CN111449657A - Bedside pulmonary ventilation-blood flow perfusion electrical impedance tomography method based on saline angiography - Google Patents
Bedside pulmonary ventilation-blood flow perfusion electrical impedance tomography method based on saline angiography Download PDFInfo
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Abstract
The invention discloses a bedside electrical impedance tomography method based on saline contrast pulmonary ventilation-blood perfusion. In addition, the invention also discloses an image monitoring device, an image monitoring system and a pulmonary embolism diagnosis system based on the method. The method improves the blood perfusion imaging quality, and calculates the ventilation percent of dead space, the intra-pulmonary circulation percent, the regional ventilation-blood flow matching percent according to the blood perfusion imaging quality, thereby having higher practicability. The method of the invention can be used for diagnosing the pulmonary embolism, the sensitivity is 90.9%, the specificity is 98.6%, and the method has high clinical application value.
Description
Technical Field
The invention belongs to the field of clinical medicine, and particularly relates to a bedside pulmonary ventilation-blood perfusion electrical impedance tomography method based on saline contrast.
Background
In contrast to conventional methods, EIT does not require the patient to breathe through a tube or sensor, does not apply ionizing X-rays, and can be used for long periods of time, e.g., 24 hours or even longer.
In EIT, as disclosed in US patent US5626146, a plurality of electrodes, typically from 8 to 32, are arranged on the surface of the body to be examined. The control unit ensures that an electrical signal, e.g. an electrical current, is applied to one or more pairs of electrodes on the skin to create an electric field, which in turn is detected by the other electrodes. The electrodes used to apply the current are referred to as "current injection electrodes", although one of them may serve as a reference potential, such as ground. Typically, 3 to 10mARMS are injected in the frequency range of 0.1-1000 kHz. With the remaining electrodes, the resulting voltage is detected (forming an "EIT data vector" or "scan frame") and then used to estimate the distribution of electrical impedance in the body. Specific algorithms are developed to convert a set of voltages into an image.
At present, the bedside pulmonary vessel perfusion imaging quality based on an Electrical Impedance Tomography (EIT) is poor, and the bedside pulmonary vessel perfusion imaging quality is interfered by resistance signals such as heart pulsation, pulmonary vessel pulsation and the like, and the clinical applicability is poor. In order to improve the imaging quality, a saline angiography technology electrical impedance imaging technology method is researched and developed, saline is injected through a central venous catheter, apnea is performed at the same time, the change of thoracic resistance signals is collected, a local resistance-time change curve of the saline angiography is established, but the types of resistance-time curve analysis methods are more, the saline reaching to the right atrium is identified in the saline injection process, the resistance signals are reduced and easy to interfere, the imaging analysis is influenced, and the accurate first arrival time lung time point of the saline is difficult to obtain.
In the bedside pulmonary blood perfusion imaging analysis, the distribution percentage of ventilation and blood flow is mostly concentrated by the current electrical impedance technology, belongs to semi-quantitative evaluation, and is technically difficult to enter the ventilation dead space and the equivalent calculation of intrapulmonary circulation.
The method aims to solve the technical problem of bedside electrical impedance pulmonary perfusion imaging, and improves the accuracy and application value.
Disclosure of Invention
Technical problem
One of the purposes of the invention is to provide a bedside electrical impedance tomography method based on saline contrast pulmonary ventilation-blood flow perfusion.
It is another object of the present invention to provide an image monitoring apparatus.
It is a further object of the present invention to provide an image monitoring system.
It is a fourth object of the present invention to provide a method and a system for diagnosing pulmonary embolism.
Technical scheme
According to one aspect of the invention, a bedside saline contrast-based pulmonary ventilation-perfusion electrical impedance tomography method is provided. The method comprises the following steps:
(1) breath hold tests, requiring a minimum of over 8 seconds;
(2) injecting saline water to perform pulmonary blood perfusion radiography, and continuously acquiring the change of electrical impedance signals of the chest;
(3) and performing off-line analysis on the resistance signal data.
The specific operation of the step (1) is as follows: breath holding test, requiring a minimum of more than 8 seconds (when the ventilator is mechanically ventilated, the breath holding button is pressed for 10s for expiration or inspiration; the patient orders to hold breath for 8 seconds for spontaneous breathing); after the breath holding test is passed, an EIT examination can be performed by a saline angiography.
The concentration of the injection saline of the present invention was 10%, and the injection amount was 10 ml.
The specific operation of the step (2) is as follows: connecting the test subject with a pulmonary electrical impedance monitoring instrument, preparing 10% NaCl10ml, and confirming that the test subject establishes a central venous catheter; after breath holding starts, injecting 10% NaCl10ml from a central venous catheter into the body to carry out pulmonary blood perfusion radiography; changes in thoracic electrical impedance signals were continuously acquired beginning 2 minutes prior to the saline injection.
The step (3) of performing off-line analysis on the resistance signal data comprises the following steps:
a. constructing a lung blood flow perfusion image;
b. constructing a lung ventilation image;
c. a lung ventilation/blood flow distribution image is constructed.
The specific operation of constructing the pulmonary blood flow perfusion image in the step a is as follows: the whole resistance curve begins to decline as the starting point (T0) when saline enters the body during breath holding, as the starting point (T1) when saline enters the pulmonary blood vessel after a cardiac cycle, and the lowest point of the whole resistance is the end point (T2) when saline passes through the pulmonary blood vessel, and the resistance curve of the time period of T0-T1 reflects that saline enters the right heart and does not reflect pulmonary blood vessel perfusion, and the curve of the time period is not adopted in the analysis for reducing interference; resistance-time change curves (slope fits) for the various lung regions for the T1-T2 time periods were used for construction.
The specific operation of constructing the lung ventilation image in the step b is as follows: lung ventilation image construction was performed by changes in lung resistance over at least 5 consecutive respiratory cycles within 1 minute prior to injection.
The specific operation of constructing the lung ventilation/blood flow distribution image in step c is as follows: the lung ventilation image and the lung blood flow perfusion image take 20% of the maximum pixel points as a threshold value to construct a lung ventilation/blood flow distribution image.
According to another aspect of the present invention, there is provided an image monitoring apparatus including a data receiver, an image processor, and a controller.
The data receiver is responsible for receiving lung ventilation impedance data and lung blood perfusion impedance data measured by the lung electrical impedance monitoring instrument.
The image processor is responsible for generating a lung ventilation image and a lung blood perfusion image from the lung ventilation impedance data and the lung blood perfusion impedance data. The image processor generates an image from the impedance data according to the method described above.
The controller is responsible for controlling display of at least one of a lung ventilation image, a lung blood perfusion image, according to a screen mode and a measurement site.
The controller may include an image and waveform output control module, an impedance measurement control module, and an information determination and transmission module.
The image and waveform output control module may be configured to control display of at least one of a lung ventilation image, a lung blood flow perfusion impedance image, and a lung ventilation/blood flow distribution image according to a preset screen mode or a measurement site of a subject desired to be monitored.
The measurement site may refer to a site that is more accurately monitored with respect to the state of at least one of the lungs, heart of the subject.
The screen mode may include a plurality of screen regions divided based on a certain pathological state of the subject to display at least one of a lung ventilation image, a lung blood flow perfusion impedance image, and a lung ventilation/blood flow distribution image.
The impedance measurement control module may be configured to control the electrical impedance monitoring instrument to measure lung ventilation impedance data, lung blood flow perfusion impedance data at the chest of the subject.
The information determination and transmission module may be configured to control features implemented by the data receiver and the image processor and transmit the received lung ventilation impedance data, lung blood flow perfusion impedance data, to the image processor to enable the lung ventilation impedance data, lung blood flow perfusion impedance data to be generated as an image.
Moreover, the information determination and transmission module may be configured to control transmission of the received lung ventilation impedance data, lung blood flow perfusion impedance data, and at least one of the generated lung ventilation impedance image, lung blood flow perfusion impedance image to the outside.
According to a further aspect of the present invention, there is provided an image monitoring system comprising the image monitoring apparatus as described above.
Further, the system may further comprise a pulmonary electrical impedance monitoring instrument. The pulmonary electrical impedance monitoring instrument is responsible for measuring pulmonary ventilation impedance data and pulmonary blood perfusion impedance data.
According to a further aspect of the invention there is provided a method of diagnosing pulmonary embolism, the method comprising constructing a lung ventilation/blood flow distribution image using the method described above, calculating the percentage of dead space ventilation% (regions ventilated only but not perfused by blood flow as a percentage of the total region), and diagnosing pulmonary embolism when the% dead space ventilation > 30.37%.
According to a further aspect of the invention, there is provided a pulmonary embolism diagnosis system comprising a diagnosis device which operates the diagnosis method as described above.
Preferably, the system further comprises an image monitoring device as described above.
More preferably, the system further comprises a pulmonary electrical impedance monitoring instrument.
Pulmonary embolism refers to clinical and pathophysiological syndromes of pulmonary circulatory disturbance caused by various emboli entering pulmonary circulation to block pulmonary artery or other branches, and comprises pulmonary thromboembolism, fatty embolism syndrome, amniotic fluid embolism, air embolism and the like.
Technical effects
The method of the invention removes the resistance signal of a cardiac cycle by ventilation, effectively reduces the interference of the heart, reliably identifies the time node when the saline contrast agent first reaches the lung area, and can maintain the original lung area as much as possible.
The method of the invention provides pre-test breath-holding evaluation, and improves the efficiency of blood flow distribution evaluation.
According to the method, a 20% threshold value is determined through screening, the quality of blood perfusion imaging is improved, and therefore the ventilation of dead space, the intrapulmonary bypass and regional ventilation-blood flow matching% (V/Q Macth%) are calculated, and the method is more practical.
The method of the invention can be used for diagnosing the pulmonary embolism, the sensitivity is 90.9%, the specificity is 98.6%, and the method has high clinical application value.
Drawings
FIG. 1 shows a graph of electrical impedance versus time;
fig. 2 shows a right heart image and a pulmonary blood flow perfusion image, where a: a right heart image; b: lung blood flow perfusion images;
FIG. 3 shows a ROC plot;
fig. 4 shows an image of the lungs of a pulmonary embolism patient a, where a: pulmonary blood vessel CT radiography; b: a lung ventilation image; c: lung blood flow perfusion images; d: lung ventilation/blood flow distribution images;
fig. 5 shows an image of the lungs of a hemothorax patient B, where a: carrying out lung CT radiography; b: a lung ventilation image; c: lung blood flow perfusion images; d: lung ventilation/blood flow distribution images.
Detailed Description
Before the present embodiments are further described, it is to be understood that the scope of the invention is not limited to the particular embodiments described below; it is also to be understood that the terminology used in the examples is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention. Test methods in which specific conditions are not specified in the following examples are generally carried out under conventional conditions or under conditions recommended by the respective manufacturers.
Example Lung ventilation/blood flow Profile construction and Joint analysis
Measurement case and data acquisition
The study was conducted by the ethical committee of this unit. The standard of group entry is the clinical diagnosis of respiratory failure patients, and central venous catheter injection drug therapy has been established. Exclusion of standard chest deformities or monitoring of electrical impedance presents contraindications (local skin lesions).
Patient information: 33 women, 50 men, average age 62 years, most of whom were respiratory failure patients.
EIT raw data from PulmoVista 500(
Lü beck, Germany), an EIT electrode strip containing 16 sensing electrodes was placed between the fourth to sixth ribs of the patient and a reference electrode was placed on the abdomen current excitation pattern was adjacent excitation pattern, a single EIT image contained 32 × pixels and 20 frames of image per second.
Firstly, a breath holding test requires more than 8 seconds at least (when the breathing machine mechanically ventilates, the breathing machine is properly calmed, the breathing machine is adjusted to be a complete control ventilation mode, and an expiration or inspiration hold key is pressed for 10 s; the patient self-lives breath holds for 8 seconds); after the breath holding test is passed, an EIT examination can be performed by a saline angiography.
Then, a patient is connected with a pulmonary impedance monitoring instrument, 10ml of NaCl is prepared, a central venous catheter (internal jugular vein or subclavian vein catheter can be established) is confirmed to be established for the patient, 3) saline injection is generally required to be completed by 2 operators, one operator confirms that an EIT machine works normally, starts a breath holding of the patient and sends a command of saline injection, the other operator immediately injects 10% NaC L10ml into the patient from the central venous catheter after receiving the confirmation command, the EIT monitor starts a recording mode in the whole operation period, thoracic electrical impedance signal data are continuously acquired 2 minutes before the saline injection, the whole process requires at least 5 minutes, and the process that the lung resistance is reduced due to the saline injection in the breath holding period is completely recorded, and the resistance signal data are analyzed in an off-line mode, wherein the analysis steps are as follows:
1. the whole resistance curve begins to decline as the starting point (T0) that saline enters into the body during breath holding, as the starting point (T1) that saline enters into the pulmonary vessel after a movement cycle, the lowest point of the whole resistance is the end point (T2) that saline passes through the pulmonary vessel, the resistance curve of T0-T1 time interval reflects that saline enters into the right heart, does not reflect pulmonary vessel perfusion, in order to reduce interference, the curve of the time interval is not adopted in the analysis; applying resistance-time variation curves (slope fit) of the respective lung regions for the T1-T2 time periods for lung blood flow perfusion image construction (fig. 1 and 2); the lung blood flow perfusion image was constructed as follows:
(1) calculating the perfusion volume of the ith pixel pointi(t)＝ait + b, time t, time period of the regional resistance-time curve for the acceptance analysis, aiFitting the slope of the curve, wherein the local slope can reflect the size of the perfusion volume;
(2) lung perfusion image distribution map formula
Wherein a isgThe relative lung perfusion amount of the g-th pixel point is shown, and a is the slope of a fitting straight line of the regional resistance; and N is the total number of pixel points in the lung area. The perfusion amount of each pixel accounts for the percentage of the total perfusion amount of the obtained relative lung perfusion distribution image;
2. constructing a lung ventilation image by lung resistance changes for at least 5 consecutive respiratory cycles within 1 minute prior to injection; the lung ventilation image is constructed as follows:
wherein ViThe total pixel point of the ventilation graph is N, and the number of the included respiration periods is N; delta ZiIns is the relative resistance change in inspiration, Δ ZiExp is the expiratory relative resistance change;
3. through the optimal selection of 0-40% threshold, the lung ventilation image and the lung blood flow image are determined, and 20% of the maximum pixel points are used as the threshold to construct a lung ventilation/blood flow distribution image; the specific formula is as follows:
Vk＞20％×max(VK), K∈[1,1024]
k is defined as a pixel with ventilation locally,
Pg＞20％×max(PG), G∈[1,1024]
g is defined as a pixel point with perfusion locally;
4. and (3) obtaining ventilation-blood flow combined parameters by performing area fitting analysis on the lung ventilation map and blood flow perfusion distribution:
dead space ventilation%: the percentage of total area that is only ventilated but not perfused by blood flow;
intrapulmonary bypass%: the percentage of total area that is only perfused by blood flow but not ventilated;
regional ventilation-blood flow matching% (V/Q mach%): the percentage of total area where there is both blood perfusion and ventilation.
The research proves that the method can effectively identify the abnormality of the blood flow ventilation distribution in the lung of the respiratory failure patients, 11 patients are diagnosed with acute pulmonary embolism in 83 cases of severe patients, and 72 patients are not diagnosed with pulmonary embolism clinically. The application of the related technical parameters of the invention, namely the percent of dead space ventilation is more than 30.37, the sensitivity is 90.9 percent, the specificity is 98.6 percent, and the diagnostic efficiency is obviously superior to that of the traditional serological index DD dimer. The ROC curve is shown in fig. 3.
Typical cases are:
pulmonary embolism patient a, basic information: in men, 59, acute respiratory failure after lung cancer surgery, and acute pulmonary embolism is diagnosed.
Pulmonary angiography (fig. 4A) suggested pulmonary embolism, thrombus visible in the right pulmonary artery, normal lung ventilation image (fig. 4B), decreased lung blood flow in the right side as seen in the lung blood perfusion image (fig. 4C), increased dead space ventilation in the right side as seen in the lung ventilation/blood flow distribution image (fig. 4D), consistent with clinical diagnosis.
Hemothorax patient B, basic information: in men, 40, respiratory failure, bleeding from ruptured intercostal arteries in the chest resulting in hemothorax.
Lung CT contrast (fig. 5A) suggests a lower left thoracic hemothorax, lung ventilation image (fig. 5B) suggests a lower left ventilation deficiency, lung blood perfusion image (fig. 5C) suggests a lower left ventilation deficiency, and lung ventilation/blood distribution image (fig. 5D) suggests a lower left ventilation/blood flow deficiency, consistent with clinical diagnosis.
The above embodiments are preferred embodiments of the present invention, but the embodiments of the present invention are not limited to the above embodiments, and it should be understood by those skilled in the art that various modifications or changes can be made by those skilled in the art without inventive efforts based on the technical solutions of the present invention.
Claims (10)
1. A bedside saline contrast-based pulmonary ventilation-perfusion electrical impedance tomography method, the method comprising the steps of:
(1) breath hold tests, requiring a minimum of over 8 seconds;
(2) injecting saline water to perform pulmonary blood perfusion radiography, and continuously acquiring the change of electrical impedance signals of the chest;
(3) performing off-line analysis on the resistance signal data;
preferably, the specific operation of step (1) is as follows: breath hold test, requiring a minimum of more than 8 seconds: when the breathing machine is used for mechanical ventilation, pressing an expiration or inspiration breath-hold key 10 s; the spontaneous breathing patient orders to hold breath for 8 seconds; after the breath holding test is passed, saline angiography EIT examination can be carried out;
preferably, the concentration of the injection saline is 10%, and the injection amount is 10 ml;
more preferably, the specific operation of step (2) is as follows: connecting a test subject with a pulmonary electrical impedance monitoring instrument, preparing 10% NaCl10ml, and confirming that a central venous catheter is established for the patient; after breath holding is started, injecting 10% NaCl10ml from a central venous catheter into the body to carry out pulmonary blood flow perfusion radiography; continuously collecting the change of the electrical impedance signals of the chest at the beginning of 2 minutes before the injection of the saline;
preferably, the step (3) of performing off-line analysis on the resistance signal data includes:
a. constructing a lung blood flow perfusion image;
b. constructing a lung ventilation image;
c. a lung ventilation/blood flow distribution image is constructed.
2. The method of claim 1, wherein the operation of step a comprises: the beginning of the overall resistance curve during breath holding period is named as the starting point of saline entering the body, namely T0, the starting point of saline entering pulmonary vessels is named as T1 after one cardiac cycle, the lowest point of the overall resistance is named as the end point of saline passing pulmonary vessels, namely T2, and the resistance curve of the time period of T0-T1 reflects the saline entering the right heart; pulmonary perfusion images were constructed by slope fitting using the resistance-time variation curves of the various lung regions for the T1-T2 time periods.
3. The method of claim 1, wherein the operation of step b comprises: lung ventilation image construction was performed by changes in lung resistance over at least 5 consecutive respiratory cycles within 1 minute prior to injection.
4. The method of claim 1, wherein the operations of step c comprise: the lung ventilation image and the lung blood flow perfusion image take 20% of the maximum pixel points as a threshold value to construct a lung ventilation/blood flow distribution image.
5. An image monitoring device, characterized in that the device comprises an image processor responsible for generating a lung ventilation image, a lung blood perfusion image from lung ventilation impedance data, lung blood perfusion impedance data; the image processor generating an image from the impedance data according to the method of any one of claims 1-4;
preferably, the device comprises a data receiver which is responsible for receiving the lung ventilation impedance data and the lung blood perfusion impedance data measured by the lung electrical impedance monitoring instrument; the data receiver is connected with the image processor.
6. The apparatus of claim 5, further comprising a controller responsible for controlling display of at least one of a lung ventilation image, a lung blood perfusion image according to a screen mode and a measurement site.
7. The apparatus of claim 6, wherein the controller comprises an image and waveform output control module, an impedance measurement control module, and an information determination and transmission module;
the image and waveform output control module may be configured to control display of at least one of a lung ventilation image, a lung blood flow perfusion impedance image, and a lung ventilation/blood flow distribution image according to a preset screen mode or a measurement site of a subject desired to be monitored;
the impedance measurement control module may be configured to control the electrical impedance monitoring instrument to measure lung ventilation impedance data, lung blood flow perfusion impedance data at the chest of the subject;
the information determination and transmission module may be configured to control features implemented by the data receiver and the image processor and transmit the received lung ventilation impedance data, lung blood flow perfusion impedance data, to the image processor to enable the lung ventilation impedance data, lung blood flow perfusion impedance data to be generated as an image.
8. An image monitoring system, characterized in that the system comprises the image monitoring device of any one of claims 5-7; preferably, the system further comprises a pulmonary electrical impedance monitoring instrument.
9. A method of diagnosing pulmonary embolism, the method comprising constructing a lung ventilation/blood flow distribution image by the method of claim 1, calculating a% dead space ventilation, and diagnosing pulmonary embolism when% dead space ventilation > 30.37%.
10. A pulmonary embolism diagnosis system, characterized in that the system comprises a diagnosis device, which performs the method of claim 9; preferably, the system further comprises an image monitoring device of any one of claims 5-7; more preferably, the system further comprises a pulmonary electrical impedance monitoring instrument.
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Cited By (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112057073A (en) * | 2020-09-08 | 2020-12-11 | 北京华睿博视医学影像技术有限公司 | Method, equipment and system for synchronously generating breathing and blood perfusion images |
| CN114723844A (en) * | 2022-06-10 | 2022-07-08 | 中国医学科学院北京协和医院 | Method, system and equipment for reconstructing pulsatile perfusion image corrected by saline contrast |
| CN115035208A (en) * | 2022-06-10 | 2022-09-09 | 中国医学科学院北京协和医院 | Lung perfusion and region V/Q non-invasive imaging method, system and equipment |
| CN115530791A (en) * | 2022-12-02 | 2022-12-30 | 中国医学科学院北京协和医院 | Intracardiac shunt electrical impedance image analysis method and system based on saline angiography |
| WO2023237034A1 (en) * | 2022-06-10 | 2023-12-14 | 中国医学科学院北京协和医院 | Image reconstruction and analysis method, system, and device based on saline radiography electrical impedance lung perfusion and cardiac imaging |
Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1429086A (en) * | 2000-03-13 | 2003-07-09 | 医疗物理有限公司 | Diagnostic procedures using direct injection of gaseous hyperpolarized 129Xe and associated systems and products |
| CN102821684A (en) * | 2010-03-16 | 2012-12-12 | 斯威斯托姆公开股份有限公司 | Electrode for a scanning electrical impedance tomography device and a scanning electrical impedance tomography device |
| CN105682552A (en) * | 2013-10-18 | 2016-06-15 | 安德烈亚斯·古特蔡特 | Blood flow control system and methods for in-vivo imaging and other applications |
| US20180064830A1 (en) * | 2015-02-20 | 2018-03-08 | Bayer Healthcare Llc | Contrast imaging agent with dissolved gas-evolving fluid |
| CN110072452A (en) * | 2016-11-18 | 2019-07-30 | 百来 | Image monitoring method and equipment and image monitoring system for object |
| CN110087540A (en) * | 2016-11-18 | 2019-08-02 | 百来 | Method and apparatus for pulmonary function test (pft) |
-
2020
- 2020-04-15 CN CN202010296273.0A patent/CN111449657B/en active Active
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1429086A (en) * | 2000-03-13 | 2003-07-09 | 医疗物理有限公司 | Diagnostic procedures using direct injection of gaseous hyperpolarized 129Xe and associated systems and products |
| CN102821684A (en) * | 2010-03-16 | 2012-12-12 | 斯威斯托姆公开股份有限公司 | Electrode for a scanning electrical impedance tomography device and a scanning electrical impedance tomography device |
| CN105682552A (en) * | 2013-10-18 | 2016-06-15 | 安德烈亚斯·古特蔡特 | Blood flow control system and methods for in-vivo imaging and other applications |
| US20180064830A1 (en) * | 2015-02-20 | 2018-03-08 | Bayer Healthcare Llc | Contrast imaging agent with dissolved gas-evolving fluid |
| CN110072452A (en) * | 2016-11-18 | 2019-07-30 | 百来 | Image monitoring method and equipment and image monitoring system for object |
| CN110087540A (en) * | 2016-11-18 | 2019-08-02 | 百来 | Method and apparatus for pulmonary function test (pft) |
Non-Patent Citations (1)
| Title |
|---|
| 曲志华: "机械通气下肺通气与肺灌注的电阻抗断层成像评价方法优化研究", 《中国优秀硕士学位论文全文数据库 医药卫生科技辑》 * |
Cited By (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112057073A (en) * | 2020-09-08 | 2020-12-11 | 北京华睿博视医学影像技术有限公司 | Method, equipment and system for synchronously generating breathing and blood perfusion images |
| CN114723844A (en) * | 2022-06-10 | 2022-07-08 | 中国医学科学院北京协和医院 | Method, system and equipment for reconstructing pulsatile perfusion image corrected by saline contrast |
| CN114723844B (en) * | 2022-06-10 | 2022-08-19 | 中国医学科学院北京协和医院 | Method, system and equipment for reconstructing pulsatile perfusion image corrected by saline contrast |
| CN115035208A (en) * | 2022-06-10 | 2022-09-09 | 中国医学科学院北京协和医院 | Lung perfusion and region V/Q non-invasive imaging method, system and equipment |
| CN115035208B (en) * | 2022-06-10 | 2023-11-14 | 中国医学科学院北京协和医院 | Non-invasive imaging method, system and equipment for lung perfusion and region V/Q |
| WO2023237034A1 (en) * | 2022-06-10 | 2023-12-14 | 中国医学科学院北京协和医院 | Image reconstruction and analysis method, system, and device based on saline radiography electrical impedance lung perfusion and cardiac imaging |
| CN115530791A (en) * | 2022-12-02 | 2022-12-30 | 中国医学科学院北京协和医院 | Intracardiac shunt electrical impedance image analysis method and system based on saline angiography |
| CN115530791B (en) * | 2022-12-02 | 2023-03-10 | 中国医学科学院北京协和医院 | Intracardiac shunt electrical impedance image analysis method and system based on saline angiography |
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