U.S. patent application number 15/179394 was filed with the patent office on 2017-02-09 for tissue oximetry apparatus and method.
The applicant listed for this patent is Peter Bernreuter. Invention is credited to Peter Bernreuter.
Application Number | 20170035334 15/179394 |
Document ID | / |
Family ID | 40282277 |
Filed Date | 2017-02-09 |
United States Patent
Application |
20170035334 |
Kind Code |
A1 |
Bernreuter; Peter |
February 9, 2017 |
TISSUE OXIMETRY APPARATUS AND METHOD
Abstract
An apparatus and method for determining tissue oxygenation such
as arterial and venous oxygenation and cerebral oxygenation. In one
embodiment, the optical properties of tissue are determined using
measured light attenuations at a set of wavelengths. By choosing
distinct wavelengths and using light attenuation information, the
influence of variables such as light scattering, absorption and
other optical tissue properties can be minimized.
Inventors: |
Bernreuter; Peter;
(Dettingen, DE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Bernreuter; Peter |
Dettingen |
|
DE |
|
|
Family ID: |
40282277 |
Appl. No.: |
15/179394 |
Filed: |
June 10, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13283044 |
Oct 27, 2011 |
9364176 |
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15179394 |
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11780997 |
Jul 20, 2007 |
8055321 |
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13283044 |
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11078399 |
Mar 14, 2005 |
7865223 |
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11780997 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 5/14552 20130101;
A61B 5/72 20130101; A61B 2562/0242 20130101; A61B 2560/0238
20130101; A61B 2562/0238 20130101; A61B 5/7203 20130101; A61B
5/14553 20130101; A61B 5/14551 20130101; A61B 5/742 20130101; A61B
5/1495 20130101 |
International
Class: |
A61B 5/1455 20060101
A61B005/1455; A61B 5/00 20060101 A61B005/00; A61B 5/1495 20060101
A61B005/1495 |
Claims
1. Apparatus and sensor for measuring constituents of blood in
tissue in vivo with a sensor connected to said apparatus
determining light attenuation at a combination of light emitters
and detectors comprising the following means: a light emitter and
at least two detectors, said light emitter including at least three
wavelengths, wherein a peak spectrum of one of said at least three
wavelengths is about the geometric mean value of the two other of
said three wavelengths; means for calculating at least two values
of differential attenuation vs. time Rw1, w2, Rw2,w3 with w1, w2,w3
representing the selected wavelengths; means for eliminating
influences on calibration by subtracting and adding measured light
attenuations to generate a signal; and means for generating a
resulting output signal for a constituent of blood in vivo
depending on said signal; wherein said means for generating a
resulting output minimizes the error on said resulting output.
2. The apparatus of claim 1, wherein said constituent is selected
from the group consisting of carboxyhemoglobin, methemoglobin,
glucose in blood, Hb, SvO2, SaO2 and bilirubin.
3. An apparatus for measuring constituents of blood in tissue,
including a sensor with a combination of two light emitters and two
light detectors, said apparatus comprising: means for emitting a
light wavelength combination including at least two wavelengths
with at least one emitter, wherein the peak spectrum of one of said
at least three wavelengths is about the geometric mean value of the
two others of said three wavelengths to generate a first output
signal; means for calculating differential attenuation vs. time
Rw1, w2, Rw2, w3; means for eliminating influences on calibration
by an operation which corresponds to subtracting and adding
measured light attenuations to generate an output signal for
optical properties; means for encoding information about the sensor
for compensating influences of varying optical tissue properties
related to said sensor interface; means for generating a resulting
output signal for at least one of said constituents of blood in
vivo depending on said means measured on the forehead or back or
chest or arm of the body; and means for generating an output signal
for cardiac output depending on said blood constituents, wherein
said means for generating the resulting output signal for at least
one of said constituents minimizes the error on said resulting
output.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of and claims the benefit
of priority under 35 U.S.C. .sctn.120 to U.S. patent application
Ser. No. 13/283,044, filed on Oct. 27, 2011, which is a
continuation of and claims the benefit of priority under 35 U.S.C.
.sctn.120 to U.S. patent application Ser. No. 11/780,997, filed on
Jul. 20, 2007, which is a continuation-in-part of and claims the
benefit of priority under 35 U.S.C. .sctn.120 to U.S. patent
application Ser. No. 11/078,399 filed on Mar. 14, 2005, each of
which applications is incorporated by reference herein in its
entirety.
TECHNICAL FIELD
[0002] The present invention relates to a process and apparatus for
improving accuracy of optical measurements of oxygenation of blood
in tissue.
BACKGROUND OF THE INVENTION
[0003] 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 (FIG.
1) can be registered between the light transmitter, whose radiation
passes through the tissue, and the receivers, which are integrated
in a pulse oximetry sensor. The evaluation of the sensor signals is
normally carried out at light wavelengths of w1=660 and w2=940 nm
by calculating the differential change of light absorption. It is
possible to create a measured variable R which is obtained in the
following manner or in a similar manner:
R = Rw 1 , w 2 = .DELTA. ( LAw 1 ) = ln ( I max , w 1 ) - ln ( I
min , w 1 ) .DELTA. ( LAw 2 ) ln ( I max , w 2 ) - ln ( I min , w 2
) Eq : ( 1 ) ##EQU00001##
[0004] 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 pillosity 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.
[0005] 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 lit 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.
[0006] U.S. Pat. No. 5,529,064 to Rall, 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.
[0007] U.S. Pat. No. 6,226,540 to Bemreuter, 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 Ill is Not Enough by Brian F.
Keogh in Anesth Analg (2002), 94:96-99).
[0008] 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.
[0009] 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 is 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 Grafton, 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.
BRIEF SUMMARY OF THE INVENTION
[0010] The present invention is directed to an apparatus and method
which eliminate influences on calibration by subtracting and adding
measured light attenuations, and a model-based calibration
calculation to improve precision of measured output variables. In
one embodiment, an apparatus utilizes a combination of light
emitters and detectors with a light wavelength combination of more
than two wavelengths, where the peak spectrum of a third wavelength
is about the geometric mean value of the first and second
wavelengths.
[0011] As a result, influences on the calibration of different
tissue 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.
[0012] The foregoing has outlined rather broadly the features and
technical advantages of the present invention in order that the
detailed description of the invention that follows may be better
understood. Additional features and advantages of the invention
will be described hereinafter which form the subject of the claims
of the invention. it should be appreciated by those skilled in the
art that the conception and specific embodiment disclosed may be
readily utilized as a basis for modifying or designing other
structures for carrying out the same purposes of the present
invention. It should also be realized by those skilled in the art
that such equivalent constructions do not depart from the spirit
and scope of the invention as set forth in the appended claims. The
novel features which are believed to be characteristic of the
invention, both as to its organization and method of operation,
together with further objects and advantages will be better
understood from the following description when considered in
connection with the accompanying figures. It is to be expressly
understood, however, that each of the figures is provided for the
purpose of illustration and description only and is not intended as
a definition of the limits of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] For a more complete understanding of the present invention,
reference is now made to the following descriptions taken in
conjunction with the accompanying drawing, in which:
[0014] FIG. 1 is a graph showing changes of light absorption by
blood over time;
[0015] FIG. 2 is a graph illustrating the dependency of arterial
oxygen saturation on the measurement variable R for different
optical tissue properties;
[0016] FIG. 3 shows a reflectance oximetry sensor according to the
invention in schematic cross-section;
[0017] FIG. 4 shows a finger clip sensor according to the invention
in schematic cross-section;
[0018] FIG. 5 is a diagram of a multidimensional calibration of
oxygenation for the two measuring variables R1, R2 vs SaO2;
[0019] FIG. 6 is a schematic diagram of an oximetry system in
operation;
[0020] FIG. 7 is a side view of a fetal scalp sensor according to
the invention;
[0021] FIG. 8 is a bottom view of the sensor of FIG. 7;
[0022] FIG. 9 is a bottom view of the sensor of FIG. 3;
[0023] FIG. 10 is a side cross-sectional view of a variation of the
sensor of FIG. 3;
[0024] FIG. 11 is a side cross-sectional view of another variation
of the sensor of FIG. 3;
[0025] FIG. 12, FIG. 12A-12D is a bottom view of the sensor of
Figure Hand several variations of emitter detector position on
sensor interface;
[0026] FIGS. 13A, 13B and 14 are side cross-sectional views of
reflectance sensors fixed on the forehead;
[0027] FIG. 15 shows a system for determining cardiac output;
[0028] FIG. 16 shows person with wrist worn display and sensor
interface with sensor applications on different sites of the body,
two sensor interfaces for each hemnisphere of brain placed on the
forehead;
[0029] FIG. 17A is a schematic diagram of a hardware processing
unit for an oximetry system according to the invention with
detector ground shield and elastic isolating layer towards tissue,
and FIG. 17B includes a side view of a sensor part;
[0030] FIG. 18 is a diagram of a multidimensional calibration of
oxygenation for the two measuring variables Rv1, Rv2 vs. SvO2;
and
[0031] FIG. 19 is a flow chart illustrating signal processing flow
for a model-based determination of oxygen in blood.
DETAILED DESCRIPTION OF TELE INVENTION
[0032] It is noted that as used in the present specification,
"venous" and "mixed venous" may be synonyms, "attenuation" may
refer to absolute or differential attenuation, "tissue oxygenation"
may refer to arterial, mixed venous, or venous oxygenation or a
combination of thereof, and the phrase "about" in reference to
wavelengths may quantify in a band of +/-80 nm and in reference to
distances quantifies in a band of +/-1 cm and that emitter
corresponds to emitting point that means an area where light of at
least one wavelength emitted by the sensor interface starts
penetrating tissue, weighted values for light attenuations can have
a value of one ore different values, the pulsatile part of a light
attenuation corresponds to the AC signal of pulse oximetry and the
non-pulsating part to the DC signal.
[0033] The diagram of FIG. 1 shows the fundamental effect on which
pulse oximetry and comparable methods to determine arterial blood
oxygenation are based. When measuring light absorption of tissue in
vivo light absorption changes synchronously with every heart cycle.
The diagram illustrates the change of light absorption versus time,
which is caused by arterial pulsations that can be measured while
systole and diastole. During systole and diastole the pressure on
the arterial vessel system varies from 80 mmHg to 120 mmHg. The
change of light absorption is called the AC-signal. The DC-signal,
the time-invariant part of light absorption, is caused by the
non-pulsating part of the arterial blood, the venous blood, bone,
hair, tissue and other constant absorbing constituents versus time.
The time-invariant signal is the basis for the calculation of the
mixed venous oxygenation of tissue; thus, a major part of the
absorption is caused by venous blood and a minor part by arterial
blood.
[0034] FIG. 2 shows two calibration curves in a diagram with SaO2
vs. R. Calibration line 42 is only valid for a first distinct set
of optical properties. Calibration line 40 is only valid for a
second distinct set of optical properties. The valid set of optical
properties can be determined by an optical system illustrated in
FIGS. 3 and 6 with a sensor 31S, which is placed on tissue 46 and
connected via a plug 66 to a display device 64. Additionally, FIG.
2 shows two horizontal lines at SaO2=0.6 and at SaO2=0.4 and one
vertical line at R=1.4. If an optical system determines only R
without registering the two different sets of optical properties,
this would result in an error of 0.2 SaO2 (SaO2 at first set of
optical properties--SaO2 at second set of optical properties). An
analogous relation also exists for the mixed venous saturation of
blood SvO2 and a measurement variable Rv1 and Rv2 for mixed venous
oxygenation (FIG. 18).
[0035] FIG. 3 shows an oximetry sensor 31S on the upper part of the
figure which is placed on tissue 46. The sensor 31S contains two
light emitters 31E, 32E and two light detectors 31D, 32D. The
arrows A1 through A4 show how light passes from emitters to
detectors through tissue. A1 stands representative for light which
is emitted in emitter 31E and received in detector 31D. A2 is light
emitted in emitter 32E and detected in detector 31D. A3 is light
emitted in 31E and received in 32D and A4 is light emitted in
emitter 32E and detected in detector 32D.
[0036] FIG. 4 shows a finger clip sensor 54 which is fixed on a
finger 48. The finger clip sensor incorporates emitters 31E, 32E
and detectors 31D, 32D. The electrical sensor signals of the finger
clip sensor are transmitted via a sensor cable 60. The signals can
also be conveniently transmitted wirelessly by means well known in
the art (not shown).
[0037] FIG. 5 illustrates a multidimensional calibration of SaO2
vs. R1 and R2. A certain combination of R1 and R2 corresponds to a
data point on the calibration plane, which indicates the saturation
level SaO2. An analogous relation also exists in FIG. 18 for the
mixed venous saturation of blood SvO2 and two related measurement
variables Rv1 and Rv2 for mixed venous oxygenation.
[0038] FIGS. 7 and 8 show a fetal scalp sensor 74 with a set of
emitters 31E, 32E, 33E and 34E and a set of detectors 31D, 32D, 33D
and 34D from side and bottom views, respectively. The sensor can be
fixed on the scalp of the fetus via a spiral needle 76 during
labor. Additionally, an electrocardiogram (ECG) of the fetus can be
transmitted via the needle 76.
[0039] FIG. 9 is a bottom view of sensor 31S from FIG. 3. Detectors
35D and 36D have a concentric form to maximize reception of light
emitted by the emitters 31E and 32E.
[0040] FIGS. 10-12 show several modifications of sensor 31S. FIG.
10 shows sensor in side view with a flat body where detectors 31D,
32D and the emitter 32D are grouped close together and emitter 32E
is positioned far from this group. The sensor can be fixed via a
band 108 on tissue. A light shield 110 minimizes the influence of
ambient light.
[0041] FIG. 11 shows a sensor with a sensor holder 22.
[0042] FIG. 12 is a bottom view of sensor of FIG. 11. The bottom
side of sensor holder 122 can be covered with medical glue or
adhesive. If sensor holder 122 is placed on sensor 31S according to
FIG. 11 and applied to tissue 46, fixation is possible by glue on
sensor holder 122. Sensor holder 122 can be constructed as
inexpensive and disposable. Alternatively, the bottom side of the
sensor, which is applied to tissue, can be directly covered with
glue. The disadvantage of this is that the sensor can not be
reused. The heart rate is detected via ECG-electrode 123 which
contacts the skin, FIG. 12A shows a sensor where the emitters 31E
and 132E are placed close and a first detector 31D1 is positioned
near and a second 32D is positioned far towards the emitters, FIG.
12B is a slight modification of FIG. 12B showing a sensor where
detector 31D1 is positioned in one line with the emitters 31E and
132E. In FIG. 12C instead of detector 31D1 two detectors 31D1 and
31D2 are illustrated. FIG. 12D is a modification of FIG. 12C
showing that detectors 31D1 and 31D2 can be placed in various
topologies on the sensor interface here close to the emitters 31E
and 132E.
[0043] FIGS. 13A, 13B and 14 show variations of sensor 32S applied
on the forehead of a person. In the first variation shown in FIG.
13A and 13B, sensor 32S is fixed via a band 108 to the forehead.
The arrows A32 and A42, which represent how light travels from the
emitters 31E, 32E to the detectors 31 and 32D, pass through
forehead tissue 152 and bone of skull 150 and pass or touch brain
148. The arrows A12 and A22 only pass through forehead tissue 152
and bone of skull 150. A difference of FIG. 13A and FIG. 13B is
that in FIG. 13A the detectors 31D and 32D are positioned in close
proximity whereas in FIG. 13B the emitters are placed in close
proximity.
[0044] The second variation of sensor 32S also applied on the
forehead is shown in FIG. 14. The arrows A11, A21, A31 and A41
compared with arrows A12, A22, A32 and A42 of FIGS. 13A and 13B
show that by variation of the position of light detectors and
emitters, oxygen content can be sensed differently without changing
the outline of the sensor variation used.
[0045] FIG. 15 shows a patient lying on a bed being supplied with
oxygen by an intubation tube 210, and an anesthesia machine 204.
The anesthesia machine 204 is connected to the patient and has an
inventive device for measuring oxygen consumption or carbon dioxide
production of the patient. The sensor 32S is placed on the forehead
of the patient, and is connected with oxygen extraction monitoring
device 206, which calculates SaO2 and SvO2 and oxygen extraction.
The monitoring device 206 and the anesthesia machine 204 are linked
to a third device 202, which calculates cardiac output or trend of
cardiac output.
[0046] FIG. 16 illustrates the use of oxygen monitoring at
different application sites e.g. for sports activity or other
medical applications, in which a wrist worn display device 220 can
receive oxygenation data from a forehead-band-sensor with sensor
interfaces 214 and 215 for both hemispheres of brain, from a
chest-band-sensor 224, from an arm-band-sensor 218 or a special
variation of this the wrist band with sensor interface 221 or from
a finger-glove-sensor 222.
[0047] FIG. 17a shows the hardware for evaluating oxygenation by
using two emitters 31E and 32E and two detectors 31D and 32D. The
LED-drive 226 energizes the two emitters via lines 238, 248 which
can incorporate coding hardware, to adjust calibration for the
multidimensional calibration or to adjust calibration for varying
emitter detector geometry. The amplifiers AMP1 232 and AMP2 234 are
connected to detectors 31D and 32D. The demultiplexer DEMUX 230
selects each wavelength used in every emitter timed synchronously
according to the switching state of the LED-DRIVE 226 and delivers
the measured data via an AD-Converter AD-CONV 236 to the CPU 228.
The sensor interfaces comprises an isolating layer 239 towards the
patient which may consist of elastic material. The light detectors
31D and 32D are shielded with a grounded layer 233 which is
connected to a ground line 235. The ground shield can consist for
example of an electrical conductive layer or metallic grid. FIG.
17b depicts a cross-sectional view of sensor 240.
[0048] FIG. 19 illustrates the signal flow of a model-based
calibration. An input processing circuit 260 is the first part of
the signal flow. The processing circuit is connected with a circuit
for calculating light attenuations 262 and a circuit calculating
different measurement variables 264. The calculation for light
attenuations 262 is a basis for a model-based determination circuit
for mixed venous oxygenation 266 with a joint circuit to output a
value for the mixed venous oxygenation SvO2 270. A model-based
determination circuit for arterial oxygenation 268 is connected to
the circuit for calculating light attenuations 262 and the circuit
calculating different measurement variables 264, The output value
for a arterial oxygenation circuit for SaO2 272 is linked to the
model-based calculation for SaO2 268.
[0049] 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:
R ' = Rw 2 , w 1 * LAw 2 * LAw 0 + Q Rw 1 , w 0 LAw 1 * LAw 1 eq .
( 2 ) ##EQU00002##
[0050] where Rw2,w1 and Rw1,w0 are calculated according to
equation) using wavelengths w0, w1, and w2 and Q is a correction
parameter.
[0051] Light attenuation LAwx can be calculated in the following or
similar manner:
LAwx=In(Iwx/Iwxo) eq. (3)
[0052] 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. (Graaff,
1992).
[0053] 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.
[0054] A preferred selection of the wavelengths combination to
reduce the influence of scattering is defined by the following
equation, with wavelength with as the geometrical mean value of
wavelength w0 and wavelength w2, defined as:
w1=SQRT(w0*w2) eq. (4)
[0055] This combination minimizes the variation band of correction
parameter Q, which has a default value of about one. The
measurement variable of equation (2) has minimized error related to
variation of scattering and blood content of tissue.
EXAMPLE 1
[0056] The sensor 31S shown in FIG. 3 is used to determine the
arterial oxygenation and the mixed venous blood oxygenation of
tissue with improved precision. Equation (2) is used to provide a
measurement variable R' for the arterial oxygenation. For each of
the emitters 31E and 32E, three wavelengths are defined. Initially,
two measurement wavelengths w0=940 nm and w2=660 nm are selected.
Using equation (4) the third wavelengths w1 is about 788 nm.
Wavelength w1=805 nm is chosen because it is close to the
calculated third wavelength and is additionally at an isobestic
point of the blood absorption spectrum. The next step is to
determine the resulting light attenuation LA for each of the three
wavelengths w0, w1 and w3:
LAw1=LA(A3w1)+LA(A2w1)-LA(A1w1)-LA(A4w1) eq. (5)
LAw2=LA(A3w2)+LA(A2w2)-LA(A1w2)-LA(A4w2) eq. (6)
LAw3=LA(A3w3)+LA(A2w3)-LA(A1w3)-LA(A4w3) eq. (7)
[0057] where LA(Axwy) is the logarithm of received light intensity
in the detector related to light arrow Ax at wavelength wy. 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 eq. (5)-(7) and "+" is replaced by "*" and "-" is
replaced by "/".
[0058] In the next step, Rw2,w1 and Rw1,w0 are calculated according
to equation (1). As a result Fr 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.
[0059] The quotient in (8) which is part of (2) delivers a
measurement variable Rv':
Rv ' = LAw 2 * LAw 0 LAw 1 * LAw 1 eq . ( 8 ) ##EQU00003##
[0060] 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.
[0061] A mathematically identical form of (2) is:
R ' = w 2 , w 0 * Rv ' + Q Rw 1 , w 0 * Rw 1 , w 0 eq . ( 9 )
##EQU00004##
[0062] According to eq. (9) the following equation can also be used
to determine a measurement variable R1' for SaO2:
R 1 ' = Rw 2 , w 0 * f ( 1 , Rv ' , Q ) Rw 1 , w 0 * Rw 1 , w 0 eq
. ( 10 ) ##EQU00005##
[0063] where f is an empirical function of optical tissue
parameters with variables defined above.
[0064] 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'.
[0065] It is also possible to use this method for other light
absorbing 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.
[0066] 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 2
[0067] In FIG. 4 finger clip sensor 54 is shown with the two
emitters 31E, 32E and the two detectors 31D and 32D. The benefit of
the finger clip sensor is that it is easy to apply. Equivalent to
sensor 31S in FIG. 3, four representative light paths between the
two emitters and the two detectors are possible so that all
calculations according example 1 can be performed in order to
calculate the output variables R' and Rv' as a measure for mixed
venous and arterial oxygenation in the finger 48. The corresponding
calculations can also be performed using sensor of FIG. 9. The
difference here is the alternative form of detectors 35D and 36D,
which are able to increase detected light intensity due to an
enlarged, concentric detector area.
EXAMPLE 3
[0068] FIG. 5 shows a multidimensional calibration of SAO2 vs. R1
and R2. R1 and R2 can be calculated according (1) by selecting two
wavelengths pairs where for the first wavelengths pair the
wavelengths wm1=660 nm and wm2=910 nm is chosen and for the second
wavelengths pair wm3=810 nm and wm2=910 nm. The second wavelengths
pair is less sensitive towards arterial oxygenation and is used to
compensate errors due to optical tissue parameter variations. In
order to guarantee that the multidimensional calibration delivers
improved precision in presence of varying tissue parameters, it is
important to select exactly the correspondent calibration which is
specified for a distinct wavelengths set and a distinct detector
emitter distance. Therefore additional information has to be coded
to the selected sensor. The tissue oximeter device can read out
this information and use the appropriate calibration. The coding of
information can be achieved for example by a resistor implemented
in the LED drive line of the sensor (see FIG. 17: 248, 238). A
grounded shield plane 233 between an isolating layer 239 and the
light sensing elements 31D an 32D is useful to minimize the
electrical interference and noise. The isolating layer can also be
used to decouple forces e.g. for wrist worn devices 220 with and
integrated sensor interface to control the forces of sensor
interface on tissue which can have influences on sensor precision.
Also an elastic wrist band 221 can help to decrease this
influence.
[0069] A variant of a multidimensional calibration (FIG. 5) can be
achieved by calculating R1 according to equation (2) and R2
according to equation (8). This minimizes the error of displayed
arterial oxygenation SaO2 due to varying optical tissue
absorption.
EXAMPLE 4
[0070] In FIG. 7 a fetal pulse oximetry sensor 74 is shown, which
punctures the skin on the head of the fetus with a spiral needle
76. The bottom view of FIG. 8 shows sensor 74 with 4 emitters 31E,
32E, 33E, 34E and four detectors 31D, 32D, 33D, 34D. Apparently,
more than four different light paths per selected wavelength
between emitters and detectors (is) are possible. This additional
information is used to calculate a whole set of resulting light
attenuations Lax. For the different light paths it is also possible
to compute a set of measurement variables Rx. Generating a weighted
mean value (weight can depend on the noise of the related
measurement signals) LAm and Rm of the variables LAx and Rx helps
to reduce errors due to tissue inhomogenities. To achieve a stable
measure for the optical tissue parameters, which are not influenced
by locally varying tissue compositions, is important to minimize
errors to precisely determine the inputs of model-based
parameters.
EXAMPLE 5
[0071] A brain oximeter is shown in FIG. 13A which is positioned on
the right side of the forehead of a patient. The cross section of
the brain illustrates how four light paths travel through tissue
from emitters 31E, 32E to the detectors 31D and 32D, representative
for one wavelength. A resulting light attenuation LA can be
achieved for each wavelength by adding light attenuations of A32
and A22 and subtracting therefrom the light attentions which are
related to A42 and A12. The resulting light attenuation LA is then
independent on dirt on emitters or detectors or on degeneration of
those parts, which is an important feature since those sensors can
be reused. Three wavelengths are chosen for each of the two
emitters 31E and 32E of the sensor in FIG. 13A of the brain
oximeter: wb1=660 nm, wb2=740 nm and wb3=810 nm.
[0072] 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.
[0073] A preferred emitter-detector distance between emitter 32E
and detector 31D is greater than 2 cm. In order to contrast brain
tissue and overlaying tissues one long light path should have an
emitter detector distance of about 4 cm and a shorter one with an
emitter detector distance of about 2 cm to distinguish the
overlaying structures. The relation of noise on the signal and
signal portion related mainly to brain is a good compromise for
this application. The longer the distance the emitter detector
distance is, the deeper is 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. FIG. 14
shows an example where within the sensor, the two detectors have
the maximum distance and the detector and emitter elements are
grouped symmetrically with regard to the center of the sensor. The
resulting maximum penetration depth of light of A31, A21 is here
less than maximum penetration depth of light of A32 of the sensor
which illustrated in FIG. 13A because the maximum emitter detector
distance is also less compared to sensor in FIG. 13A at the same
total outline of the sensors. Positioning emitters and detectors
asymmetrically is therefore the best choice to achieve oxygenation
measurements in deep layers of tissue. In FIG. 13B emitter 31E is
positioned close to emitter 32E. Detector 32D is positioned between
detector 31D and emitter 32E. Adding the light attenuation A32 and
A22 and subtracting A12 and A42 results in a signal where most of
the brain overlaying structures can be contrasted versus brain
tissue and where oxygenation signals can be calculated which are
originated for more than 80% from brain tissue and not overlaying
structures.
[0074] FIG. 12 shows a bottom view of a brain oximetry sensor, in
which emitter 31E and detectors 31D and 32D are positioned in a
triangle. The light paths between emitter 31E and 31D and between
31E and 32D using the wavelengths wb1=660 nm and wb3=810 nm are
determined to evaluate the measurement variables Rp1 and Rp2 which
are calculated according to equation (1). The mean value of Rp1 and
Rp 2 is used as the output value for the arterial oxygenation SaO2.
Alternatively, as shown in FIG. 12A, the emitters 31E and 32E can
be positioned where detectors 31D and 32D are located and detectors
31D and 32D are placed at the location of emitter 31E and 32E in
FIG. 12. In FIG. 12B the detector 31D1 is positioned in between of
the emitters 31E and 123E. Adding and subtracting light
attenuations of the related light paths between 31D1 and 31E and
the light path between 31D1 and 123E minimizes the influences of
shallow tissue layers as they cancel out. FIG. 12C shows a sensor
analogous to FIG. 12B. The difference here is that detector 31D1 is
replaced by detector 31D1 and 31D2. Adding the light intensities of
this two detectors before calculating the light attenuation thereof
results that the related attenuation of detector 31D1 and 31D1 for
further calculation can be handled like a single detector.
According to this emitters 31E and 123D can be positioned closer by
avoiding light shunting between detectors 31D1, 31D2 and emitters
31E and 123E. FIG. 12D shows an alternative position detectors 31D1
and 31D2. In order to monitor the oxygenation balance of brain for
both hemispheres a sensor on the right and left side can be used
according to the illustration in FIG. 16 with sensor interfaces
214, 215.
EXAMPLE 6
[0075] 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 therefore 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. FIG. 15 shows a
patient being supplied with air via an intubation tube 210. The
oxygen consumption or CO2 generation is determined within an
anesthesia machine 204. Brain oximetry sensor 32S is connected to
SaO2 and SvO2 display device 206. The information of device 204 and
device 206 is evaluated in a cardiac output monitor 202 in the
following or similar manner:
CaOut = ( oxygen consumption per time ) SaO 2 - SvO 2 eq . ( 11 )
##EQU00006##
EXAMPLE 7
[0076] 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. FIG. 16 shows an athlete
wearing various sensors which are connected by a line or wirelessly
with a wrist-worn-display 220. A sports activity sensor can have
the same topology as the above mentioned brain sensor of FIG. 12.
Emitter-detector distances however vary, depending on desired
tissue monitoring depth. Preferred wavelengths to monitor the mixed
venous oxygenation are ws1:=700 nm, ws2=805 nm and ws3=870 nm. A
resulting light attenuation LA is calculated for each wavelength:
LWws1, LAws2 and LAws3 with ws1, ws2 and ws3 as index for the
selected wavelengths. A measurement variable for the mixed venous
oxygenation Rvs is obtained in the following or similar manner:
Rvs = LAws 1 - LAws 2 LAws 2 - LAws 3 eq . ( 12 ) ##EQU00007##
[0077] Less influence of light scattering and absorption of tissue
can be achieved for the determination of mixed venous oxygenation
in this way.
[0078] 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.
[0079] 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.
[0080] The present subject matter includes various examples,
including the following:
[0081] Example 1 includes an apparatus for measuring tissue
oxygenation of a patient comprising:
a sensor interface adapted to be coupled to a patient tissue site
and including at least one light emitter emitting light into tissue
and at least one detector detecting light passing through tissue
from said at least one emitter; a processor for determining light
attenuations LAwsj dependant on light detected at a selected
wavelength, wsj; a coupling device for coupling said sensor
interface at said tissue site; a data processor for generating a
signal representative of tissue oxygenation based on said
determined light attenuations; and a display device displaying a
tissue oxygenation level.
[0082] Example 2 includes the apparatus of example 1 wherein said
data processor includes means for generating a signal
representative of tissue oxygenation and provides arterial
oxygenation information based on pulsating changes of light
attenuations.
[0083] Example 3 includes the apparatus of example 2 wherein said
sensor coupling device is an arm band.
[0084] Example 4 includes the apparatus of example 3 wherein said
armband is a wrist band.
[0085] Example 5 includes the apparatus of example 3 comprising:
elastic means for controlling a force applied to tissue through the
sensor interface.
[0086] Example 6 includes an apparatus for measuring tissue
oxygenation comprising:
a sensor interface including at least two emitters which emits
light into tissue with at least two wavelengths, and at least one
detector to receive light passing through said tissue; a storage
device for retaining information of sensor variation within said
sensor interface; and a processor for determining tissue
oxygenation using said sensor variation information of said sensor
interface.
[0087] Example 7 includes the apparatus according to example 6
wherein a light emission intensity of at least one of said emitters
and a wavelength of at least one of said emitters is compensated
for by said means for calculating.
[0088] Example 8 includes the apparatus according to example 7
wherein brain tissue oxygenation is determined using said sensor
interface with at least one emitter/detector distance being greater
than 3 cm and said sensor interface being provided at one side of a
forehead, said apparatus measuring the oxygenation of one brain
hemisphere.
[0089] Example 9 includes the apparatus according to example 8
wherein at least one emitter detector distance is about 1 cm long
and a related path can be used to determine a light attenuation or
additionally arterial oxygenation by evaluating a pulsatile part of
detected light.
[0090] Example 10 includes an apparatus for measuring tissue
oxygenation comprising:
a sensor adapted to be coupled to a forehead tissue including at
least two light emitters placed apart from each other on said
sensor with at least two different wavelengths for each emitter
where each emitter has approximately the same wavelengths which
emit light into said tissue and at least one detector for detecting
light having passed through said tissue, whereby a distance of one
of said emitters and one of said at least one detector is chosen so
that a light path penetrates through the tissue and whereby a
distance between at least one emitter-detector pair is more than 20
millimeters; means for calculating at least two signals which
depend on detected light for selected wavelengths wsj for said at
least one detector and said at least two emitters, wherein said at
least two signals are calculated by adding or subtracting light
attenuations; means for calculating attenuation corresponding to
In(intensity of steady state light received at the detector) for at
least two possible light paths between said at least two light
emitters and said at least one detector; and means for generating
an output representative of tissue oxygenation based on the at
least said two signals.
[0091] Example 11 includes the apparatus of example 10 using at
least two emitters and at least two detectors whereby for at least
two of said wavelengths for each of the wavelengths the
corresponding light attenuations for two light paths are added and
the corresponding light attenuation for two further light paths are
subtracted to generate a measure for said at least two signals.
[0092] Example 12 includes the apparatus of example 11 wherein said
sensor includes at least one emitter detector distance of at least
4 cm and a second emitter detector distance of at least 1.5 cm.
[0093] Example 13 includes the apparatus of example 10 wherein said
sensor includes at least one emitter detector distance of at least
4 cm and a second emitter detector distance of at least 1.5 cm.
[0094] Example 14 includes the apparatus of example 12 wherein at
least 65% of a generated oxygenation signal is originated by brain
tissue by adding and subtracting light paths through forehead
tissue and brain tissue,
[0095] Example 15 includes the apparatus of example 13 wherein an
emitter-detector distance of the sensor placed on one side of the
forehead to monitor a brain hemisphere is less than 20 mm long.
[0096] Example 16 includes the apparatus of example 13 having a
means to calculate a measure for arterial oxygenation using a light
signal related to an emitter-detector pair separated by a distance
of no more than 20 mm.
[0097] Although the present invention and its advantages have been
described in detail, it should be understood that various changes,
substitutions and alterations can be made herein without departing
from the spirit and scope of the invention as defined by the
appended claims. Moreover, the scope of the present application is
not intended to be limited to the particular embodiments of the
process, machine, manufacture, composition of matter, means,
methods and steps described in the specification. As one of
ordinary skill in the art will readily appreciate from the
disclosure of the present invention, processes, machines,
manufacture, compositions of matter, means, methods; or steps,
presently existing or later to be developed that perform
substantially the same function or achieve substantially the same
result as the corresponding embodiments described herein may be
utilized according to the present invention. Accordingly, the
appended claims are intended to include within their scope such
processes, machines, manufacture, compositions of matter, means,
methods; or steps.
* * * * *