US20110054343A1 - Monitoring system - Google Patents

Monitoring system Download PDF

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Publication number
US20110054343A1
US20110054343A1 US11/993,219 US99321906A US2011054343A1 US 20110054343 A1 US20110054343 A1 US 20110054343A1 US 99321906 A US99321906 A US 99321906A US 2011054343 A1 US2011054343 A1 US 2011054343A1
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Prior art keywords
processing system
impedance
subject
determining
method includes
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US11/993,219
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English (en)
Inventor
Scott Chetham
Leigh Cordwin Ward
Tim Essex
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Impedimed Ltd
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Impedimed Ltd
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Priority claimed from AU2005903510A external-priority patent/AU2005903510A0/en
Application filed by Impedimed Ltd filed Critical Impedimed Ltd
Priority to US11/993,219 priority Critical patent/US20110054343A1/en
Assigned to IMPEDIMED LIMITED reassignment IMPEDIMED LIMITED ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ESSEX, TIM, WARD, LEIGH CORDWIN, CHETHAM, SCOTT
Publication of US20110054343A1 publication Critical patent/US20110054343A1/en
Priority to US15/482,347 priority patent/US11660013B2/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/026—Measuring blood flow
    • A61B5/029—Measuring blood output from the heart, e.g. minute volume
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A61B5/0537—Measuring body composition by impedance, e.g. tissue hydration or fat content
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/063—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using impedance measurements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4842—Monitoring progression or stage of a disease
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4869—Determining body composition
    • A61B5/4875—Hydration status, fluid retention of the body
    • A61B5/4878—Evaluating oedema
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7278—Artificial waveform generation or derivation, e.g. synthesizing signals from measured signals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient; User input means
    • A61B5/742—Details of notification to user or communication with user or patient; User input means using visual displays
    • A61B5/744—Displaying an avatar, e.g. an animated cartoon character
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2560/00—Constructional details of operational features of apparatus; Accessories for medical measuring apparatus
    • A61B2560/02—Operational features
    • A61B2560/0266—Operational features for monitoring or limiting apparatus function
    • A61B2560/0271—Operational features for monitoring or limiting apparatus function using a remote monitoring unit

Definitions

  • the present invention relates to a method and apparatus for monitoring biological parameters, and in particular to a method and apparatus for performing impedance measurements.
  • One existing technique for determining biological parameters relating to a subject involves the use of bioelectrical impedance. This involves measuring the electrical impedance of a subject's body using a series of electrodes placed on the skin surface. Changes in electrical impedance at the body's surface are used to determine parameters, such as changes in fluid levels, associated with the cardiac cycle or oedema.
  • Lymphoedema is a condition characterised by excess protein and oedema in the tissues as a result of reduced lymphatic transport capacity and/or reduced tissue proteolytic capacity in the presence of a normal lymphatic load. Acquired, or secondary lymphoedema, is caused by damaged or blocked lymphatic vessels. “The commonest inciting events are surgery and/or radiotherapy. However, onset of lymphoedema is unpredictable and may develop within days of its cause or at any time during a period of many years after that cause.
  • WO00/79255 describes a method of detection of oedema by measuring bioelectrical impedance at two different anatomical regions in the same subject at a single low frequency alternating current. The two measurements are analysed to obtain an indication of the presence of tissue oedema by comparing with data obtained from a normal population.
  • machines are only adapted to provide only one form of impedance analysis and as a result, provide a standard output that must then be interpreted by the operator.
  • different operating modes it is necessary for the operator of the machine to be aware of any intricacies associated with the selected measurement mode, as well as being able to interpret the different outputs that may be available.
  • the present invention provides a method of performing impedance measurements on a subject, the method including, in a processing system:
  • the method includes, in the processing system:
  • the representation includes, for each lead connection, a respective colour indication, the colour indication being indicative of a colour for a respective lead.
  • the method includes, in the processing system:
  • each measurement is performed for a corresponding body segment.
  • the method includes:
  • the method includes, in the processing system:
  • the impedance measurement type is for determining at least one of:
  • the method includes, in the processing system:
  • the method includes, in the processing system:
  • the representation is in the form of at least one of
  • the method includes, in the processing system:
  • the method includes, in the processing system:
  • the method includes in the processing system:
  • the subject parameter is at least one of
  • the method includes, in the processing system, determining the at least one subject parameter from a remote database.
  • the method includes, in the processing system:
  • the processing system is coupled to a reader for sensing coded data from a surface, and wherein the method includes, in the processing system:
  • the subject identification device is a bracelet having coded data disposed thereon.
  • the method includes, in the processing system:
  • the positioning of the electrodes is performed in accordance with the theory of equal potentials.
  • the positioning of the electrodes includes:
  • processing system is coupled to a monitoring unit, and wherein the method includes, in the processing system:
  • the monitoring unit includes at least two channels, each channel being adapted to measure the impedance across a respective body segment, and wherein the method includes, in the processing system, causing at least one impedance measurement to be performed using each channel.
  • the monitoring unit includes a processor, and wherein the processor is for:
  • the method includes, causing the impedance measurement to be performed by:
  • the present invention provides apparatus for performing impedance measurements on a subject, the apparatus including a processing system for:
  • the present invention provides a method of performing impedance measurements on a subject, the method including, in a processing system:
  • the method includes, in the processing system:
  • the representation is in the form of at least one of
  • the method includes, in the processing system:
  • the method includes in the processing system:
  • the subject parameter is at least one of:
  • the method includes, in the processing system:
  • the present invention provides apparatus for performing impedance measurements on a subject, the apparatus including a processing system for:
  • the present invention provides a method of performing impedance measurements on a subject, the method including, in a processing system:
  • processing system is coupled to a monitoring unit, and wherein the method includes, in the processing system:
  • the method includes using a monitoring unit including a processor, and wherein the processor is for:
  • the method includes, causing the impedance measurement to be performed by:
  • the method includes using a monitoring unit including at least two channels, each channel being adapted to measure the impedance across a respective body segment, and wherein the method includes, in the processing system, causing at least one impedance measurement to be performed using each channel.
  • each channel being adapted to measure the impedance across a respective body segment, and wherein the method includes, in the processing system, causing at least one impedance measurement to be performed using each channel.
  • the method includes, in the processing system:
  • the impedance measurement type is for determining at least one of:
  • the method includes in the processing system:
  • the subject parameter is at least one of:
  • the method includes, in the processing system, determining the at least one subject parameter from a remote database.
  • the method includes, in the processing system:
  • the processing system is coupled to a reader for sensing coded data from a surface, and wherein the method includes, in the processing system:
  • the subject identification device is a bracelet having coded data disposed thereon.
  • the present invention provides apparatus for performing impedance measurements on a subject, the apparatus including a processing system for:
  • the present invention provides a method for configuring a processing system for use in impedance analysis of a subject, the method including, in a processing system:
  • the configuration data includes the instructions.
  • the method includes, in the processing system, decrypting the received configuration data.
  • the method includes, in the processing system:
  • the processing system includes first and second processing systems, and wherein the method includes:
  • the method includes, in the processing first system, at least one of:
  • the method includes, in the processing system, receiving the configuration data from at least one of a computer system and a communications network.
  • the method includes, in the processing system:
  • the method includes, in the processing system:
  • the present invention provides apparatus for configuring a processing system for use in impedance analysis of a subject, the apparatus including a processing system for:
  • processing system forms at least part of at least one of:
  • the present invention provides a method for configuring a processing system for use in impedance analysis of a subject, the method including, in a computer system:
  • the method includes, in the computer system:
  • the method includes, in the computer system, determining the configuration data is required in response to at least one of:
  • the method includes, in the computer system:
  • the present invention provides apparatus for configuring a processing system for use impedance analysis of a subject, the method including, in a computer system:
  • the broad forms of the invention may be used individual or in combination, and may be used for diagnosis of the presence, absence or degree of a range of conditions and illnesses, including, but not limited to oedema, pulmonary oedema, lymphoedema, body composition, cardiac function, and the like.
  • FIG. 1 is a schematic of an example of impedance determination apparatus
  • FIG. 2 is a flowchart of an example of a process for performing impedance determination
  • FIG. 3 is a schematic of a second example impedance determination apparatus
  • FIGS. 4A and 4B are a flowchart of a second example of a process for performing impedance determination
  • FIG. 5 is a flowchart of an example of a process for performing impedance determination
  • FIGS. 6A and 6B are a flow chart of a second example of a process for performing impedance determination
  • FIGS. 7A to 7C are a flow chart of an example of a process for oedema analysis
  • FIGS. 8A and 8B are examples of a GUI used in providing subject details
  • FIG. 9A is an example of a GUI used in providing electrodes on a subject
  • FIGS. 9B and 9C are examples of typically electrode placements
  • FIGS. 9D to 9I are examples of a GUI used in performing the impedance measurements
  • FIGS. 10A to 10D are examples of a GUI used in viewing measured impedance parameters
  • FIGS. 11A and 11B are examples of a GUI used in selecting references
  • FIGS. 11C to 11H are examples of a GUI used in presenting the results of an impedance analysis
  • FIG. 12 is an example of a GUI used in performing total body impedance measurements
  • FIG. 13 is a schematic diagram of an example of a system architecture for updating a measuring device
  • FIG. 14 is a schematic of a GUI used in configuring the apparatus of FIG. 3 ;
  • FIG. 15 is a flow chart of an overview of an example of the process of updating a measuring device
  • FIG. 16 is a flow chart of a first example of the process of updating a measuring device.
  • FIG. 17 is a flow chart of a second example of the process of updating a measuring device.
  • FIG. 1 An example of apparatus suitable for performing an analysis of a subject's impedance will now be described with reference to FIG. 1 .
  • the apparatus includes a measuring device 1 including a processing system 2 coupled to a signal generator 11 and a sensor 12 .
  • the signal generator 11 and the sensor 12 are coupled to respective electrodes 13 , 14 , 15 , 16 , provided on a subject S, via leads L, as shown.
  • An optional external interface 23 can be used to couple the measuring device 1 to one or more peripheral devices 4 , such as an external database or computer system, barcode scanner, or the like.
  • the processing system 2 is adapted to generate control signals, which causes the signal generator 11 to generate one or more alternating signals, such as voltage or current signals, which can be applied to a subject S, via the electrodes 13 , 14 .
  • the sensor 12 determines the voltage across or current through the subject S, using the electrodes 15 , 16 and transfers appropriate signals to the processing system 2 .
  • the processing system 2 may be any form of processing system which is suitable for generating appropriate control signals and interpreting an indication of the measured signals to thereby determine the subject's bioelectrical impedance, and optionally determine other information such as the cardiac parameters, presence absence or degree of oedema, or the like.
  • the processing system 2 may therefore be a suitably programmed computer system, such as a laptop, desktop, PDA, smart phone or the like.
  • the processing system 2 may be formed from specialised hardware.
  • the I/O device may be of any suitable form such as a touch screen, a keypad and display, or the like.
  • the processing system 2 , the signal generator 11 and the sensor 12 may be integrated into a common housing and therefore form an integrated device.
  • the processing system 2 may be connected to the signal generator 11 and the sensor 12 via wired or wireless connections. This allows the processing system 2 to be provided remotely to the signal generator 11 and the sensor 12 .
  • the signal generator 11 and the sensor 12 may be provided in a unit near, or worn by the subject S, whilst the processing system 2 is situated remotely to the subject S.
  • the outer pair of electrodes 13 , 14 are placed on the thoracic and neck region of the subject S.
  • the electrodes would typically be positioned on the limbs, as required.
  • an alternating signal is applied to the subject S. This may be performed either by applying an alternating signal at a plurality of frequencies simultaneously, or by applying a number of alternating signals at different frequencies sequentially.
  • the frequency range of the applied signals may also depend on the analysis being performed.
  • the applied signal is a frequency rich current from a current source clamped, or otherwise limited, so it does not exceed the maximum allowable subject auxiliary current.
  • voltage signals may be applied, with a current induced in the subject being measured.
  • the signal can either be constant current, impulse function or a constant voltage signal where the current is measured so it does not exceed the maximum allowable subject auxiliary current.
  • a potential difference and/or current are measured between an inner pair of electrodes 15 , 16 .
  • the acquired signal and the measured signal will be a superposition of potentials generated by the human body, such as the ECG, and potentials generated by the applied current.
  • the distance between the inner pair of electrodes may be measured and recorded.
  • other parameters relating to the subject may be recorded, such as the height, weight, age, sex, health status, any interventions and the date and time on which they occurred.
  • Other information, such as current medication, may also be recorded.
  • buffer circuits may be placed in connectors that are used to connect the voltage sensing electrodes 15 to the leads L. This ensures accurate sensing of the voltage response of the subject S, and in particular helps eliminate contributions to the measured voltage due to the response of the leads L, and reduce signal loss.
  • a further option is for the voltage to be measured differentially, meaning that the sensor used to measure the potential at each electrode 15 , 16 only needs to measure half of the potential as compared to a single ended system.
  • the current measurement system may also have buffers placed in the connectors between the electrodes 13 , 14 and the leads L.
  • current can also be driven or sourced through the subject S symmetrically, which again greatly reduced the parasitic capacitances by halving the common-mode current.
  • Another particular advantage of using a symmetrical system is that the micro-electronics built into the connectors for each electrode 13 , 14 also removes parasitic capacitances that arise when the subject S, and hence the leads L move.
  • the acquired signal is demodulated to obtain the impedance of the system at the applied frequencies.
  • One suitable method for demodulation of superposed frequencies is to use a Fast Fourier Transform (FFT) algorithm to transform the time domain data to the frequency domain. This is typically used when the applied current signal is a superposition of applied frequencies.
  • FFT Fast Fourier Transform
  • Another technique not requiring windowing of the measured signal is a sliding window FFT.
  • the applied current signals are formed from a sweep of different frequencies, then it is more typical to use a processing technique such as multiplying the measured signal with a reference sine wave and cosine wave derived from the signal generator, or with measured sine and cosine waves, and integrating over a whole number of cycles. This process rejects any harmonic responses and significantly reduces random noise.
  • Impedance or admittance measurements are determined from the signals at each frequency by comparing the recorded voltage and current signal.
  • the demodulation algorithm will produce an amplitude and phase signal at each frequency.
  • the processing system 2 operates to generate control signals which are provided to the signal generator 11 at step 110 , thereby causing the signal generator to apply an alternating current signal to the subject S, at step 120 .
  • the signal is applied at each of a number of frequencies f i to allow multiple frequency analysis to be performed.
  • the sensor 12 senses voltage signals across the subject S.
  • the measuring device operates to digitise and sample the voltage and current signals across the subject 5 , allowing these to be used to determine instantaneous bioimpedance values for the subject S at step 150 .
  • the processing system 2 includes a first processing system 10 having a processor 20 , a memory 21 , an input/output (I/O) device 22 , and an external interface 23 , coupled together via a bus 24 .
  • the processing system 2 also includes a second processing system 17 , in the form of a processing module.
  • a controller 19 such as a micrologic controller, may also be provided to control activation of the first and second processing systems 10 , 17 .
  • the first processing system 10 controls the operation of the second processing system 17 to allow different impedance measurement procedures to be implemented, whilst the second processing system 17 performs specific processing tasks, to thereby reduce processing requirements on the first processing system 10 .
  • the generation of the control signals, as well as the processing to determine instantaneous impedance values is performed by the second processing system 17 , which may therefore be formed from custom hardware, or the like.
  • the second processing system 17 is formed from a Field Programmable Gate Array (FPGA), although any suitable processing module, such as a magnetologic module, may be used.
  • FPGA Field Programmable Gate Array
  • first and second processing systems 10 , 17 , and the controller 19 are typically controlled using one or more sets of appropriate instructions. These could be in any suitable form, and may therefore include, software, firmware, embedded systems, or the like.
  • the controller 19 typically operates to detect activation of the measuring device through the use of an on/off switch (not shown). Once the controller detects device activation, the controller 19 executes predefined instructions, which in turn causes activation of the first and second processing systems 10 , 17 , including controlling the supply of power to the processing systems as required.
  • the first processing system 10 can then operate to control the instructions, such as the firmware, implemented by the second processing system 17 , which in turn alters the operation of the second processing system 17 . Additionally, the first processing system 10 can operate to analyse impedance determined by the second processing system 17 , to allow biological parameters to be determined. Accordingly, the first processing system 10 may be formed from custom hardware or the like, executing appropriate applications software to allow the processes described in more detail below to be implemented.
  • the second processing system 17 includes a PCI bridge 31 coupled to programmable module 36 and a bus 35 , as shown.
  • the bus 35 is in turn coupled to processing modules 32 , 33 , 34 , which interface with ADCs (Analogue to Digital Converters) 37 , 38 , and a DAC (Digital to Analogue Converter) 39 , respectively.
  • ADCs Analogue to Digital Converters
  • DAC Digital to Analogue Converter
  • the programmable module 36 is formed from programmable hardware, the operation of which is controlled using the instructions, which are typically downloaded from the first processing system 10 .
  • the firmware that specifies the configuration of hardware 36 may reside in flash memory (not shown), in the memory 21 , or may be downloaded from an external source via the external interface 23 .
  • the instructions may be stored within inbuilt memory on the second processing system 17 .
  • the first processing system 10 typically selects firmware for implementation, before causing this to be implemented by the second processing system 17 . This may be achieved to allow selective activation of functions encoded within the firmware, and can be performed for example using configuration data, such as a configuration file, or instructions representing applications software or firmware, or the like, as will be described in more detail below.
  • this allows the first processing system 10 to be used to control operation of the second processing system 17 to allow predetermined current sequences to be applied to the subject S.
  • different firmware would be utilised if the current signal is to be used to analyse the impedance at a number of frequencies simultaneously, for example, by using a current signal formed from a number of superposed frequencies, as compared to the use of current signals applied at different frequencies sequentially.
  • FIGS. 6A to 6C An example of operation of the apparatus will now be described with reference to FIGS. 6A to 6C .
  • an operator selects an impedance measurement type using the first processing system 10 .
  • This may be achieved in a number of ways and will typically involve having the first processing system 10 store a number of different profiles, each of which corresponds to a respective impedance measurement protocol.
  • the profile will typically be stored in the memory 21 , or alternatively may be downloaded from flash memory (not shown), or via the external interface 23 .
  • this will cause the first processing system 10 to load desired code module firmware into the programmable module 36 of the second processing system 17 at step 210 , or cause embedded firmware to be activated.
  • code module used will depend on the preferred implementation, and in one example this is formed from a wishbone code module, although this is not essential.
  • the second processing system 17 is used to generate a sequence of digital control signals, which are transferred to the DAC 39 at step 230 .
  • This is typically achieved using the processing module 34 , by having the module generate a predetermined sequence of signals based on the selected impedance measurement profile. This can therefore be achieved by having the second processing system 17 program the processing module 34 to cause the module to generate the required signals.
  • the DAC 39 converts the digital control signals into analogue control signals I + , I ⁇ which are then applied to the current source 11 at step 240 .
  • the current source circuit operates to amplify and filter the electrical control signals I + , I ⁇ at step 250 , applying the resulting current signals to the electrodes 13 , 14 at step 260 .
  • the current circuit through the subject can optionally be shorted at step 270 , using a switch SW, to thereby discharge any residual field in the subject S, prior to readings being made.
  • the measurement procedure commences, with the voltage across the subject being sensed from the electrodes 15 , 16 .
  • the voltage across the electrodes is filtered and amplified using the buffer circuit shown in FIG. 5 at step 290 , with the resultant analogue voltage signals V being supplied to the ADC 37 and digitised at step 300 .
  • the current applied to the subject S is detected with the analogue current signals I being digitised using the ADC 38 at step 320 .
  • the digitised voltage and current signals V, I are received by the processing modules 32 , 33 at step 330 , with these being used to performed preliminary processing of the signals at step 340 .
  • the processing performed will again depend on the impedance measurement profile, and the consequent configuration of the processing modules 32 , 33 .
  • This can include for example, processing the voltage signals V to extract ECG signals.
  • the signals will also typically be filtered to ensure that only signals at the applied frequencies f i , are used in impedance determination. This helps reduce the effects of noise, as well as reducing the amount of processing required.
  • the second processing system 17 uses the processing signals to determine voltage and current signals at each applied frequency with these being used at step 360 to determine instantaneous impedance values at each applied frequency f i .
  • the ADCs 37 , 38 and the processing modules 32 , 33 are typically adapted to perform sampling and processing of the voltage and current signals V, I in parallel so that the voltage induced at the corresponding applied current are analysed simultaneously. This reduces processing requirements by avoiding the need to determine which voltage signals were measured at which applied frequency. This is achieved by having the processing modules 32 , 33 sample the digitised signals received from the ADCs 37 , 38 , using a common clock signal generated by the processing module 36 , which thereby ensures synchronisation of the signal sampling.
  • the instantaneous impedance values can undergo further processing in either the first processing system 10 , or the second processing system 17 , at step 370 .
  • the processing of the instantaneous impedance signals will be performed in a number of different manners depending on the type of analysis to be used and this in turn will depend on the selection made by the operator at step 200 .
  • the FPGA operates to generate a sequence of appropriate control signals I + , I ⁇ , which are applied to the subject S using the signal generator 11 .
  • the voltage induced across the subject is then sensed using the sensor 12 , allowing the impedance values to be determined and analysed by the second processing system 17 .
  • Using the second processing system 17 allows the majority of processing to be performed using custom configured hardware. This has a number of benefits.
  • a second processing system 17 allows the custom hardware configuration to be adapted through the use of appropriate firmware. This in turn allows a single measuring device to be used to perform a range of different types of analysis.
  • this vastly reduces the processing requirements on the first processing system 10 .
  • This allows the first processing system 10 to be implemented using relatively straightforward hardware, whilst still allowing the measuring device to perform sufficient analysis to provide interpretation of the impedance.
  • This can include for example generating a “Wessel” plot, using the impedance values to determine parameters relating to cardiac function, as well as determining the presence or absence of lymphoedema.
  • the measuring device 1 can be updated.
  • the measuring device can be updated by downloading new firmware via flash memory (not shown) or the external interface 23 .
  • processing is performed partially by the second processing system 17 , and partially by the first processing system 10 .
  • processing it is also possible for processing to be performed by a single element, such as an FPGA, or a more generalised processing system.
  • the FPGA is a custom processing system, it tends to be more efficient in operation than a more generic processing system. As a result, if an FPGA alone is used, it is generally possible to use a reduced overall amount of processing, allowing for a reduction in power consumption and size. However, the degree of flexibility, and in particular, the range of processing and analysis of the impedance which can be performed is limited.
  • the above described example strikes a balance, providing custom processing in the form of an FPGA to perform partial processing. This can allow for example, the impedance values to be determined. Subsequent analysis, which generally requires a greater degree of flexibility can then be implemented with the generic processing system.
  • a further disadvantage of utilising an FPGA alone is that it complicates the process of updating the processing, for example, if improved processing algorithms are implemented.
  • an operator of the apparatus provides details of a type of impedance measurement to be performed.
  • the operator positions electrodes on the subject before connecting leads to the electrodes based on connection instructions provided by the apparatus at step 520 .
  • This process will therefore typically involve having the operator place a number of electrodes on the subject and then connecting leads to selected ones of the electrodes based on the particular measurement being performed.
  • the measuring device 1 will operate to perform impedance measurements by generating an appropriate current sequence and applying this to the subject via the electrodes 13 , 14 .
  • the measuring device 1 determines if further impedance measurements are required and if so the process returns to step 520 to allow the operator to connect leads to different ones of the electrodes as required. This process is repeated until sufficient impedance measurements have been collected to perform the required analysis.
  • step 550 the process moves on to step 550 with the measuring device 1 operating to process the impedance measurements and provide an indication of required information to the operator.
  • this may be achieved in a number of ways and that typically, this involves having the operator select a predetermined impedance measurement procedure and then follow instructions provided by the measuring device 1 to allow the impedance measurements to be correctly collected.
  • FIGS. 6A and 6B describe the process of collecting impedance data.
  • the operator activates the measuring device 1 causing the first processing system 10 to determine a list of the available measurement types.
  • the available measurement types will be determined either from the memory 21 , or alternatively downloaded via the external interface 23 and are based on predetermined profiles which provide suitable instructions to allow the measuring device 1 to perform the required impedance measurements.
  • the profiles will depend for example on factors such as the type of impedance measurements to be performed, or the like.
  • the profile will be different for cardiac parameter determination as compared to oedema detection.
  • the first processing system 10 will display a list of available measurement types to the operator utilising a suitable GUI.
  • the operator selects an appropriate one of the measurement types. This causes the first processing system 10 to access the corresponding profile and determine if any additional information is required, such as body parameters including age, weight, sex, an indication of body segments, such as limbs to be analysed, or the like.
  • the first processing system 10 can be adapted to assist the operator in selecting the correct measurement type.
  • the particular measurement that should be made may depend on a number of factors, such as the body parameters, as well as whether any interventions have occurred.
  • the operator can provide details of the body parameters, interventions, or the like.
  • the first processing system 10 can then uses these to access details of available measurement types and determine the preferred measurement type for the given situation.
  • the first processing system 10 may access an LUT (look-up table) that specifies the measurement profile that should be used in different circumstances.
  • LUT look-up table
  • the relationships in the LUT can be defined by medically qualified personnel, thereby removing the requirement on the operator to make a medical decision.
  • rules may be provided in the profiles, so that the first processing system 10 is only able to access profiles that are suitable for the current body parameter and intervention status.
  • Rules can alternatively be derived using heuristic algorithms based on selections made by medically qualified operators during measurement procedures. It will be appreciated that in this instance, as the device is used, the first processing system 10 will collate information regarding the body parameters and intervention status of the subject and the measurement profile selected, and use this to derive rules used in future profile selection. Such heuristic algorithms are known in the art and will not be described in any further detail.
  • these techniques allow different measurement profiles to be selected based on factors such as the age, height, weight, race, sex or the like, of the subject, as well as the current intervention status.
  • a further feature that can be implemented is to allow the first processing system 10 to access one or more remote databases, which may form one of the peripheral devices 4 , to determined information regarding the subject. This can include information such as the body parameters, and details of any interventions or the like.
  • a search database option allowing the subject information to be retrieved. This is typically performed on the basis of a subject identifier, such as a unique number assigned to the individual upon admission to a medical institution, or may alternatively be performed on the basis of name or the like.
  • a database is generally in the form of an HL7 compliant remote database, although any suitable database may be used.
  • the subject can be provided with a wristband or the like which includes coded data indicative of the subject identifier.
  • the measuring device 1 can be coupled to a peripheral device 4 for determining the subject identifier.
  • the data may be in the form of a barcode, with the peripheral device 4 being a barcode scanner.
  • RFID Radio Frequency ID
  • the barcode reader detects the barcode provided on the subject's wrist band, and determines a subject identifier from the detected barcode.
  • the barcode reader provides data indicative of the sensed subject identifier to the first processing system 10 , thereby allowing the first processing system 10 to access the subject record from the database as described above.
  • the first processing system 10 displays an indication of the required information, or an appropriate database search screen at step 610 , allowing the operator to provide or retrieve subject information at step 615 .
  • the first processing system 10 operates to determine a measurement procedure at step 620 .
  • the measurement procedure will be determined from the profile and is typically in the form of a sequence of measurements that need to be made.
  • the profile will also include an indication of electrode placements for each of the measurements, together with details of the required current sequence that must be applied to each electrode configuration in order for the necessary measurements to be collected.
  • the first processing system 10 displays an indication of the required electrode positions allowing the operator to position the electrodes on the subject at step 630 .
  • the first processing system 10 determines and displays an indication of a lead connection.
  • the lead connection represents the next body segment to be measured and this is achieved utilising a suitable representation described in more detail below.
  • this may be achieved using four leads corresponding to two current leads, and two voltage leads, with each lead having a respective colour.
  • the display highlights particular electrode positions in an appropriate colour thereby allowing the operator to connect each lead to the corresponding electrode at step 640 .
  • the first processing system 10 determines a current sequence which is to be applied to the subject and causes this to be generated utilising the processing module, which in this example is an second processing system 17 .
  • the operation of the second processing system 17 can be controlled using instructions provided by the first processing system 10 .
  • the instructions could be in any one of a number of forms, and may correspond to firmware, embedded systems, software, or the like. In the event that firmware is used, this may be either provided by the first processing system 10 , or retrieved from an internal or external memory by the second processing system 17 as required, based on instructions from the first processing system 10 .
  • the instructions specify the configuration of the second processing system 17 thereby allowing the impedance measurements to be correctly made and subsequently analysed. It will therefore be appreciated that the instructions will depend on the selected impedance measurement profile selected above. It will be appreciated that if firmware is used, this may reside in flash memory (not shown), in the memory 21 , or may be downloaded from an external source via the external interface 23 .
  • the second processing system 17 measures the current through and/or voltage across the electrodes for each of the applied current frequencies f t before confirming that the measurement is completed at step 650 .
  • the measuring device 1 operates to determine if further measurements are required at step 655 . In the event that further measurements are required the process returns to step 635 to allow the measurements to be performed.
  • processing of the impedance measurements is performed based on the selected measurement type.
  • the analysis may be performed either in the first processing system 10 , or the second processing system 17 , or in a combination of the second processing system 17 or the first processing system 10 , depending on the preferred implementation.
  • the software implemented by the first processing system 10 , or the firmware used by the second processing system 17 will typically be selected based on selected impedance measurement type and will therefore be indicated in the impedance measurement profile.
  • the operator need only select a respective profile to perform an impedance measurement and obtain a result.
  • the first processing system 10 uses the selected profile to determine the sequence of measurements that need to be performed, operates to instruct the operator in locating the electrodes and then connecting these in the necessary sequence.
  • the first processing system 10 can also determine from the profile, the software and/or firmware which is needed to perform the analysis, allowing this to be downloaded into the first processing system 10 and/or the second processing system 17 as required. Consequently, the measuring device 1 can automatically determine the required processing to be performed on the impedance measurements, allowing a result to be presented directly to the operator, thereby obviating the need for the operator to provide any input during the process.
  • oedema is a build-up of fluid in a particular limb. Accordingly, in this example, by measuring the impedance of the limb it is possible to determine information regarding fluid levels and hence determine the presence or absence of oedema.
  • oedema typically occurs after an injury has occurred or surgery has been performed. Accordingly, if it is possible to perform a measurement of the limb prior to surgery, analysis of the impedance after surgery can be used to detect the onset of oedema. However, if no such measurement has been made, it is necessary to use an alternative reference to determine whether the current fluid levels are indicative of the presence of oedema.
  • FIGS. 7A to 7C An example of the process for allowing oedema measurements to be made will now be described with reference to the flowchart shown in FIGS. 7A to 7C and with reference to the graphical user interface (GUI) screen shots shown in FIGS. 8 , 9 , 10 and 11 .
  • GUI graphical user interface
  • an operator of the monitoring device 1 views available measurement profiles displayed by the measuring device 1 .
  • the operator selects a peripheral oedema measurement, with the first processing system 10 operating to select an appropriate oedema measurement profile, typically from the memory 21 , at step 710 .
  • the first processing system 10 may download appropriate firmware into the second processing system 17 , allowing the correct current sequences to be generated, and the measured potentials to be analysed.
  • the measuring device 1 displays a GUI 1000 as shown in FIG. 8A .
  • the GUI includes a number of fields, shown generally at 1001 , which allow data regarding the individual to be provided.
  • the data includes name information such as name, address, sex, height, weight or the like. Additionally, an indication of the limbs at risk from oedema can be input as shown at 1002 .
  • the subject record is typically stored in a subject database accessed via the external interface 23 , or the like.
  • the subject record includes the subject data, and details of any performed impedance measurements for the respective subject, thereby allowing the subject record to form a subject history for use in longitudinal analysis.
  • the operator can perform a search to retrieve the record from the database.
  • the database is typically a HL7 compliant remote database, and it will therefore be appreciated that the database may be the same database from which the subject details are retrieved, as described above with respect to step 705 .
  • the processing system will update the GUI 1000 at step 720 , as shown in FIG. 8B to display any previously measured impedance values, which may be used as reference data, as will be described in more detail below. Searching, editing and creation of records using the input controls shown generally at 1004 .
  • the first processing system 10 generates a GUI 1010 , an example of which is shown in FIG. 9A , and which is used in allowing the operator to provide electrode connections.
  • the GUI 1010 includes an indication of subject details at 1011 .
  • a representation 1012 of the subject is provided, which shows general electrode connection points 1012 A, indicating where on the subject electrodes should be provided.
  • the general arrangement is to provide electrodes on the hand at the base of the knuckles and between the bony protuberances of the wrist, as shown in FIG. 9B , and on the feet at the base of the toes and at the front of the ankle, as shown in FIG. 9C .
  • the GUI 1010 also displays details for each limb at 1017 A, 1017 B, 1017 C, 1017 D, including an indication of whether the limb is an at risk limb. This is also shown on the representation 1012 at 1017 E.
  • An instruction field is shown generally at 1018 is provided to display instructions to the operator, with an indication of the selected measurement procedure being shown at 1019 , and general measuring device status information being provided at 1020 .
  • a comments field 1021 can also be used to record comments regarding the measurements made.
  • the operator typically updates the weight of the subject in the subject details 1011 , which may undergo significant variations over time due to changes in fluid levels within the subject's body.
  • the operator may also respecify the at risk limbs, which is useful when a subject develops further lymphoedema. For example, a subject may start off with unilateral lymphoedema of the left leg and over time may develop a lymphoedema in the right leg. This leg can be recorded at that point as being affected by the use of the “at risk” check boxes.
  • the measurement procedure can be initiated by clicking the “ok button” 1022 .
  • both the weight and comments for each measurement are recorded as part of the corresponding subject record in the subject database. This allows the practitioner to track weight and clinical comments over the period of measurement.
  • the electrode-lead placement GUI 1010 is updated as shown in FIG. 9D to direct the operator to connect the leads from the measuring device 1 the electrodes.
  • the representation 1012 indicates which of the electrodes should be connected to the monitoring apparatus, as shown at 1013 , 1014 , 1015 , 1016 , to thereby form the current electrodes 13 , 14 , and the voltage electrodes 15 , 16 .
  • This is achieved using colour coding, by using leads having colours corresponding to those shown on the representation, thereby ensure that each electrode is correctly connected to the measuring device 1 .
  • the representation 1012 shows the electrode configuration required to measure the impedance in the right arm.
  • this configuration uses the theory of equal potentials, allowing the electrode positions to provide reproducible results for impedance measurements. For example when current is injected between electrodes 1013 and 1016 in FIG. 9D , electrode 1014 could be placed anywhere along the left arm, since the whole arm is at an equal potential. This is advantageous as it greatly reduces the variations in measurements caused by poor placement of the electrodes by the operator. It also greatly reduces the number of electrodes required to perform segmental body measurements, as well as allowing the limited connections shown to be used to measure each of limbs separately.
  • the operator uses a measure button 1023 to cause the measuring device 1 to perform the impedance measurement, with general measuring device status information being provided at 1020 .
  • the first processing system 10 determines from the profile, the next measurement to be performed, and generates the GUI including appropriate information in the representation 1012 and the instruction field 1018 .
  • the operator connects electrodes in accordance with the electrode connections shown on the representation 1012 , and once this has been completed selects the measurement button 1023 , causing the measurement to be performed.
  • the monitoring device 1 generates the required current signal(s), and applies these to the subject, before measuring the current and voltage across the subject at step 735 , to allow instantaneous impedance values to be determined at a number of different frequencies f i .
  • step 740 it is determined if further measurements are required. If so, the measuring device 1 operates to update the GUI 1010 , at step 745 , based on the next measurement to be performed, as shown for example, in FIG. 9E .
  • the representation 1012 is updated to show the next required electrode connections 1013 , 1014 , 1015 , 1016 , which in this case correspond to performing measurements on the right leg. Additionally, the first processing system 10 will also display preliminary results from the completed measurement. Thus, in this example, as the right arm has already been measured, an impedance parameter indication is shown at 1017 A, in FIG. 9E .
  • Steps 730 to 745 are then repeated as required, which in this case involves performing at least four sets of measurements, one for each limb, as shown in FIGS. 9F and 9G .
  • step 750 with the monitoring device updating the GUI 1010 to indicate that the measurement process is completed 1018 , and that the measurements can be saved using the button 1024 , as shown in FIG. 9H .
  • the first processing system 10 can update the GUI 1000 to reflect the saved measurements as shown in FIG. 9I , at step 755 .
  • the operator can review the measured impedances as well as analysing the impedances to determine the onset of oedema.
  • the operator selects raw impedance data display.
  • the first processing system 10 displays the raw impedance parameters utilising a GUI 1030 .
  • the GUI includes subject details at 1031 , and a measurement selection inputs 1032 . This allows the operator to select measurements of interest, which in this example includes measurements from the left arm.
  • the first processing system 10 displays an overview of parameters determined from the impedance measurements at 1033 .
  • the parameters derived will depend on the analysis being performed and will typically include parameters such as the impedance at zero, characteristic and infinite frequencies (R 0 , Z c , R ⁇ ). These can be derived based on the impedance response of the subject, which at a first level can be modelled using the equation (1), known as the Cole model, in which:
  • ⁇ has a value between 0 and 1 and can be thought of as an indicator of the deviation of a real system from the ideal model.
  • the value of the impedance parameters R 0 and R ⁇ may be determined in any one of a number of manners such as by:
  • the first processing system 10 can also be adapted to test adherence of the measurements to the Cole model.
  • the Cole model assumes that the impedance measurements lie on a semi-circular impedance locus. Accordingly, the first processing system 10 can determine if the measured values fit a semi-circular locus to thereby determine if the Cole model is satisfied.
  • the measured impedance parameter values can be compared to theoretical values derived using the equation (2), to thereby allow the degree of concordance to the Cole model to be determined.
  • a number of tabs 1034 can be used to allow different representations of the measured impedance values to be provided in a window 1035 .
  • the impedance values can be listed as shown in FIG. 10B , or plotted as reactance verses frequency or resistance verses frequency as shown in FIGS. 10C and 10D respectively.
  • Frequency controls 1036 are provided to allow impedance measurements above or below threshold limits to be omitted from the displayed results, as shown by threshold markers 1037 A, 1037 B. Additionally a rejection limit can be applied to discard data points that fall outside a threshold variation from an idealised semi-circular locus provided on the “Wessel” plot.
  • the operator selects any references to be used.
  • the reference will typically be in the form of earlier data collected for the respective subject, thereby allowing a longitudinal analysis to be performed.
  • the system may also or alternatively use a normal population database table, which includes reference values obtained from different subjects.
  • This database table is essentially a single subject database table into which all measurements of normal population subjects (people without lymphoedema) are added.
  • FIG. 11A An example of such normal population data displayed using the GUI 1000 is shown in FIG. 11A .
  • This table then acts as a pool of data from which normalised values for raw impedance data and ratios of impedance data can be generated, allowing comparison with measured values for the subject to be performed.
  • This generation of this normalised data is in the form of mean (averaged) values that are selected to be relevant to the test subject.
  • the selection is performed based on the subject information and may be performed on the basis of any one of a number of factors, such as age, sex, height, weight, race, interventions, or the like.
  • test subject has unilateral lymphoedema of the dominant arm and is female then the normalised data drawn from the normal population database will be calculated from the dominant arm measurements from female subjects that are present in the in the normal population database.
  • step 775 the operator is presented with a GUI 1040 similar to that shown in FIG. 11A , which allows the operator to select appropriate records from the normal population table, as shown by the highlighted entry at 1041 .
  • this is generally achieved by ensuring measurements taken prior to surgery or events that put them at risk of developing lymphoedema.
  • a common example is baseline measurements taken before surgical intervention for breast cancer that can be use to track subjects fluid shifts post surgery by comparison of study measurements to these baseline generated mean values.
  • Subject specific baselines can be generated automatically from measurements in the subject's database table. This can be achieved using the GUI 1000 shown in FIG. 11B , in which the subject's record is displayed. Located on the GUI 1000 are two selection windows 1042 , 1043 that are used to define the measurements used from the subject's database table to generate mean data values for comparison to study measurements.
  • the process can also be used to add data to the normal population table. This is achieved by performing the measurement process outlined above, and in the event that the subject does not suffer from oedema, for example if surgery has not yet been performed, importing the data into the normal population table. This can be performed in addition to adding the measurements to the subject record, so that measurements collected from a healthy individual can be used for subsequent longitudinal analysis and/or as a normal population reference.
  • the measuring device 1 determines if a reference is available, and if so, the first processing system 10 compares the currently determined parameters to one or more reference values at step 795 , and utilises this to generate reports which are displayed at step 800 .
  • the first processing system 10 can analyse the impedance of contra-lateral limbs at step 785 and provide an appropriate output at step 800 . This may be achieved for example by determining an index based on a ratio of the extra- to intra-cellular fluid levels in each leg, and then comparing the values determined to assess whether there is difference between the limbs, and hence whether there is a likelihood of oedema being present.
  • the extracellular fluid resistance R e is determined from:
  • R i R ⁇ ⁇ R e R e - R ⁇
  • the first processing system 10 typically determines the index for each limb. A ratio of the determined index for different pairs of limbs are then compared at step 790 , thereby allowing the operator to determine if there is a likelihood of bilateral oedema.
  • the report is presented using a GUI 1050 that includes subject details shown generally at 1051 .
  • the GUI includes controls 1052 that allow the operator to select whether reference data is to be used and the nature of the reference data.
  • the process will return to step 540 to reassess the nature of the output dependent on the type of reference selected.
  • a drop down list is provided to indicate the nature of the parameter that is to be displayed
  • checkboxes are provided indicating the limbs for which the parameter is to be displayed.
  • a limb of interest and a reference limb can be selected using the check boxes 1054 , 1055 as shown.
  • the parameters available for charting include:
  • the lymphogram or impedance vector plot is a graphical representation of when a subject's measurements move relative to a reference ellipse.
  • the reference ellipse can be generated from a 95% confidence interval based on the subject specific baseline data or the normal population data.
  • data points of a study body segment move outside the ellipse the subject's condition is worsening and lymphoedema is present in that body segment.
  • the ellipse can be generated for and displayed for each body segment chosen using the reference limb checkbox.
  • the data points displayed are those generated from the study body segment data for the subject.
  • the study body segments and reference body segments are chosen using the body segment selector check boxes located underneath the chart.
  • FIG. 11C shows an example of a lymphogram in which the index for left and right legs is compared.
  • the index remains within the ellipse shown generally at 1056 highlighting that lymphoedema is not present.
  • the right arm and left arm are compared as shown in FIG. 11D , the values for the ratio comparisons fall outside the reference ellipse 1056 indicating that the right arm is suffering from oedema.
  • the lymphogram includes a comparison between limbs, and accordingly, the checkboxes 1053 B are not used.
  • FIG. 11E is an example of the ratio of limb ratios in which a ratio of the index for the right arm and right legs is plotted against time. In this instance, it can be seen that a significant variation is present at 1057 indicating the likelihood of oedema.
  • checkboxes 1053 B are not used, and are ignored.
  • This function will display the ratio of the R 0 of the reference body segment divided by that of a study body segment for each measurement in the subject's database table.
  • the index I can also be displayed for each body segment for all measurements in the subject's database table as a chart over time, as shown in FIG. 11F .
  • the body segments represented on the chart are selected using the control 1053 .
  • the 1054 , 1055 are omitted for clarity.
  • the value of R 0 can also displayed for each body segment for all measurements in the subjects database table as a chart over time.
  • the value of R ⁇ can also displayed for each body segment for all measurements in the subjects database table as a chart over time.
  • the value of R i can also displayed for each body segment for all measurements in the subjects database table as a chart over time.
  • the characteristic frequency can also displayed for each body segment for all measurements in the subjects database table as a chart over time.
  • SEE standard estimate of errors
  • the value of the time delay (Td) associated with each measurement can also displayed for each body segment for all measurements in the subjects database table as a chart over time.
  • reference values can also be displayed based either on the normalised population reference or subject specific reference.
  • FIG. 11F An example of the use of a subject's specific reference value is shown in FIG. 11F .
  • the reference value is based on R 0 as shown at 1058 . Accordingly, it can be seen that variation of the value R 0 compared to the reference is indicative of oedema.
  • the generation of a report by comparison to normal population data will be performed in a similar manner.
  • a further feature of the process is the ability to associate event markers with specific measurements in the measurement database table.
  • Event markers can provide commented time points that correspond to measurements and points in time. These can be customised by the user to indicate important events that need to be documented on the longitudinal analysis charts. Such events may include, onset date of lymphoedema, the start of massage intervention etc. These markers will be displayed automatically on the longitudinal charts that are a function over time. Event markers can also be shown on charts as shown for example in FIG. 11H .
  • the first processing system 10 therefore selects the types of analysis or representation that is most appropriate for determining the presence or absence of oedema based on the currently available data. This therefore removes the requirement for the operator to make an assessment of which form of report would provide the most accurate indication of the onset of oedema.
  • the impedance measurements are collected for each of the limbs, with the assessment of the preferred type of analysis being performed after the measurements have been performed.
  • the first processing system 10 can be adapted to determine the preferred type of analysis first and then only perform the measurements required in order for the type of analysis to be performed.
  • a limited limb analysis can be performed, in which the operator specifies the limbs for which measurements are to be made prior to the measurement process. In this instance, data will only be collected for the limbs of interest.
  • profiles can be configured to allow a range of different measurements to be performed.
  • TBW total body water
  • the volumes of extracellular and intracellular fluid can be derived from the values R 0 , R ⁇ , as these depend on the values of the extracellular and intracellular resistance, as discussed above.
  • the TBW can be used in:
  • measurement profiles can be determined to allow measurement of:
  • a base station 1300 is coupled to a number of measuring devices 1 , and a number of end stations 1303 via a communications network 1302 , such as the Internet, and/or via communications networks 1304 , such as local area networks (LANs), or wide area networks (WANs).
  • the end stations 1303 may also be coupled to measuring devices 1 , as shown.
  • the end station 1303 may be any form of end station but is typically a desktop, laptop, tablet, PDA, Smart Phone or the like.
  • the base station 1300 includes a processing system 1310 , coupled to a database 1311 . This allows the base station 1300 to be used to update the measuring devices 1 , as will be described in more detail below.
  • the measuring devices 1 can be connected via the external interface 23 , directly to the end stations 1303 , or via one of the networks 1302 , 3104 . This may be achieved via a wired, or wireless connection, depending on the nature of the external interface 23 , the end stations 1303 , and the networks 1302 , 1304 .
  • the end station 1303 can be used to control the measuring device 1 to perform the measurement procedure.
  • the measuring device 1 therefore operates to generate required excitation signals, apply these to the subject, and measure the resulting voltages generated across the subject. Once impedance measurements have been collected, these are transferred via the external interface 23 to the end station 1303 , which operates to analyse the measured impedance values and generate the appropriate GUIs shown in FIGS. 8 to 11 .
  • the operator of the system is generally required to place the measuring device 1 in a predetermined operating mode allowing the end station 1303 to generate any required control signals to activate the measurement process.
  • the measuring device 1 will therefore typically operate to perform single measurements at a given time.
  • the end station 1303 will display the next electrode configuration to be used to the operator.
  • the operator will connect the electrodes, 13 , 14 , 15 , 16 to the subject, in the displayed arrangement, and then indicate to the end station 1303 when this has been completed.
  • the end station 1303 will then transfer a control signal to the measuring device 1 causing the next measurement to be performed.
  • the end station 1303 can implement a measurement-halt check. During this process if the end station 1303 detects measurements within a predetermined time interval, such as 5 seconds, the end station 1303 generates an alert indicating that the measuring device 1 is not provided in single measurement mode, and that this should be adjusted.
  • a predetermined time interval such as 5 seconds
  • the end station 1303 can effectively perform the tasks performed by the first processing system 10 in the examples throughout the specification. Accordingly, the device could be provided without the first processing system 10 , with the functionality usually performed by the first processing system 10 being performed by an end station 1303 . In this arrangement, the end station 1303 therefore effectively forms part or all of the first processing system 10 . This allows the measuring device 1 to be provided including only the second processing system 17 coupled directly to the external interface 23 to allow the measuring device 1 to be controlled by the end station 1303 . This would typically be achieved via the use of suitable applications software installed on the end station 1303 .
  • communication between the end station 1303 and the measuring device 1 is typically controlled using the GUI 1060 shown in FIG. 14 .
  • the GUI includes fields 1061 for defining IP connection details, which allows the end station 3 to connect to the measuring device 1 , via the external interface 23 , via a TCP/IP or other network.
  • Fields 1062 are used for defining paths via which the references can be obtained, with the fields 1063 defining details of the database from which the references should be obtained.
  • Fields 1064 and 1065 are used to define parameters relating to the impedance analysis to be performed, including default frequency, rejection and time delay limits, as well as reference ranges or the like. Finally fields 1066 are used to define properties of the resulting analysis report.
  • GUI can also be used to provide connections to remote databases, such as HL7 compliant subject databases.
  • the architecture can be implemented in any one of a number of manners depending on the circumstances in which the measuring device 1 is to be used.
  • the selection and/or analysis of the impedance measurements can be performed by a central base station coupled to a number of measuring devices via a suitable communications system, such as a computer network or the like.
  • a suitable communications system such as a computer network or the like.
  • the base station transfers an indication of this to the respective monitoring thereby causing the measuring device 1 to display the necessary electrode connections.
  • the determined measurements are returned to the base station for analysis.
  • the process involves determining a measuring device 1 is to be configured with an upgrade, or the like, before configuration data is created at step 1510 .
  • the configuration data is typically uploaded to the device or the end station 1303 before the device is activated at 1530 , or applications software on the end station 1303 is executed.
  • the processing system 2 uses the configuration data to selectively activate features, either for example by controlling the upload of instructions, or by selectively activating instructions embedded within the processing system 2 or the controller 19 .
  • Features within applications software installed on the end station 1303 can be activated in a similar manner.
  • the configuration data could consist of instructions, such as a software or firmware, which when implemented by the processing system 2 causes the feature to be implemented.
  • this process may be utilised to update the operation of the firmware provided in the second processing system 17 , the processing system 10 or the controller 19 to allow additional functionality, improved measuring algorithms, or the like, to be implemented.
  • the configuration data could be in the form of a list of features, with this being used by the processing system 2 to access instructions already stored on the measuring device 1 .
  • Configuration of configuration data in this manner allows the measuring device to be loaded with a number of as yet additional features, but non-operational features, when the device is sold.
  • by updating the configuration data provided on the measuring device 1 this allows these further features to be implemented without requiring return of the measuring device 1 for modification.
  • the feature receives approval for use.
  • techniques may be available for measuring or detecting lymphoedema in a predetermined way, such as through the use of a particular analysis of measured voltage signals or the like.
  • approval may not yet have been obtained from an administering body such as the Therapeutic Goods Administration, or the like.
  • the feature is disabled by appropriate use of a configuration data.
  • the configuration data can be modified by uploading a new updated configuration data to the measuring device, allowing the feature to be implemented.
  • the base station 1300 includes a processing system 1310 , coupled to a database 1311 .
  • the base station 1300 operates to determine when updates are required, select the devices to which updates are applied, generate the configuration data and provide this for update to the devices 1 .
  • the processing system 1310 may therefore be a server or the like.
  • a user's end station 1303 such as a desk top computer, lap top, Internet terminal or the like
  • the communications network 1302 , 1304 such as the Internet.
  • any suitable communications system can be used such as wireless links, wi-fi connections, or the like.
  • the base station 1300 determines that there is a change in the regulatory status of features implemented within a certain region. As mentioned above this could occur for example following approval by the TGA of new features.
  • the base station 1300 uses the change in regulatory status to determine new features available at step 1610 , before determining an identifier associated with each measuring device 1 to be updated at step 1620 .
  • changes in regulatory approval are region specific, this is typically achieved by having the base station 1300 access database 1311 including details of the regions in which each measuring device sold are used.
  • the database 1311 includes the identifier for each measuring device 1 , thereby allowing the identifier of each measuring device to be updated to be determined.
  • the base station 1300 determines the existing configuration data, typically from the database 1311 , for a next one of the measuring devices 1 , before modifying the configuration data to implement the new features at step 1640 .
  • the configuration data is then encrypted utilising a key associated with the identifier.
  • the key may be formed from a unique prime number associated with the serial number, or partially derived from the serial number, and is typically stored in the database 1311 , or generated each time it is required using a predetermined algorithm.
  • step 1660 the encrypted configuration data is transferred to the measuring device 1 as described above.
  • the first processing system 10 determines the encryption key, and uses this to decrypt the configuration data. This may be achieved in any one of a number of ways, such as by generating the key using the serial number or other identifier, and a predetermined algorithm. Alternatively, this may be achieved by accessing a key stored in the memory 21 . It will be appreciated that any form of encryption may be used, although typically strong encryption is used, in which a secret key is used to both encrypt and decrypt the configuration data, to thereby prevent fraudulent alteration of the configuration by users, as will be explained in more detail below.
  • the first processing system 10 activates software features within the second processing system 16 using the decrypted configuration data.
  • this provides a mechanism for automatically updating the features available on the measuring device. This may be achieved either by having the second processing system 16 receive new firmware from the processing system 10 , or by activating firmware already installed on the second processing system 16 , as described above.
  • the process can be used to allow features to be activated on payment of a fee.
  • a user may purchase a measuring device 1 with limited implemented functionality. By payment of a fee, additional features can then be activated as and when required by the user.
  • the first processing system 10 when the user selects an inactive feature at step 1700 , the first processing system 10 will generate an indication that the feature is unavailable at step 1710 . This allows the user to select an activate feature option at step 1720 , which typically prompts the user to provide payment details at step 1730 .
  • the payment details are provided to the device manufacturer in some manner and may involve having the user phone the device manufacturer, or alternatively enter the details via a suitable payment system provided via the Internet or the like.
  • step 1740 once the payment is verified, the process can move to step 1620 to allow an automatic update to be provided in the form of a suitable configuration data. However, if payment details are not verified the process ends at 1750 .
  • encrypting the configuration data utilising a unique identifier means that the configuration data received by a measuring device 1 is specific to that measuring device. Accordingly, the first processing system 10 can only interpret the content of a configuration data if it is both encrypted and decrypted utilising the correct key. Accordingly, this prevents users exchanging configuration data, or attempting to re-encrypt a decrypted file for transfer to a different device.
  • the configuration data it would be typical for the configuration data to include any required firmware to be uploaded, allowing this to be loaded into the second processing system 16 , using the first processing system 10 .
  • This firmware can then either be automatically implemented, or implemented in accordance with the list of available features provided in the configuration data.
  • this provides a mechanism for updating and/or selectively activating or deactivating features, such as measuring protocols, impedance analysis algorithms, reports interpreting measured results, or the like. This can be performed to ensure the measuring device conforms to existing TGA or FDA approvals, or the like.
  • the end station 1303 can be used to download configuration data, or alternatively transfer instructions to any one of the processing systems 2 , 10 , 17 , 19 used by the measuring device 1 , to allow updating of the device operation.
  • the above described processes can be used for diagnosing the presence, absence or degree of a range of conditions and illnesses, including, but not limited to oedema, lymphoedema, body composition, or the like.

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