WO1993007801A1 - Method and apparatus for non-invasive blood analyte determination - Google Patents
Method and apparatus for non-invasive blood analyte determination Download PDFInfo
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- WO1993007801A1 WO1993007801A1 PCT/GB1992/001894 GB9201894W WO9307801A1 WO 1993007801 A1 WO1993007801 A1 WO 1993007801A1 GB 9201894 W GB9201894 W GB 9201894W WO 9307801 A1 WO9307801 A1 WO 9307801A1
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- animal
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- analytes
- blood
- detecting
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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
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
- A61B5/14558—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters by polarisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14532—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring glucose, e.g. by tissue impedance measurement
Definitions
- This invention relates to the determination of blood analytes by a non-invasive method.
- the method itself is a general one, and can be used for a wide variety of materials present in blood, it is of particular interest in the non-invasive measurement of substances of interest in diabetes, such as glucose and glycated haemoglobin.
- Blood glucose level testing is almost universally regarded as the first line in maintaining the control of diabetes. Typically, it may be desirable for the blood glucose level of a diabetic patient to be monitored several times during a day.
- the most common method of blood glucose level testing in current practice uses test strips to which a blood sample is applied. This requires a small blood sample to be withdrawn, usually by pricking the finger. The strips are usually tested using a portable battery operated glucose meter which reads the strips quantitatively. Obviously, it is undesirable for repeated blood samples to be taken from patients, and much interest has focused in recent years on non-invasive techniques for blood measurement.
- NIR near infrared region
- EP-A-0160768 discloses a technique for measuring glucose by a non-invasive infrared technique in which a body part (typically a finger) is irradiated with one or more pairs of wavelengths in the region of from 1000 to 2700 n , and detecting the transmitted or reflected radiation.
- a broad band optical source is filtered to produce desired wavelengths one after the other.
- the wavelengths are chosen such that the intensity of collected light at at least one wavelength depends on the glucose concentration present, while the collected intensity at at least one other wavelength is in principle independent of the glucose concentration present.
- the intensity measurements are converted to measure the glucose concentration by standard techniques of NIR spectroscopy.
- the wavelengths ⁇ _ are chosen from 1575, 1765, 2100, and 2270 ⁇ 15 nm.
- O/90/07905 also relates to the determination of blood glucose, using NIR.
- a body part again generally a finger, is irradiated using NIR of a number of different frequencies using an array of light emitting diodes (LEDs).
- LEDs light emitting diodes
- Interference filters are employed to restrict the response of each detector and/or the emission of each LED to a particular NIR band, and calibration algorithms are used to relate glucose levels to a linear combination of the detected bands.
- the use of a greater number of wavelengths improves sensitivity, and enables accuracy to be improved over the device of EP-A-0160768.
- a method for determining non- invasively the presence and/or concentration of blood analytes in an animal which method comprises,
- the front surface of the eye has a number of advantages over other surfaces which have previously been proposed for non-invasive NIR spectroscopy for blood analyte (in particular glucose) determination.
- blood analyte in particular glucose
- the eye tends to have a very stable temperature, as compared with many other parts of the body
- the eye has a number of other advantages for such measurement.
- the front surface of the eye (the white of the eye), and the adjoining tissues (for example, in the corner of the eye) are particularly well supplied at their surface with blood vessels.
- the superficiality of the blood vessels in the eye enables reflection spectral measurements to be made from the eye at wavelengths which would be unsuitable for other body parts. This is because the blood vessels in other body parts are situated sufficiently far below the tissue surface that infrared radiation does not penetrate to them in significant amounts.
- a further advantage of the surface ocular tissue is that it is relatively simple in structure and does not give rise to high levels of scattering.
- An additional advantage of carrying out measurement on the eye is that, because the surface is relatively smooth and is maintained in a moist condition, specular reflection occurs at relatively well defined angles, and it is therefore relatively easy to separate specular refection from diffuse reflection. It is the defuse reflection which carries the bulk of the spectral information representative of blood analyte levels.
- means In order to be able to determine reflected light from the front surface of the eye, means must be provided both for illuminating the said front surface, and for detecting light which is diffusely reflected (backscattered) from the illuminated surface. It is also necessary to provide means of locating either or both of the illuminating means and the detecting means, with respect to the facial features of the individual concerned.
- apparatus for determining non-invasively the presence and/or concentration of blood analytes in an animal comprising:-
- the said surface is the front surface of the eye
- the apparatus includes means for locating the illumination means and/or the detecting means in a fixed location with respect to facial features of the animal.
- the location means may preferably be a molding shaped to fit the particular face contours of the individual, for example the eye socket and/or nose of the individual.
- a "standard" assembly carrying the illumination means and detecting means may be provided, and adapted to be fixed in a defined location to a molding shaped to the facial contours of the particular individual in question, so that, after the molding has been produced for that individual, the device may thereafter reproducibly be located in the same place.
- the device may be specially adapted so as to focus on the edge regions of the eye which are particularly strongly supplied with blood vessels, and in particular the inner and outer corners of the eye.
- the device is provided with means for minimising the effects of specular reflection. In one embodiment, this may be done by so positioning the illumination means and the detector on the device so that specular reflection is substantially eliminated.
- the device may be so orientated as to ensure that specularly reflected light does not reach the detector.
- the- detector may be such as to be capable of detecting spatial variations in the reflected signal.
- the detector may include a CCD array. The provision of such an array enables the location of the specular reflection to be readily ascertained, and, once ascertained, compensation may be applied to minimise its affects (for example by ignoring entirely the region in space in which the specular reflection occurs).
- means are provided for discriminating between diffuse reflection and specular reflection from the eye surface based on the extent of polarization of the light on reflection.
- This may take the form of a polarizer associated with either the illumination means, the detecting means, or both, so orientated as to minimize the signal obtained from specular reflection.
- a polariser may be inserted in the light beam to linearly polarise the light incident on the eye perpendicular to the plane of incidence.
- An analyser also consisting of a polariser, may be inserted in the beam following its reflection from the eye. This polariser is orientated so as to block specularly reflected light from the eye.
- the analyser may be crossed with respect to the polariser. Circularly polarised light might also be used.
- a wave plate may also be used in conjunction with polarising elements.
- a further aspect of the invention is concerned with the nature of the instrument itself, and of the NIR bands which are detected.
- the device disclosed in WO90/079O5 indicates the desirability of measuring absorption at a number of points in the NIR spectrum, and combining the results obtained from these points in order to obtain quantitative results which indicate more accurately the presence of analytes present.
- This reference relies however on the use of individual LEDs and/or detectors. This results in a device which is mechanically very complex, and therefore difficult and expensive to produce.
- WO90/079O5 describes measurements made at wavelengths of up to about llOOnm, a region of the spectrum which is detectable using low-cost silicon detectors.
- glucose absorption in this region is very weak, and the absorptions overlap very strongly with water absorption.
- detectors for use at longer wavelengths are more expensive, and the use of individual detectors for each absorption band is therefore very expensive if longer wavelengths are to be detected.
- the device in question was viewed as something of a curiosity when it was proposed in the mid-60s, and so far as we are aware it has never been produced commercially.
- apparatus for determining non-invasively the presence and/or concentration of blood analytes in an animal co prising -
- the apparatus may preferably be used in accordance with the first aspect of the invention for carrying out measurements on the front part of the eye, but may also be employed on other body surfaces.
- the modulating means preferably includes a rotatable grating, means for rotating the grating, and means for producing an image of the grating on the grating, at a position which is displaced in the plane of the grating from the position of the grating by an amount dependent upon the wavelength of the light forming the image.
- the means for producing an image of the grating on the grating preferably includes a dispersing element, for example a prism.
- spectral measurements should be taken at many wavelengths, particularly when determining the concentration of blood analytes present in small amounts.
- Standard analytical techniques may be utilized for deriving concentration data from the spectral measurements made, for example multiple linear regression, partial least squares, or principal components regression.
- infrared signals obtained from an animal in order to determine blood analytes may be enhanced by determining the variation of the said spectrum which is in phase with the pulse of the animal. Similar techniques are conventionally used in so called “pulse oximetry", which are employed to determine blood oxygen content optically. So far as we are aware however, no proposal has ever been made hitherto to enhance the sensitivity of blood analyte determination by infrared spectroscopy by using similar techniques linked to the coronary pulse. Accordingly, in a further aspect of the invention, there is provided apparatus for determining non- invasively the presence and/or concentration of blood analytes in an animal comprising:-
- a further aspect of the invention provides a method of determining non-invasively the presence and/or concentration of blood analytes in an animal comprising:- a. illuminating a surface of the body of the animal with infrared radiation b. detecting infrared radiation reflected from the said surface and analyzing the spectrum of the said reflected radiation to determine the presence and/or concentration of the said analytes, characterised in that the method includes the step of detecting the pulse of the animal, and determining the variation of the said spectrum which is in phase with the said pulse.
- This aspect of the invention is of most benefit when the NIR spectrum determination is carried out on a part of the body to which the blood supply is highly pulsatile, for example a finger or an ear lobe.
- the blood supply to the front surface of the eye is relatively non-pulsatile, and therefore this method is of limited value when applied to the front surface of the eye. It is however a benefit to employ this aspect of the invention with the aspect of the invention discussed earlier, relating to the modulation of the light employed, in accordance with its wavelengths.
- Figure 1 is a schematic diagram of a device according to the invention for measuring blood glucose levels
- Figure 2 is a schematic plan view of a device according to the invention
- Figure 3 is a section on AA of Figure 2;
- Figure 4 is a side view of the device of Figure 2;
- Figure 5 is a schematic representation of the instrument in use;
- Figure 6 illustrates an arrangement for decreasing specular reflection in a device according to Figures 1 and 2;
- Figure 7 is a schematic representation of an alternative embodiment, for minimising specular reflection
- Figure 8 illustrates a further alternative method
- Figure 9 is a schematic diagram of the so called “mock interferometer", for modulating a light beam at a frequency dependent upon its wavelengths;
- Figure 10 is a schematic diagram of the incorporation of such a modulation device into a device according to the invention for ocular blood analyte determination; and Figure 11 is a more detailed schematic representation of a device according to the invention incorporating means for modulating a light beam.
- Figure 1 is a schematic diagram, illustrating the major components for - carrying out glucose measurements on the front surface of the eye, according to the preferred embodiment of the invention.
- the apparatus of Figure 1 includes a light source 1 (typically a filament lamp such as a tungsten/ halogen lamp), reflector 2, and collimating lens 3, for producing a parallel light beam.
- the parallel light beam is passed through a light modulator 4, which will be described in more detail hereinafter, which modulates the light beam, at a modulation frequency which is dependent upon the wavelength of the light.
- the modulated light beam 7 passes through a beam splitter 8, and focusing lens 9, which focuses the modulated beam on the front surface 10 of the eye, for measuring the concentration of blood analytes.
- the arrangement is such that the focused beam impinges upon an edge region of the eye, which is particularly well suffused with surface blood vessels.
- Diffusely reflected light from the surface 10 is collected by lens 9, and passes back through beam splitter 8, to be focused by lens 11, on detector 12.
- a processing unit 5 is provided, linked to detector 12 and to light modulator 4.
- Processing unit 5 includes a number of electronic filtering circuits, so that the intensity of light reflections at a plurality of modulation frequencies (and consequently at a plurality of infrared wavelengths) may be detected.
- the detector 12 may be preferably a non-imaging concentrator.
- the processing unit 5 may take the form of a "licroprocessor, and appropriate software.
- Processor unit 5 also includes means for carrying out analysis of the resulting absorption bands detected, using for example multiple linear regression, partial least squares, or principal components regression.
- the device may also include a pulse detector 6, which enables the pulse of the individual to be detected.
- a pulse detector 6 which enables the pulse of the individual to be detected.
- the pulse detector 6 may be of any form conventionally used for pulse oxi etry. Pulse oximetry is a technique for determining the oxygenation of blood using optical absorption measurements on a body part.
- the red or infrared absorption of a body part is measured at two wavelengths one of which is chosen because it is absorbed equally by oxyhaemoglobin (oxygenated haemoglobin) and deoxyhaemoglobin (deoxygenated haemoglobin) and another because it is absorbed strongly by one form of haemoglobin but only weakly by the other.
- a pulse oximeter monitors the absorption of the tissue at the two wavelengths caused by increases and decreases in the volume of-the blood present in the tissue.
- the pulsatile component of the absorption is due primarily to the blood in the tissue rather than the surrounding tissues.
- the ratio of amplitudes of the two pulsatile signals provides a measure of the oxygenation of the tissue.
- Processor 5 includes a phase-sensitive detector, linked with the input from pulse detector 6, such that only the component of the detected signal which varies in phase with the detected pulse is passed to the detection circuitry.
- the processor 5 is capable of separating the static and alternating (pulsatile) components of the optical spectrum.
- the pulsatile component of the spectrum is strongly correlated to the blood absorption spectrum, and thus provides a good basis on which to carry out the calculation of blood analyte concentration.
- Figures 2 to 5 illustrate the external appearance of a practical embodiment of a portable device according to the invention.
- the device of Figures 2 to 4 comprises a body
- the components within body 20 are configured such that the focused beam intended to impinge on the front surface of the eye passes through an aperture 21 in the body 20.
- a screw-threaded adaptor 22 to which is affixed by means of the screwthread a moulding 23, which is shaped to the facial contours of the user, and includes a flexible eye and nose piece.
- the shape of the molding 23 ensures that the device is located correctly with regard to the particular facial features of the individual, and that the light beam impinges on the desired location on the front of the eye.
- a sculpted hand grip 24 is provided for the convenience of the user.
- the upper surface of the body 20 carries a start button 25, operated by the user, and an LCD screen 26 for displaying the measurements obtained.
- any other detection system capable of obtaining an infrared spectrum from the front surface of the eye may be employed, for example a Fourier Transform spectrometer.
- specularly reflected light contains far less spectral information about the blood than light which is diffusely reflected (backscattered)
- a simple arrangement is illustrated in Figure 6.
- the spatial arrangement is simply arranged so that the focused light beam impinges upon the eye surface at a point 10 where the curvature is such that specular reflection tends to be away from the detection system.
- the light modulator and processor unit have been omitted, for clarity.
- detector 12 is a CCD imaging device, having an array of detection points.
- the arrangement includes a beam stop 13 for limiting the width of the collimating beam to enable the detector to gather light from a larger range of angles than is occupied by the specular reflection.
- the modulator and processing unit are not shown, for clarity.
- the processing means 5 is programmed and arranged so as to locate the region on the detector 12 at which the specular reflection is received. Normally, the specular reflection will be relatively sharp and produce an intense signal, and it is therefore a straightforward matter to determine the point at which the specular reflection occurs, and to give a lower weighting (or a zero weighting) to the signal received from that region of the detector.
- Figure 8 shows an alternative means of suppressing the effects of specular reflection, on the basis of the light polarisation. Only the components of the system relevant to this aspect are shown in Figure 8, for clarity.
- a polariser 33 is inserted, to polarise the light incident on the eye.
- the polariser may be a linear polariser, orientated for example to polarise the light perpendicular to the plane of incidence, or a circular polariser.
- an analyzer 30 is positioned between lens 31 and lens 32, so as to block specularly reflected light from the eye.
- a waveplate may also be used in conjunction with the polarising elements.
- Figure 9 is a schematic representation of the so called "mock interferometer” referred to in the reference by Lawrence Mertz, mentioned above, and illustrates the way in which a simple mechanical arrangement can be utilized to modulate a light beam at a frequency which depends upon its wavelengths.
- a schematic representation of a simple mechanism incorporating such a device in an analyzer in accordance with the invention is illustrated in Figure 10.
- an optical grating 40 having a spacing of approximately ten lines per millimetre is located in a rotating mount, and light is passed through the grating, and focused by a lens 42.
- a mirror backed dispersing prism 44 reflects the light beam through the lens 42, and forms an image of the grating on the grating surface. Because the position of the image on the grating is dependent upon the wavelengths of the light, the coincidence of the grating lines and image lines, and therefore the chopping or modulation frequency, it is also dependent upon the wavelengths.
- Figure 10 shows schematically how such a device may be incorporated into a device according to the invention, the same reference numbers being used as in Figure 1.
- Figure 11 A more detailed schematic representation of such a device is illustrated in Figure 11. Again, the same reference numbers being used as in Figure 1.
- the device includes a polychromatic light source 1 (a tungsten halogen filament lamp), and a reflector 2 and •collimating lens 3 as in Figure 1.
- the collimated light beam then passes through a light modulator, comprising a disc 40, on the surface of which is an optical grating.
- the grating may be either a phase grating or an amplitude grating, and has a spacing which is large compared to the wavelength of light (typically a spacing of the order of ten line pairs per millimetre).
- Disc 40 is rotated at a constant speed by means of an electric motor 41.
- An optical system comprising lenses 42, mirrors 43, and a dispersing element 44, is arranged so as to form an image of the rotating grating on the surface of the grating itself.
- the lenses 42 are separated from each other by the sum of their focal lengths f, and are positioned such that the grating is in the focal planes of the lenses closest to it.
- the position of the image on the disc 40 depends upon the amount by which the light is dispersed by element 44, and thus upon the wavelength of the light in question.
- the light which is transmitted by the grating is chopped or modulated, at a frequency which varies cyclically, but which depends upon the translation of the image in relation to the grating, and thus upon the wavelength of the light.
- the modulated light passes through beam splitter 8 and lens 9, is reflected from the front surface of the eye (or any other suitable body part), and detected by detector 12.
- Electrical signals from the detector are then analyzed by dividing them into frequency "bins" in a known manner, for example using electronic filters, such as discrete RC circuits tuned to the frequencies of interest, or a lock- amplifier and frequency synthesizer.
- electronic filters such as discrete RC circuits tuned to the frequencies of interest, or a lock- amplifier and frequency synthesizer.
- the reflection spectrum of the eye may be obtained by transforming the time varying signal using a Fourier transform with a non-uniform sampling interval (see Lawrence Mertz "Transformations in Optics", John Wylie & Sons, Inc., New York, 1965).
- a particularly advantageous feature of this type of arrangement is the high optical throughput of the device, as there is no need for the light to pass through a slit. High throughput is a significant advantage for a battery powered instrument, as it minimises the electrical power consumption of the device. It also minimises the time required to make a measurement of analyte concentration to a particular accuracy.
- the modulation method discussed above is particularly advantageous when utilized in a device for scanning the front surface of the eye, it also has advantages for analyte determination using other parts of the body, for example the retina, choroid, optic nerve head (optic disc), finger, earlobe, lip, or other tissue with a good blood supply.
- the optic nerve head can be advantageous in some circumstances, because of its good blood supply and pulse, good optical access to blood perfused tissue, very stable temperature, lack of pigmentation, and the ability to use simple optical arrangements taking advantage of the optics of the eye.
- the levels of glucose in the aqueous humor and difficulty in obtaining sufficient light levels restrict the usefulness of the back of the eye in this context.
- some forms of eye disease, such as cataracts make utilization of the retina, choroid or optic nerve head difficult.
- the wavelength and strength of water absorptions in the near infrared portion of the spectrum vary with temperature.
- the phenomenon adds to the difficulty of developing a reliable calibration algorithm for the determination of blood analyte concentrations.
- the temperature of the body part under investigation is measured, by measurement of the NIR absorption of water in the region in question.
- temperature can be measured using a thermistor, thermocouple, or other conventional means.
- the heating or cooling mechanism which might be an electrical resistor or thermoelectric element respectively, is linked to a temperature sensor, such as those described above, by means of a feedback loop. It is preferable to raise the body temperature rather than to cool it because the body temperature rarely increases by much, whereas it may cool considerably, and because increasing the temperature of the body part increases the amount of blood in the tissue and increases the strength of the pulsatile component of the flow, as shown in "Noninvasive Pulse Oximetry Utilising Skin Reflectance Photoplethysmography", Y. Mendelson and B.D.
- heating of the body part may be achieved by utilising the infrared radiation employed for the spectral determination to heat the body part under investigation.
- the simplicity of the device means that measurements can be made of a large number of wavelengths, using suitable calibration algorithms. Different wavelengths can be used for different population groups, or even for different individuals, further enhancing the ability of the instrument to measure accurately the blood glucose or other blood analyte concentration.
- the instrument itself can be used for the purposes of calibration.
- the derivation of appropriate calibration algorithms for various blood analytes is simply a matter of deriving a suitably large data set for known patients of varying blood analyte concentration, and obtaining appropriate correlations between absorption at various frequencies, and the blood analyte concentrations, using any of the techniques noted above.
- the methods disclosed may also be employed in the determination of other blood analytes, for example alcohols and in particular ethanol, urea, total and high density cholesterol, haemoglobin, oxyhaemoglobin, low and high density lipoproteins, triglycerides, total protein, albumin, and globulins in serum.
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Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
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JP5507537A JPH07508426A (en) | 1991-10-17 | 1992-10-06 | Blood sample measuring device and method |
EP92922310A EP0609341A1 (en) | 1991-10-17 | 1992-10-16 | Method and apparatus for non-invasive blood analyte determination |
Applications Claiming Priority (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GB919122045A GB9122045D0 (en) | 1991-10-17 | 1991-10-17 | A novel means of non-invasively measuring blood glucose concentration |
GB9122045.9 | 1991-10-17 | ||
GB9125471.4 | 1991-11-29 | ||
GB919125471A GB9125471D0 (en) | 1991-10-17 | 1991-11-29 | A novel means of non-invasively measuring blood glucose concentration |
GB929207149A GB9207149D0 (en) | 1992-04-01 | 1992-04-01 | An improved instrument for measuring blood oxygen in deep arterial blood |
GB9207149.7 | 1992-04-01 |
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Publication Number | Publication Date |
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WO1993007801A1 true WO1993007801A1 (en) | 1993-04-29 |
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Application Number | Title | Priority Date | Filing Date |
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PCT/GB1992/001894 WO1993007801A1 (en) | 1991-10-17 | 1992-10-16 | Method and apparatus for non-invasive blood analyte determination |
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EP (1) | EP0609341A1 (en) |
JP (1) | JPH07508426A (en) |
WO (1) | WO1993007801A1 (en) |
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Also Published As
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JPH07508426A (en) | 1995-09-21 |
EP0609341A1 (en) | 1994-08-10 |
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