Telehealth-Enabled Ultrasound-Bioimpedance Viscoelastographic Edema Monitoring

支持远程医疗的超声生物阻抗粘弹性成像水肿监测

• 批准号: 8460425
• 负责人: William F Weitzel
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8460425
• 关键词: Address; Algorithms; Blood Pressure; Caring; Cells; Chronic Kidney Failure; Clinical; Communication; Communities; Computer software; Congestive Heart Failure; Dancing; Data; Data Collection; Devices; Dialysis patients; Disease; Diuretics; Edema; Evolution; Future; Goals; Health; Heart Diseases; Home environment; Hydration status; Hypoalbuminemia; Image; Information Technology; Kidney Diseases; Laboratories; Limb structure; Liquid substance; Liver Failure; Liver diseases; Lymphedema; Maps; Measurement; Measures; Methods; Modality; Modeling; Monitor; Nature; Patient Monitoring; Patients; Peripheral; Pharmaceutical Preparations; Phase; Physical Examination; Physicians; Pressure Transducers; Reading; Resistance; Resolution; Rural; Secure; Sepsis; Sodium; Solid; Stimulus; Stress; Structure; System; Techniques; Telemedicine; Testing; Time; Tissue Model; Tissues; Ultrasonography; United States; United States Department of Veterans Affairs; Validation; Venous; Veterans; Weight; Wireless Technology; base; clinical decision-making; cost; design; electric impedance; ergonomics; extracellular; improved; instrument; medically underserved; meetings; novel; programs; research clinical testing; soft tissue; telehealth; tool; viscoelasticity

DESCRIPTION (provided by applicant): There is an enormous clinical problem in optimally managing the fluid status for a number of disease states, including chronic kidney disease (CKD), congestive heart failure (CHF), liver failure, and lymphedema. Currently, serial physical examinations by a skilled clinician provide the input for clinical decision making. However, serial examinations are a challenge, especially in rural, medically underserved communities and quantitative, operator independent hydration status assessments are lacking. Remote monitoring telehealth initiatives using weights and blood pressure measurements provide some information, but technology allowing rapid, robust, repeatable measurements of hydration status would be a major advance. In recent years, bioimpedance measurements have been shown to be useful in monitoring dialysis patients, where a dry weight determination is needed for optimal fluid status management. However, confounding effects from cellular ionic content hamper future evolution of this technique. We have developed approaches for strain-based bioimpedance measurements that will allow this field to advance. In addition, we have laid the groundwork to develop an alternative and complementary method for quantifying peripheral edema. The use of ultrasound strain imaging dynamically and quantitatively characterizes changes of a subsurface elastic medium under stress. Using these strain measurements, along with bioimpedance readings, we can completely characterize the visco- and poro-elastic parameters of a patient's edematous state. However, this technique is untested and needs to be developed and validated. Edematous tissue can be viewed as a poroelastic material containing both fluid and solid components. While bioimpedance measurements are responsive to volume fluid changes in tissue, ultrasound measurements primarily depend on the solid component of tissue. Combined, these modalities promise to offer a more complete analysis of edematous tissue while quantifying fluid hydration status with a precision yet seen clinically. Parallel to these concerns over hydration status, remote care in the form of telehealth and telemedicine is emerging as an important tool for numerous patient groups. Especially for rural, underserved communities, the ability to remotely communicate important reliable indicators of hydration status to their physicians can dramatically improve our ability to address health concerns. The overall goal of this proposal is to develop a clinically useful, robust, reproducible, quantitative tissue hydration measurement apparatus that will be low-cost, suitable for home or remote patient monitoring, with secure data handling. We will accomplish this by first developing appropriate hardware and software to independently test the ability of ultrasound and bioimpedance to detect changes in poroelastic structures under quasi-static and dynamic loading conditions. Algorithms and models based on the collected data will be developed and validated using PIV, load cell, and pressure transducer measurements. Parallel to this, a telehealth program will be developed including both the wireless capabilities needed as well as preliminary testing on alerts and warning systems that could be utilized once fluid hydration status readings are incorporated into remote monitoring regimes. Finally, a compact, convenient device will be developed ready for clinical testing combining both ultrasound and bioimpedance modalities to accurately and quantitatively determine tissue hydration of peripheral extremities and transmit the data securely over telehealth communication lines. Management of patients with diuretics or extracorporeal therapies requires proper assessment of volume status. This is important for a wide variety of clinical situations. Importantly, this proposal supports the Veterans Administration telehealth initiative and will improve the health of Veterans needing remote health monitoring.

描述（由申请人提供）： 最佳地管理许多疾病状态的液体状况，包括慢性肾脏疾病（CKD），充血性心力衰竭（CHF），肝衰竭和淋巴水肿，存在一个巨大的临床问题。当前，熟练的临床医生进行的串行身体检查为临床决策提供了意见。但是，串行检查是一个挑战，尤其是在农村，医疗服务不足的社区中，缺乏定量，操作员独立的水合状态评估。使用重量和血压测量的远程监控远程医疗计划提供了一些信息，但是允许快速，健壮，可重复测量水合状态的技术将是一个重大进步。 近年来，已经证明生物阻抗测量值可用于监测透析患者，在监测最佳液体状态管理需要干重的患者中。但是，细胞离子含量的混淆影响阻碍了该技术的未来演变。我们已经开发了基于应变的生物阻抗测量的方法，这些方法将使该领域发展。 此外，我们为开发一种量化外围水肿的替代方法和互补方法奠定了基础。超声应变的使用动态成像和定量表征了应力下地下弹性培养基的变化。使用这些应变测量以及生物阻抗读数，我们可以完全表征患者水肿状态的粘粘性和毛孔弹性参数。但是，该技术未经测试，需要开发和验证。 水肿组织可以看作是含有液体和固体成分的毛弹性材料。虽然生物阻抗测量值对组织的体积流体变化有反应，但超声测量主要取决于组织的固体成分。这些模式结合在一起，有望对水肿组织进行更完整的分析，同时以临床上的精确度量化流体水合状态。 与这些对水合状况的关注点并行，远程护理的远程护理和远程医疗的形式正在成为众多患者群体的重要工具。特别是对于农村，服务欠缺的社区，将重要的保湿状况的重要可靠指标与医生交流的能力可以极大地提高我们解决健康问题的能力。 该提案的总体目标是开发一种临床上有用的，可靠的，可再现的，定量的组织水合测量设备，该设备将是低成本，适用于家庭或远程患者监测，并具有安全的数据处理。我们将通过首先开发适当的硬件和软件来独立测试超声和生物阻抗在准静态和动态加载条件下检测毛弹性结构的变化的能力来实现这一目标。基于收集到的数据的算法和模型将使用PIV，负载电池和压力传感器测量来开发和验证。与此相关的是，将制定远程医疗计划，包括所需的无线功能以及对警报和警告系统进行初步测试，一旦将流体水合状态读数纳入远程监控制度，该计划就可以使用。最后，将开发一种紧凑，方便的设备，以准备结合超声和生物阻抗方式的临床测试，以准确并定量确定周围肢体的组织水平，并通过远程医疗通信线安全地传输数据。 使用利尿剂或体外疗法的患者需要正确评估体积状态。这对于各种临床情况很重要。重要的是，该提案支持退伍军人管理远程医疗倡议，并将改善需要远程健康监控的退伍军人的健康。