which is dependant on a multidimensional calibration of SvO2 vs. Rvs and Rv.
Although the description above contains many specificities, these should not be constructed as limiting the scope of the invention but as merely providing illustrations of some of the presently preferred embodiments of this invention. For example the shape of the emitters can be rectangular, emitters can include LEDs, detectors photodiodes; the shape of the brain sensor can be round; the proposed methods to calculate arterial and mixed venous oxygenation of tissue can be combined in different combinations, signals can be processed by Kalman filters in order to reduce influence of noise caused by motion or other unwanted sources, etc.
Claims
1-25. (canceled)
26. An apparatus for measuring tissue oxygenation comprising:
- a sensor interface including at least one emitter configured to emit light into tissue with at least three wavelengths and at least one detector configured to receive light scattered by the tissue; and
- a processor coupled to the sensor interface and configured to calculate tissue oxygenation using the at least three wavelengths, the tissue oxygenation corresponding to venous blood oxygenation, the processor further configured to compensate for influence of varying optical tissue properties which are exponentially decreasing with increasing wavelength.
27. The apparatus of claim 26 wherein the processor is configured to read coded information corresponding to the sensor interface and configured to use the coded information in calculating tissue oxygenation.
28. An apparatus comprising:
- a sensor interface configured for coupling to a forehead of a person, the sensor interface including at least one light emitter configured to emit at least three different wavelengths of light into tissue, the sensor interface including at least two detectors configured to detect scattered light, the sensor interface having an emitter-detector distance of at least 2 cm;
- a processor coupled to the sensor interface and configured to calculate at least two light attenuations LAwsj which depend on detected light for selected wavelength wsj for the at least two detectors; and
- a display device coupled to the processor and configured for displaying tissue oxygenation corresponding to venous blood and for displaying arterial blood oxygenation based on pulse oximetry, the tissue oxygenation based on the least two light attenuations LAwsj.
29. The apparatus of claim 28 wherein the processor is configured to compensate for influence of varying optical tissue properties which are exponentially decreasing with increasing wavelength, and wherein the sensor interface includes an electrode configured for contacting a skin of the person, and wherein the sensor interface is coupled to an encoder, the encoder configured to store coded information about a wavelength of the sensor interface and configured to store the emitter-detector distance.
30. The apparatus of claim 28 wherein the at least one light emitter includes an LED and a demultiplexer, wherein an emitter timing is controlled by the demultiplexer.
31. The apparatus of claim 28 wherein the display device is configured to display a value that corresponds to oxygen extraction based on arterial oxygenation and venous oxygenation.
32. The apparatus of claim 28 in which at least one light emitter emits at about 660 nm.
33. The apparatus of claim 28 wherein the processor is configured to determine arterial blood oxygenation based on at least one light path between the at least one light emitter and one of the at least two detectors, wherein the at least one light path is less than 2 cm.
34. The apparatus of claim 28 wherein the at least one light emitter emits light at wavelengths of about wb1=740 nm and wb2=805 nm.
35. The apparatus of claim 28 wherein the at least one light emitter emits light at a wavelength of about wb3=660 nm.
36. The apparatus of claim 28 wherein the at least one light emitter include an LED configured to emit light into the tissue.
37. The apparatus of claim 28 wherein the light attenuations LAwsj are configured to reduce the dependency of the output for tissue oxygenation on Hb and blood content.
38. The apparatus of claim 28 wherein the processor is configured to calculate a value corresponding to a difference of arterial blood oxygenation and tissue oxygenation.
39. The apparatus of claim 28 wherein the display device is configured to display a pulse rate.
40. The apparatus of claim 28 wherein the display device is configured to display a blood constituent including carboxyhemoglobin, methemoglobin, glucose in blood, Hb, SvO2, SaO2, or bilirubin.
41. An apparatus for measuring tissue oxygenation comprising:
- a sensor interface adapted to be coupled to the forehead of a person and including at least one light emitter and configured to emit light into tissue at at least three different wavelengths and having at least two detectors configured for detecting scattered light, wherein a detector-emitter distance is at least 2 cm, the sensor interface having an electrode configured for contacting a skin of the person;
- a processor coupled to the sensor interface and configured to calculate at least two light attenuations LAwsj which depend on detected light for selected wavelength wsj for the two detectors; and
- a display device coupled to the processor and configured for displaying an output for tissue oxygenation corresponding to venous blood, the output based on the light attenuations LAwsj.
42. The apparatus of claim 41 wherein the electrode is configured to detect an electrocardiogram (ECG) signal.
43. The apparatus of claim 41 wherein the sensor interface is configured for fixation to the forehead using medical glue, a fixation band, and a disposable sensor holder.
44. An apparatus for measuring tissue oxygenation comprising:
- a sensor interface including at least one emitter and at least one detector, the at least one emitter configured to emit light into tissue with at least three wavelengths and the at least one detector to receive light scattered by the tissue;
- a processor configured to calculate tissue oxygenation corresponding to venous oxygenation;
- a sensor encoder configured to store coded information about a wavelength of the sensor interface; and
- wherein the processor is configured to reduce an error associated with varying sensor hardware.
45. The apparatus of claim 44 wherein the sensor encoder is configured to store coded information about calibration of sensor geometry.
46. An apparatus for measuring tissue oxygenation comprising:
- a sensor interface including at least one emitter configured to emit light into tissue with at least three wavelengths and at least one detector to receive light scattered by the tissue;
- a processor configured to calculate tissue oxygenation corresponding to venous oxygenation;
- a sensor encoder configured to store coded information about calibration of sensor geometry; and
- wherein the processor is configured to reduce an error associated with varying sensor hardware.
Type: Application
Filed: Mar 4, 2014
Publication Date: Sep 4, 2014
Inventor: Peter Bernreuter (Dettingen)
Application Number: 14/196,725
International Classification: A61B 5/1455 (20060101); A61B 5/145 (20060101);