INFLUENCE OF THE TEXTILE EIT-SENSOR BELT ON QUALITY OF THORACIC X-RAY AND COMPUTED TOMOGRAPHY IMAGES

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1 INFLUENE OF THE TEXTILE EIT-SENSOR ELT ON QUALITY OF THORAI X-RAY AND OMPUTED TOMOGRAPHY IMAGES Hammermüller S. 1, Waldmann A. 1, öhm S.H. 1 1 Swisstom AG, Landquart, Switzerland The Effects of prone positioning

2 Swisstom APPLIATION EXAMPLES INTRODUTION The ionizing radiation of x-ray and computed tomography (T) fall progressively into disrepute because they are known to cause damages. [1] EIT is a new visualization technique, which is based on the measurement of electrical conductibility of biologic tissues. Depending on state and/or functional condition, conductivity can differ greatly. [2,3] The electrical conductivity of human lung tissue is 5 times lower compared to most other tissues within the thorax. Thanks to the resulting high contrast, the lungs are very suitable to be monitored by this imaging technique. Additionally, the marked differences between inspiration and expiration lead to cyclic changes in conductivity. These changes can continuously be visualized by EIT and regional analysis is possible. That is why EIT could be established in clinics used as a tool to evaluate characteristics of the ventilated lungs. [4,5] Despite its side effects, computed tomography (T) is still important for the assessment of morphologic conditions of lung tissues and the regional distribution of ventilation within it. EIT is expected to reduce the frequency of T-examinations needed. Similarly, chest x-ray will not disappear from clinical routine in intensive care because of its universalism, but EIT gains significance. Due to the remaining importance of T and x-ray in the assessment of the lung s state the question arises whether the presence of the Sensorelt of Swisstom AG around the patient s thorax during imaging examinations alters the quality or interpretability of chest radiographs or T images. AKGROUND The Sensorelt of Swisstom AG is predominantly made of textile fibers. Thus, parts that can affect the quality of x-ray-base imaging techniques causing artefacts are minimized. (Fig. 1)

Swisstom APPLIATION EXAMPLES A Figure 1: Insight into the structure of the Sensorelt with (A) integrated EIT chips QUESTION Does the presence of Swisstom s Sensorelt around the patient s thorax

3 Swisstom APPLIATION EXAMPLES A Figure 1: Insight into the structure of the Sensorelt with (A) integrated EIT chips QUESTION Does the presence of Swisstom s Sensorelt around the patient s thorax during examinations have a negative effect on the quality or interpretability of chest radiographs or T images? RESULTS Example A A patient with severe acute respiratory distress syndrome was treated with veno-venous extracorporeal membrane oxygenator (vvemo) for life threatening oxygenation impairment. For this purpose, a 21 french drainage cannula was placed into the femoral vein and its correct placement was confirmed by a chest radiograph. For the continuous monitoring of lung protective ventilation, an EIT Sensorelt was placed around the patient s chest. (Fig. 2)

Swisstom APPLIATION EXAMPLES A Figure 2: hest radiograph of the patient after the placement of the drainage cannula during continuous EIT monitoring. The separate EIT chips are distinctly visible.

4 Swisstom APPLIATION EXAMPLES A Figure 2: hest radiograph of the patient after the placement of the drainage cannula during continuous EIT monitoring. The separate EIT chips are distinctly visible. However, the radiologic interpretability is not affected. A: femoral EMO cannula; : standard EGelectrodes; : EIT Sensorelt, integrated EIT chips Example A patient with severely impaired oxygenation was transferred to an ARDS center for advanced treatment. EIT monitoring was initiated immediately to guide lung protective ventilation. To evaluate the morphology of the lungs and the regional aeration state, a thoracic T scan was performed. EIT-monitoring was continued during the examination. (Fig. 3)

5 Swisstom APPLIATION EXAMPLES A Figure 3: Thoracic T scan performed during continuous EIT-monitoring. The EIT chips within the belt caused no artifacts which could have negatively influenced the interpretability of the T-image. A: Sensoreltonnector; : EIT chips, integrated in Sensorelt ONLUSION Swisstom s Sensorelt is built in a way that its few radio opaque parts have little influence on the quality of x-ray-based imaging techniques. Neither the interpretability of chest radiographs nor of thoracic T-images is affected by the presence of the Sensorelt during the examinations. Thus, there is no need to interrupt the continuous EIT monitoring by removing the belt prior to x-ray or T-examinations.

6 Swisstom APPLIATION EXAMPLES SOURES [1] Stadler A. (2009): Strahlenexposition und Strahlenschutz. In: Schäfer-Prokop (Hrsg). Radiologische Diagnostik in der Intensivmedizin. Stuttgart, New York: Thieme, 4-8. [2] Muders T, Luepschen H, Putensen (2010): Impedance tomography as a new monitoring technique. urr Opin rit are. 16(3): [3] osta EL, Lima RG, Amato M (2009): Electrical impedance tomography. urr Opin rit are 15: [4] rochard L. & Hedenstierna G. (2016): Ten physiologic advances that improved treatment for ARDS. Intensive are Med. 42(5): [5] Hammermüller S.(2016): Ohne schädliche Strahlung. Intensiv. 23(06):

7 Swisstom APPLIATION EXAMPLES

Karel Roubík, Vladimír Sobota

Electrical Impedance Tomography for lung recruitment monitoring Technical aspects of clinical usage and interpretation Karel Roubík, Vladimír Sobota Faculty of Biomedical Engineering Czech Technical University