WO2023043314A1 - Dispositif informatique de retour d'informations et procédé de traitement d'ecg - Google Patents

Dispositif informatique de retour d'informations et procédé de traitement d'ecg Download PDF

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Publication number
WO2023043314A1
WO2023043314A1 PCT/NL2022/050523 NL2022050523W WO2023043314A1 WO 2023043314 A1 WO2023043314 A1 WO 2023043314A1 NL 2022050523 W NL2022050523 W NL 2022050523W WO 2023043314 A1 WO2023043314 A1 WO 2023043314A1
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WIPO (PCT)
Prior art keywords
camera
ecg
processing
feedback
torso
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PCT/NL2022/050523
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English (en)
Inventor
VAN Peter Michael DAM
VAN Eelco Mattias DAM
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Ecg Excellence B.V.
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Publication of WO2023043314A1 publication Critical patent/WO2023043314A1/fr

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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
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0062—Arrangements for scanning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0077—Devices for viewing the surface of the body, e.g. camera, magnifying lens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
    • A61B5/684—Indicating the position of the sensor on the body
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/70—Determining position or orientation of objects or cameras
    • G06T7/73—Determining position or orientation of objects or cameras using feature-based methods
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/10—Image acquisition modality
    • G06T2207/10024—Color image
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/10—Image acquisition modality
    • G06T2207/10028—Range image; Depth image; 3D point clouds
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30048—Heart; Cardiac
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30204—Marker

Definitions

  • the present invention relates to a feedback computer device for rendering ECG related feedback and outputting the same . Furthermore, the invention relates to a method implemented on a feedback computer device comprising a processing device comprising a processor and at least a memory, for recording and processing of ECG measurement data and for rendering feedback signals by the feedback computer device .
  • ECG recording have been a way of providing relevant medical information regarding the functioning of a heart of a person in order to diagnose disorders or ailments of the heart and cardiovascular system .
  • An ECG is generally performed by a person requiring a well-established skill set in order to obtain a level of reliability of ECG recordings .
  • the present inventors have been devising methods of analyzing ECG recording information and rendering feedback based on such analysis to both later analyzing doctors and ECG recording staf f .
  • Such methods of analysis and rendering require di f ferent or improved standards of recording ECG information from a subj ect . It had been established that these methods require higher emphasis of locations of placement of such leads on the torso .
  • the present inventors also considered advantages of other, below indicated improvements of selecting ECG information for better analysis that have been available . It is the purpose of the present inventors to improve upon the prior art by providing a system and method capable of analysis with improved results of recording and selection .
  • the present invention provides a feedback computer device for rendering ECG related feedback and outputting the same comprising :
  • processing device comprising a processor and at least a memory for processing input information and rendering output information
  • - receiving means arranged for receiving a 3D or anatomic model and/or processing thereof , such as a heart model and/or a torso model comprising the heart model ,
  • - receiving means arranged for receiving ECG recordal data and/or processing thereof , preferably with corresponding 3D torso information, of an ECG, performed on the torso ,
  • a 3D camera unit preferably including an image camera and a depth camera
  • a camera interface arranged to interface between the processing device and the 3D camera unit ,
  • proj ector unit for generating and/or proj ecting feedback information based on the feedback signals
  • proj ector interface arranged to interface between the processing device and the proj ector unit .
  • the device may be proj ected onto a torso of a subj ect and at which exact locations leads of the ECG device should be placed for optimal ECG results and/or receiving optimal ECG recordal data and/or processing thereof .
  • the device can optimally generate and/or proj ect feedback information .
  • processing of generating such feedback information is performed by the processing device of the feedback computer device .
  • any processing of information of any part of the device is performed by the processing device of the feedback computing device .
  • she processing devices are available , such as as part of the camera unit , camera interface , proj ector unit , proj ector interface , receiving means for receiving a 3D or anatomic model , or receiving means for receiving ECG recordal data .
  • Preferred embodiment provides a housing, the housing comprising the processing device , 3D camera unit , camera interface , proj ector unit and proj ector interface , preferably the housing comprising mounting means for mounting the housing to a positioning device , such as a stand or mount such as a wall mount .
  • a positioning device such as a stand or mount such as a wall mount .
  • a further preferred embodiment provides a point of interest identi fication module embodied in software or hardware for identi fying at least one point of interest , embodied in hardware or software .
  • Such point of interest preferably comprise locations of the ECG device leads , a detected manubrium and xiphoid locations , but in general any point on the torso/body for which changes in position, orientation and/or relative location towards any other point of interest or itsel f through time .
  • a further preferred embodiment provides a point of interest processing module , such as for processing, monitoring or observing of the at least one point of interest .
  • a point of interest processing module receives information regarding such points of interests during performing of receiving the ECG recordal data, in order to process ECG recordal data while taking into account relevant points of interest data, such as movements thereof .
  • improved interpretation data regarding the ECG recordal data may be generated dur- ing processing of the ECG recordal data .
  • a further preferred embodiment provides a determination module for performing a selection of a beat , such as by means of determining of suitability of an ECG recording of a heartbeat for further processing and/or storage thereof , him preferably by means of determining a trigger moment or actuation moment for determining of which heart beat or heart beats , a respective ECG is to be recorded for storage and/or analysis .
  • the device selects a beat based on which the ECG recording is stored and/or designated as preferred relative to possible beats that are subj ect to physical disturbances by the body, such as by breeding or movement .
  • Such selection of the best possible beat requires a high skill of an operator operating ECG machine according to the prior art . It is for example di f ficult to even recogni ze a situation in which such disturbance happens . It is therefore preferred to determine search disturbances based on received information from for instance the camera unit or cameras .
  • a further preferred embodiment provides means for identi fying and/or monitoring of movement and/or breathing related movement of at least one of the at least one point of interest , preferably including means for relating to this movement to a breathing rhythm . It is highly advantageous when ECGs are recorded based on a beat or a number of beats that are not subj ect to movement and/or breathing related to movement .
  • a further preferred embodiment provides interfacing means to connect to a depending device comprising at least a camera interface with camera and/or a proj ector interface with proj ector, preferably wherein the computer device comprises means of controlling the depending device .
  • a further preferred embodiment provides determining means for veri fying or comparing lead placements on the torso with the placements of earlier ECG sessions .
  • An advantage of such embodiment is that highly reliable comparisons may be made between the previous ECG sessions and newer ECG sessions or to the present ECG session .
  • the ECG sessions may be better compared .
  • some distinctions between the ECG sessions maybe determined or estimated based on recorded di f ferences in placement of the leads into various ECG sessions .
  • a further preferred embodiment provides processing means for processing 3D camera unit recording information of at least one marker attached to the chest is used, and/or wherein location information of an estimate of the manubrium or typhoid is used .
  • the use of such a marker is advantageous as the marker may be directly used upon the recognition as a point of interest of which movements may be detected .
  • the markers are also helpful for mentioning a torso model to the actual torso .
  • a further preferred embodiment provides that the starting point of the determination of the sternum line is assumed to be at a predetermined location below the camera, such as in the middle of a recording area of the camera . This preferred embodiment is advantageous when the camera may be placed at such a location that such a determination is obtainable in a reliable manner .
  • a further preferred embodiment provides that a starting point of the determination of the sternum line is determined based on a determination of a location of body parts , such as shoulders or head of the body .
  • a further preferred embodiment provides means for proj ecting a predetermined lead configuration onto the torso , including other elite configuration other than a standard 12 lead configuration .
  • Such preferred embodiment is for instance advantageous when a certain lead configuration provides better measurements in relation to certain diseases or conditions .
  • the Brugada condition is an example of a condition that is better detectable with a distinct placement of leads of the ECG signal providing device .
  • a further aspect of the present invention relates to a method implemented on a feedback computer device comprising a processing device comprising a processor and at least a memory, for recording and processing of ECG measurement data and for rendering feedback signals by the feedback computer device ,
  • a 3D or anatomic model and/or processing thereof such as a heart model and/or a torso model comprising the heart model ,
  • a 3D camera unit preferably including an image camera and a depth camera
  • a 3D camera unit preferably including an image camera and a depth camera
  • proj ection information by means of a proj ector interface arranged to interface between the processing device and the proj ector unit .
  • a further preferred embodiment provides steps of defining at least one point of interest or assembling an array comprising at least two of the at least one point of interest , preferably including steps of tracking movement or a pattern of movement of such points of interest .
  • a further preferred embodiment provides steps of performing selection of a beat , such as by means of determining of suitability of an ECG recording of a heartbeat for further processing and/or storage thereof , preferably by means of determining a trigger moment or actuation moment for determining of which heart beat or heart beats , a respective ECG is to be recorded for storage and/or analysis .
  • a further preferred embodiment provides steps of performing selection of a beat based on movement or a pattern of movement , preferably of at least one of the at least one point of interest .
  • a further preferred embodiment provides steps of processing 3D camera unit recording information wherein one of the at least one point of interest coincides with an actual ECG lead location, an actual marker location, a manubrium location point , and him a xiphoid location point .
  • a further preferred embodiment provides steps of connecting to a depending device comprising at least a camera interface with camera and/or a proj ector interface with proj ector, preferably wherein the computer device comprises means of controlling the depending device .
  • a further preferred embodiment provides steps of performing any step is performed by means according to any embodiment according to the present invention .
  • Fig . 1 shows a first preferred embodiment of a device according to the present invention, preferably in a master slave arrangement with connections to at least one external signal recording device , at least one external signal processing device and/or at least one external storage device .
  • Fig . 2 shows a preferred marker arrangement on a torso .
  • Fig . 3 shows an embodiment of a torso model in relation to a torso .
  • Fig . 4 shows an example of an ECG graph .
  • Fig . 6 shows preferred ECG lead positions according to a to preferred embodiments .
  • Fig . 7 shows ECG graphs as explained below .
  • Fig . 8 shows a schematic representation of a proj ection area of a device according to Fig . 1 .
  • Fig . 9- fig . 17 show preferred embodiments of methods according to the present invention .
  • Fig . 18 shows an example of an EEG registration and graph as a result of rendering with a device and/or according to a method according to a preferred embodiment .
  • Fig . 19 space shows an example of an EEG registration and graph as a result of rendering with a device and/or according to a method according to a preferred embodiment .
  • a standard 12-lead electrocardiogram (ECG) is one of the fundamental diagnostic tools in clinical medicine .
  • ECG visuali zes the electrical activity of the heart by recording body surface potentials using electrodes positioned on the thorax . These electrode positions are often standardi zed and based on anatomical landmarks .
  • the ECG is used to diagnose both acute cardiac diseases such as acute coronary syndrome and for longitudinal monitoring of cardiac diseases such as progression of cardiomyopathy .
  • ECG waveforms are influenced by factors , such as heart rhythm, heart rate , cardiac anatomy, ventricular wall thickness , cardiac electrophysiology and cardiovascular disease . Other factors vary over time in a limited way but may also influence ECG waveforms such as the orientation of the heart in the thorax and the shape of the thorax .
  • electrode placement variations or misplacement are a maj or technical error source when recording ECGs in clinical practice .
  • minor shi fts in precordial electrode positions up to 10 mm can have a relatively mild influence in positive cases
  • larger shi fts , including shi fts of >20 mm, signi ficantly af fect the ECG waveform morphology possibly resulting in misdiagnosis .
  • Variability in electrode positioning between consecutive ECG measurements is common and limits the applicability of the ECG during longitudinal monitoring of cardiovascular disease over time . Therefore , achieving identical electrode positions during longitudinal follow-up measurements is likely to enhance the diagnostic value of long-term ECG monitoring .
  • a 3D camera and/or proj ector device is proposed according to the invention to proj ect , capture and store the position of precordial ECG electrodes .
  • the 3D camera is able to capture the 3D shape of the torso , which is preferably be used to determine preferred ECG electrode positions .
  • the stored electrode positions allow for accurate electrode repositioning for consecutive 12-lead ECG recordings such as by merging the captured 3D shape of the chest and the stored data . These determined or stored electrode positions are subsequently be proj ected on the chest using the proj ectors of the system .
  • the aim of the provided 3D camera and/or proj ector system is to guide an operator to position the ECG electrodes accurately and reproducible on the chest over multiple serial ECG measurements to enable longitudinal ECG waveform comparison .
  • the waveform comparison will then be used to monitor cardiac disease onset and/or progression .
  • the standard example of the lead configuration refers to the standard 12 lead ECG configuration, see Fig . 6 , which shows a preferred standard 12 lead configuration and a disease speci fic Brugada lead configuration .
  • the device is arranged to provide one or more of the following :
  • Proj ecting is provided by a proj ector, i . e . LED proj ector, laser proj ector, laser pointer, or alike .
  • Color information in the proj ected image data is preferably rendered in relation to for example colors of the used lead system/ lead wires .
  • veri fication is performed based on information from one or more 3D camera' s that preferably comprise at least one depth sensor and/or color sensor .
  • a spatially configurable feedback computer device comprising a computer device according to the present invention or preferred embodiments thereof ,
  • Positions of ECG electrodes that are used when recording an ECG are pre-defined and preferably estimated in relation to the body build and body characteristics . In clinical practice such locations depend on anatomical structures of the torso , in case of application of the standard 12-lead ECG recording the position of the ribs and their intercostal space , the left clavicle and left side , the wrists and the ankles are leading . Depending on the required lead configuration alternatives from this standard 12-lead ECG recording preferred embodiments provide additional guidance , such as based on additional anatomical structures .
  • a recording is preferably made of the torso resulting in a 3D shape of the torso .
  • a dependent 3D camera and knowing the position, rotation and angle between the 3D camera' s , multiple recordings is preferably combined into one 3D camera space by transforming all recorded images to the view of one of the camera' s or an alternative point in space above the torso .
  • breathing and/or displacement of the body is preferably taken into account .
  • the trans formed positions are preferably proj ected on the torso by the feedback computer device according to the invention or embodiments thereof in an easy and fail-proof and repeatable way .
  • the feedback computer device preferably comprises a master device M that comprises the processing device and a storage to maintain and use the device configuration, operational parameters and algorithms for performing functions of the device according to the invention or preferred embodiments .
  • a master device M that comprises the processing device and a storage to maintain and use the device configuration, operational parameters and algorithms for performing functions of the device according to the invention or preferred embodiments .
  • one or more slave devices S are attachable to provide improved information measurements and feedback by incorporating such the slave device ( s ) as part of the feedback computer device .
  • the device is preferably mounted to a fixed or movable stand or wallmount , that is preferably positioned adj acent to a bed, table or chair or any other appropriate location to recording ECG with use of the feedback computer device according to the present invention .
  • the feedback computer device preferably comprises one or more 3D camera' s delivering 3D depth information to be merged and/or co-processed with color information .
  • These camera ( s ) are preferably located at fixed positions of the feedback computer device device . Preferably, this allows recording of images with the camera ( s ) including at least the surface of the torso , i . e . shoulders to the abdomen, and the left side of the torso in the field of view .
  • the angle with the Y-Z-plane and rotation around the camera normal are preferably known or derivable from overlapping image information or otherwise .
  • the master device when only a master device is used, it may be arranged movably such that the master device is being rotated above the torso while collecting image data for constructing the personali zed model . It is also envisaged to hold the feedback computer device handheld for recording the torso from several sides while moving it , preferably after which the device is attached to a fixed location during providing of feedback by means of proj ections by the proj ector in such a way that it may proj ect at locations of the torso in which most or all of the relevant leads are located, preferably the left side and the top of the torso .
  • the feedback computer device preferably comprises one or more proj ectors to proj ect rendered feedback information on the torso .
  • Each proj ector is preferably arranged in either a master or a slave device as described in the above in relation to preferred embodiments .
  • the feedback computer device is preferably located at fixed positions in such a way that the area that can be illuminated by the proj ect ( s ) cover at least the surface of the torso , i . e . shoulders to the abdomen .
  • proj ectors For all proj ectors it is preferred that its relevant and/or absolute position relative to the torso , the angle with the Y-Z-plane and/or a rotation around the proj ector normal are known .
  • the processing unit Preferably, of the feedback computer device , the processing unit :
  • - is configured to load a configuration from the storage of positions related to ECG lead positions to proj ect relevant feedback information related to the configuration of the feedback computer device containing the exact positions , angle and rotation of the 3D camera ( s ) and proj ector ( s ) relative to the fixed position of the feedback computer device regarding its location relative to the torso ,
  • - is configured to load 3D torso model information from a model database from its memory or a remote storage with information about the locations of preferably the manubrium and xiphoid in these models ,
  • - is configured to obtain 3D image data and process this 3D image data, by combining it based on the loaded camera configuration, from one or more camera ( s ) and/or multiple images in time to construct a 3D surface of the torso and locali ze the manubrium and xiphoid locations in this surface where the manubrium and xiphoid locations in the constructed surface can for example be found by attaching one or more recogni zable markers at these locations on the torso ,
  • a relevant template model from the 3D model database , based on derived manubrium and xiphoid locations from the constructed 3D image torso surface .
  • Further preferred derived information is preferably taken into account , like torso width and curvature of the side , breasts and shoulder surface and its derived chest circumference sideways and towards the shoulders ,
  • Such model is preferably virtually positioned based on the fitting in the same 'virtual ' environment enabling the combination of the model , the constructed surface , subsequent recorded 3D image data and the configured fixed position of the feedback computer device in an aligned manner,
  • - is configured to combine a constructed 3D torso surface and the personali zed torso model with the loaded lead configuration to show by proj ecting feedback information on the model and thus locating the targeting positions in the 'virtual ' environment of the feedback computer device ,
  • proj ector is configured to , based on the loaded configuration, determine the proj ector to use to proj ect rendering information based on field of view of the proj ectors covering the area ( from model and/or constructed surface ) and identi fying the smallest angle between the proj ecting nor- mal and the normal of the area to proj ect and construct images per configured and connected proj ector to proj ect from these lead locations and
  • - is configured to store information about the proj ected rendering information for the torso to be used during a future ECG recording .
  • - is configured to determine points of interest to track on the camera recordings of a torso from the storage and the triggers to store or send to the external interface
  • the feedback computer device is arranged at a location of which the height can be adj usted to extend a field of vision or proj ectable area to cover the torso .
  • the feedback computer device is arranged on a movable or ridable cart for easy positioning or constructed on a wall-mount .
  • markers on the manubrium and xiphoid it is envisaged to apply markers to be attached on one or more further locations on the torso replacing the used manubrium and xiphoid merging method in the algorithms with a respective adapted algorithm .
  • the method is performed without such marker .
  • a trained neural network and/or at least one point cloud algorithm like an Iterative Closest Point algorithm, is used to analyze the recorded 3D data to locate the torso , its shoulders and sides of the torso and derive the location and length of the sternum thus identi fying preferably determined locations such as the manubrium and xiphoid locations .
  • the recorded data from the camera' s of the mixed reality device is preferably used to locali ze the manubrium and xiphoid on the torso and virtual environment of the mixed reality device will thus be aligned with the 'virtual ' feedback computer device environment .
  • This provides an advantageous direct merging of the model and the original medical imaging data from which the model was derived into the mixed reality . This provides an option to perceive the internal organs proj ected within the torso at the correct position of the torso .
  • breathing is preferably tracked by determining the displacement of the torso during the breathing cycle .
  • Typical displacement of the xiphoid, such as by several centimeters is detectable .
  • This information is preferably stored, exported and/or communicated through the external interface to be combined with the synchronously recorded signal like an ECG and the breathing cycle is preferably combined with this data to take breathing into account with the ECG analysis/ interpretation .
  • disturbances in a breathing cycle or movement of the torso is tracked by determining the di f ferences in the breathing cycle , for example due to talking, or displacement of the torso .
  • This preferably provides information on expected noise on the measure signal like an ECG .
  • Steps of preferred embodiments according to the Figs . 9- 19 are briefly laid out below . These steps are examples of steps of preferred embodiments , of which it is clear to the skilled person that steps within a single flowchart are described as individual additions to preferred embodiments that are to be understood as optional within each flowchart of each embodiment . Furthermore , each step may be implemented independently in another embodiment .
  • representations of a torso are shown by way of example in relation to merging 3D images from two 3D cameras already converted to the world coordinates ( top images ) merges with a selected and personali ze model (bottom image ) .
  • the device internal origin relates to a internal device origin to which respective camera' s and proj ectors positions , angles and rotations are defined and known in the feedback computer device configuration enabling the merging of the 3D images and determining the proj ector to use when proj ecting a lead location
  • the device world origin relates to a device world origin after the torso model has been generated enabling the positioning of the lead to locations such that these are elite locations are preferably rendered to points in 3D space that can be proj ected as feedback from the feedback computer device according to embodiments .
  • the white line 24 generally hori zontal through the xiphoid or bottom marker preferably indicating the xiphoid, indicates the position the contours 29 ( cross-section) are taken from ( the lower white line 24 showing the contour ) .
  • the green dot 25 shows the rotation point
  • the orange lines the upwards vector 26 and the rotating vector to validate con- tour points to belong to the torso contour .
  • the straight green lines 30 , 31 generally to the side of the torso , shown the determined sides of the torso .
  • a relation is shown between an area to proj ect indicated by A, the proj ected area, where information on the torso is preferably rendered and proj ected and a proj ecting area defined by the field of view of the proj ector including an area of non-used space indicated by B to adj ust a position of the image to handle changes due to breathing and/or re-positioning of the torso .
  • the feedback computer device is initiali zed . It loads a device configuration relating to included components like at least one 3D camera, at least one proj ector, calibration settings , model database .
  • step 200 the feedback computer device adapts to a positioning or repositioning of the device over the torso and checks the position thereof and adj ust the device said device internal origin used coordinate system to the said device world origin coordinate system .
  • the step 300 serves to receive image data from the stream for all found 3D cameras , analyze the data and deliver tracking coordinates .
  • the step 500 serves to derive a personali zed model from the recorded image data, tracking coordinates and models from the model database or position a provided model from a previous recording in the device world and prepare rendering and proj ection of feedback information, such as related to the ECG lead location, on the personali zed model in world coordinates .
  • the step 600 serves to proj ect the ECG lead locations with the proj ector ( s ) and interact with an us- er/operator to attach the leads to the torso and to check i f the user/operator has attached the leads to the correct location being either the locations of the previous recording or the default locations . Instructs the user to adj ust incorrect placed leads .
  • the step 700 serves to store any retrieved and derived information from the current session for later or subsequent use during another session .
  • step 100 serves to prepare an initial state in a feedback computer device comprising a stand with attached 3D camera' s and proj ectors , through the device with a cable connected to a user interface device with means to store information and instruct the user/operator to perform actions and give feedback .
  • the step 105 serves to retrieve the number of 3D cameras 3 , 3 ' that are comprised in the feedback computer device 1 with, for each camera 3 , their field of view, position, rotation and normal angle with respect to the feedback computer device world origin .
  • This information can either be retrieved from a local storage on the device CPU element 8 , 8 ' or from the connected storage medium 13 .
  • the step 115 serves to retrieve the number of proj ectors 4 , 4 ' that are comprised in the feedback computer device with, for each proj ector, their field of view, position, rotation and normal angle with respect to the feedback computer device world origin .
  • This information can either be retrieved from a local storage on the device CPU element 8 or from the connected storage mediuml 3 .
  • the step 120 serves to locate and load the models from the model database into memory and for each model the locations of the manubrium and xiphoid and/or an other used reference points on the torso .
  • This information can either be retrieved from a local storage on the device CPU element or from the connected storage medium 13 .
  • the step 125 serves to initiali ze the cameras and proj ectors according to the locally stored configuration . There needs to be at least one camera . There needs to be at least one proj ector .
  • Step 150 serves to check i f data of a previous recording is available and i f so , load this data into memory .
  • This information can either be retrieved from a local storage on the device CPU element or from the connected storage medium . It can also have been uploaded from an external device onto the local storage or connected storage medium . Store it in memory .
  • This information preferably contains a previous generated personali zed model and the used lead configuration and lead locations with respect to this model and the locations of the manubrium and xiphoid and/or an other used reference points on this torso model .
  • Step 160 serves to retrieve the marker 22 , 23 is used during the current recording session and what the characteristics and rules are to recogni ze it in the recorded color image of the 3D camera .
  • the characteristics preferably comprises geometrical shapes , colors and geometrical positions of the and other containing shapes .
  • This optional marker is preferably positioned on the torso at a defined position, like the manubrium and xiphoid defining the top and bottom of the sternum, and in a defined orientation knowing how the feedback computer device is preferably positioned over the torso .
  • This information can either be retrieved from a local storage on the device CPU element or from the connected storage medium . It is stored in memory .
  • Step 180 serves to retrieve the ECG lead configuration ( s ) from an external signal recording device 11 to use for the ECG recording identi fying sequence of the leads with the algorithm to get the locations on the model and the colors to use when proj ecting .
  • These can eighter be default lead locations or previously stored used lead locations in combination with the previously created personali zed model to re-proj ect and re-attach the leads to .
  • the positions of the leads may be determined by using center of the personali zed torso and per lead applying a defined angle from the upwards vector at the position of the heart origin, see also 545 .
  • This information can preferably be retrieved from a local storage on the device CPU element or from the connected storage medium 13 . It is preferably stored in memory .
  • Step 190 serves to load the configuration of the type of ECG patch and connectors to be used .
  • This information can either be retrieved from a local storage on the device CPU element or from the connected storage medium . It is stored in memory .
  • Step 195 serves to load points of interest and how these points should be treated .
  • These points can for example be the locations of the leads , the detected manubrium and xiphoid locations , but preferably any point on the tor- so/body for which changes in position, orientation and/or relative location towards any other point of interest or itself through time.
  • the dynamic behavior is preferably checked during the operation. It is stored in memory. See step 800.
  • Step 199 serves to output relevant information required to operate the feedback computer device is loaded into memory and ready to be used.
  • Step 200 is shown in greater detail in Fig. 11 and preferably serves to prepare and/or load 3D camera information retrieved in step 105, the optional marker characteristics retrieved in step 165 and ECG lead configuration from step 190 and the body characteristics retrieved in step 195 from memory.
  • Step 205 serves to start configured and attached camera' s the camera streams to retrieve live image information from all camera's.
  • Step 210 serves to start the projectors and project a line, such as the sternum line, in the space downwards from the top of the feedback computer device, when it is positioned over the sternum of the torso by the operator by moving the feedback computer device.
  • a line such as the sternum line
  • the feedback computer device is preferably positioned physically in a way that the projected line overlays the sternum bone. This line ensures that the projectors are preferably able to project the correct locations for the leads, i.e. the field of view provides the correct projection, see Fig . 8.
  • the projectors may indicate the projection field by projecting a maximum outline.
  • Step 215 serves to take a recorded image from the steams of a started 3D camera ( s ) .
  • Step 220 serves to adj ust the 3D data' s coordinate system from camera space to a feedback computer device space by applying the feedback computer device trans formation derived from the loaded camera configuration containing the translation, angle and rotation . This was the image data gets trans formed as being taken from the origin of the feedback computer device .
  • these images are in the same feedback computer device coordinate system and are preferably overlayed on top of each other .
  • These overlayed images are preferably used to construct a 3D surface of the torso .
  • Step 225 serves to locate in the recorded image the 3D coordinates of the manubrium and xiphoid by using step 300 .
  • Step 235 serves to load and check the found coordinates from step 300 . This is preferably done when the coordinates have not been f ound/updated in one of the images in one streaming sequence since preferably images are in feedback computer device space , see step 220 and figure 5 . They are preferably to be found in at least one of the images .
  • the feedback computer device keeps aligned with the real world .
  • This identi fication from all camera images is preferably used to adj ust the position of the device feedback computer device to the real world with its origin related to the found xiphoid point .
  • the xiphoid is estimated at the distance of 200 mm from the manubrium point over the sternum down . For children' s torsos such length is preferably smaller .
  • the identi fication will deliver the world origin point that is preferably used to adj ust the position of the feedback computer device system to the real world .
  • the device world point is chosen to be the xiphoid point on the torso . When the model has been positioned this origin point is preferably the center of the model .
  • the xiphoid point on the torso is preferably used to set the translation, the real height , shi ft and rotation of the feedback computer device to make this point equal to the device world origin .
  • the angle between the line from xiphoid to manubrium and the device virtual feet-head axis defines a rotation of the feedback computer device .
  • the feedback computer device coordinate system is aligned with the real world coordinate system .
  • Step 255 serves the purpose of , i f there are more cameras conf igured/ found in the device setup, to handle the next camera' s image by returning to step 215 for the subsequent images .
  • Step 265 serves to provide a check i f the device is correctly positioned by the device operator . This is done by checking i f the coordinates of the proj ected sternumline are in line with the found sternum-line of the torso . I f the device is correctly positioned by the user and the feedback computer device is correctly adj usted to the world coordinates in step 245 , the next step can be executed . I f not go back to step 210 to repeat checking and adapting the device position .
  • Step 299 serves to , i f the device is correctly positioned over the torso , correctly adapt the device coordinate system is correctly adapted to the real world coordinate system and the trans formation is stored to memory .
  • Step 300 serves to load the optional marker characteristics retrieved in step 160 and body parts from step
  • Step 205 serves to take the constructed 3D surface of the torso from step 220 .
  • Step 300 is speci fied in greater detail in Fig . 12 .
  • step 200 serves to load the optional marker characteristics retrieved in step 160 and body parts from step 170 from memory .
  • Step 305 serves to take the constructed 3D surface of the patients torso from step 220
  • Step 315 serves to retrieve , i f the marker is configured to be used I s/are sternum marker ( s ) present .
  • Step 325 serves to , such as based on the marker characteristics retrieved in step 160 , locate the marker in the image .
  • the marker is treated as a known element in the image and as such the optimal reference point to identi fy the torso and start analyzing the torso surface to extract this torso from the whole recorded surface .
  • Step 335 serves to , when the at least one marker is found in the image , use information pertaining to the marker to determine the sternum position and the related orientation manubrium and xiphoid points .
  • the positions are preferably validated by checking the contours to the left and right from the sternum line to check i f they are equally in distance/depth left and right from the sternum line . I f small di f ferences are found, the position of the sternum line is preferably optimi zed by shi fting small steps to left or right and check i f the contours become more equal in the distance/depth from the sternum line . With the optimal sternum line and marker locations found continue to step 355 to extract torso parameters .
  • step 345 I f the at least one marker is not detected or infi- 1 delity detected .
  • Step 345 serves to use machine learning algorithms for matching the recorded 3D image of the torso to sternum positions .
  • This approach enables the direct use of the 3D image without the markers , and thus improve the accuracy of the sternum position and length .
  • the device feedback computer devicepref erably is been positioned in a way that the proj ected sternum line is below the top of the feedback computer device , see figure 5 device internal origin .
  • steps 345 processes by applying the found marker from step 325 and marker derived sternum line .
  • a plane is defined by this sternum line dividing the left and right side of the recorded 3D body data .
  • a possible deviation in the marker derived sternum line position and orientation is preferably corrected . This is preferably done by :
  • TCP iterative closest point
  • the initial position of the arm as described in step 210 preferably ensures that the sternum is preferably assumed under the arm device with the sternum approximately in the center of the recorded data .
  • the initial plane is preferably derived from this center line dividing left and right again to find the symmetry and optimi ze it to the sternum line .
  • the arm is not yet positioned correctly and the recorded data is preferably neglected requiring the operator to adj ust the arms position .
  • algorithms are preferably used to locali ze the shoulders and head of the body . Based on these locations the initial sternum plane is preferably derived to optimi ze again in the same way .
  • Step 355 From the found sternum line take the xy- phoid position on it and extract the contour points to the left and right from it . Continue to add points to these contours until the following criteria are met ( see figure 4 ) :
  • Step 365 Based on the determined torso side ( s ) and by mirroring the contour with respect to the sternum line, a complete contour of the torso (except the back) is preferably extracted.
  • the back of the torso is preferably estimated based on either: a) the detected table height as it determines the back side, b) or by the width of the torso, which preferably serves as a measure for the torso depth (sternum till spine) which is in normal subjects around a relation of 0.7 (height/ width torso)
  • multiple torso contour may be extracted along the sternum line.
  • the chest circumference contour (s) is stored in memory.
  • Step 395 The information retrieved from the steps 355, 365 and the sternum location and the manubrium and xiphoid locations from 325/355 is preferably the tracking coordinates of the torso or parts thereof.
  • Step 399 serves to output the body part tracking coordinates with their body characteristics are preferably stored to memory.
  • Step 500 serves to load the tracking coordinates from step 300 (395) , transformation matrix from step 200 and if the previous recording information is preferably used or the default ECG lead locations from step 100 (preferably 150 or 180) from the memory
  • Step 505 serves to record a new set of images for the newest time-frame from all configured camera's and align the image data to the word coordinate system based on the calibration and the transformation determined in task 200.
  • the image data is preferably merged into one aligned 3D image delivering a whole 3D image of the chest with maximum pixel information.
  • Step 515 serves to check if a model from a previous recording procedure for the subject is available (step 150)
  • Step 525 relates to a situation in which no previous recoding model is available so a new personalized model needs to be created.
  • For each model in the database the tracking coordinate positions on the model are obtained.
  • the best fitting model is selected from the database that, at the position of the found chest circumference (s) , relative to the detected tracking coordinates in the 3D image data, meets the circumference best.
  • Step 535 serves to take the torso contours from step 365 and position the model in the center of it. Adjust the model by moving the surface to the aligned pixel data to personalize the model at the front side and to the contours at the back. See figure 3. Check the model chest circumference to meet the found circumference from the image data and adapt where needed. Aligned image and the personalized model is stored in memory.
  • Step 545 From the personalized model, the positions of the leads on the model chest are estimated based on the adjusted heart position from step 535 within the model and the angles between the upwards normal of the model.
  • the pre-configured angles would for example be: VI: -10°, V2 : 10°, V3 : 27°, V4 : 39°, V5 : 64.5°, V6: 90°. This is retrieved in the configuration in step 180.
  • step 555 a previous recording is available.
  • the model is loaded from that previous recording and the retrieved ECG lead locations relative to that. Distinct offsets are determined for the previous ECG lead locations relative to a reference coordinate from that recording.
  • Step 565 serves to adjust the world coordinate system from the device feedback computer device to include the model by translating the world origin to the heart position of the personalized model and rotate the 3D recorded data derived sternum-line to the personalized model sternum- line.
  • the device world coordinate system preferably includes the model and the lead positions.
  • Step 599 serves to output the personalized model with lead locations with respect to this model is available and the device feedback computer device world transformation has been updated to include the model.
  • Step 600 serves to get the personalized model with lead locations from task 500 and continue to retrieve image data from the 3D cameras and process this with task 200 where for step 245 the outcome is preferably combined with the changes from step 565.
  • the used ECG patch type to enable recognizing the patches is obtained.
  • Configured points of interest from step 195 are obtained.
  • Step 605 serves to determine the lead location to project with the 2D projector by:
  • Step 615 serves to retrieve camera images and use the procedure of task 200 to get the tracking coordinates from 300.
  • Step 625 serves to check if the new determined tracking coordinates still correspond with the previous tracking coordinates. If this differs with more than 2 millimeters, go to step 645 to re-position the leads to project. Otherwise continue to check for lead patch attachment in to step 645.
  • Step 635 serves to adjust the feedback computer device position again to the changed real world by using the new found tracking coordinates from step 215 and apply them with the created model to task 500 to update the device feedback computer device position in the real world with included model and adjust the information to project by going to step 605.
  • Step 645 serves to create an aligned image as described in step 535. Check if, for the new aligned image, if there are any changes to the colors and depth at the locations of the projected lead positions. If detected, check if these changes meet the criteria for lead patches as loaded in step 190. This is done based on the shape, color and height configuration values. If the changes meet the patch criteria indicate that lead by changing the projected color or area size for that lead the change was detected for .
  • Step 655 serves to check, for the new aligned image, if there are any changes to the colors and depth at the locations of the configured points of interest. This is done based on relative positions from a fixed point on the model , like the manubrium location . I f detected, use step 800 to track dynamic points of interest .
  • Step 675 serves to compare the found coordinates from the previous step with the target lead coordinates from step 500
  • Step 685 serves to check i f all leads are correctly located .
  • Step 690 serves to determine i f one or more leads are not correct located, inform the user/operator about the misplacement using the user interface and go back to step 615 .
  • Step 695 serves to store all real lead coordinates from this step to memory .
  • Step 699 serves to output final tracking coordinate , lead locations and body characteristics used during recording are stored with the used lead location used during recording .
  • Step 700 serves to get torso tracking coordinates from step 300 ( 395 ) and the current recording ECG lead locations from the memory .
  • Step 705 serves to get the body part tracking coordinates from step 500 ( 535 ) .
  • Step 715 serves to store the personali zed model from 500 to either a local storage on the device logic element or to the connected storage medium .
  • Step 725 serves to the current recording ECG lead locations from step 600 ( 695 ) .
  • Step 735 serves to store the current recording ECG lead locations to either a local storage on the device logic element or to the connected storage medium .
  • Step 800 serves to obtain from step 195 the points of interest to check the dynamic behavior .
  • Step 805 serves to obtain from step 600 ( 645 ) the changes in subsequent recorded image data and the locations through time in the data of the dynamic points of interest .
  • Step 810 serves to load for the points of interest the last stored states and derive changes in the latest recordings for each point of interest and derive displacement changes between multiple points of interest that need to be tracked .
  • Step 815 serves to use step 900 to handle the breathing detection .
  • Step 899 serves to store detected changes and states (preferably new positions ) for the points of interest and provide the triggers for external systems .
  • Step 900 serves to prepare and obtain from step 195 the points of interest used for breathing detection to check the dynamic behavior for and the trigger moment and positions in the breathing cycle to generate triggers .
  • Step 905 serves to obtain the displacement for each used point of interest between the new recorded data and the previous recorded data .
  • I f a point is moving outwards from the body, the breathing cycle is moving to max exhale , otherwise the max inhale .
  • step 910 the breathing cycle is found by checking the displacement of the used points of interest .
  • a displacement of 30- 60 mm is expected .
  • i f a breathing cycle time has already been determined and for each used point i f the new position is still within the found breathing cycle .
  • I f no complete breathing cycle is detected yet , i . e . the position of a point of interest has reached once max exhale and returned to it again, store cycle time and the maximum in- and exhale locations for the points of interest .
  • the max in- and exhale positions are preferably reached when the position of the used points of interest are preferably approximately steady, +/- 0 . 3 mm, for at least 1 second or is moving in reversed direction compared to previously detected inhale or exhale moving directions .
  • step 915 the breathing cycle will show a sinusoidal movement through time . I f this movement is interrupted or changed, the breathing cycle is disturbed . This might be cause by talking or coughing, sudden muscle contractions and/or movement of the body . This disruption will influence any electrical signal measurement like an ECG recording by introducing potential arti facts , like noise , in the measure (ECG) signal . I f this occurs or i f normal breathing continues again, use 918 to trigger for this event . A point of such step is to prevent taking ECG when such aberration is present .
  • Step 118 serves to send a trigger through the external interface to any attached device that is able handle it to inform about potential disturbed or restored signals and store the trigger information . Detecting these disturbances until normal breathing is detected again will cause the signal to contain less or no noise any more . This will enable automatic detection of time lapses that must not be taken into account when the data is being stored and/or being analyzed . This will support the operator or connected external recording or analysis device that is able handle the send trigger in recording/analyzing better signal data because . Providing this trigger will lower the requirements or skills of the operator during the recording procedure for finding the right moment to record/analyze and supports automated recording, such as because the device can prevent using an ECG recording that was made during such aberration .
  • Step 920 serves to check i f maximum breathing exhale has been reached, see step 910 .
  • the movement of the heart during the breathing cycle is preferably at its default position, i . e . not slightly rotated and moved in the chest due to in-/decrease of the lungs during inhale and movement of the diaphragm . I f this occurs use 925 to trigger for this event .
  • Step 925 serves to send a trigger through the external interface to any attached device that is able handle it to inform about the maximum exhale moment reached and store the trigger information .
  • Creating a personali zed model at maximum exhale using steps 300 and 500 , will deliver the minimal personali zed torso model in combination with a heart at its default position . This model must be used to take breathing into account when performing analysis on the recorded signal data that uses the personali zed model .
  • Step 930 serves to check i f maximum breathing inhaling stage has been reached, see step 910 .
  • the heart rotates and moves slightly in the chest by in-/decrease of the lungs during inhale and movement of the diaphragm . I f this occurs step 925 is applied to trigger for this event .
  • Step 935 serves to send a trigger through the external interface to any attached device that is able handle it to inform about the maximum inhale moment reached and store the trigger information .
  • Creating a personali zed model at maximum inhale using steps 300 and 500 , will deliver the maximal personali zed model .
  • This model must be used to take breathing into account when performing analysis on the rec- orded signal data that uses the personali zed model .
  • the model will also take the rotation and movement of the heart into account when positioning it into the torso model .
  • Step 940 serves to track a signal recording lead displacement due to breathing or any other repeating movement through time to enable using this displacement when analyzing the data .
  • a signal recording lead displacement due to breathing or any other repeating movement is reduced.
  • the locali zation is preferably improved even further . I f this must be tracked use 945 to trigger for this event .
  • Step 745 serves to send a trigger through the external interface to any attached device that is able handle it to inform about the lead displacement and store the trigger information .
  • Step 999 serves to store detected changes and states ( like new positions ) for the points of interest and provide the triggers for external systems and log files .
  • a corrected termination of the sternum line such as in the curriculum claim 10 , 11 , it generally determines according to the following calculations , which are in the application of per se known calculus .
  • a set of points P c Rn is said to present mirror, reflection, or bilateral symmetry i f there exists a hyperplane H c Rn of dimension n
  • mirror symmetry is a property of a set of points present ( as in “the set is mirror symmetric” )
  • mirror reflection is a mathematical trans form ( e . g . "the mirror symmetric of the set is taken with respect to an arbitrary plane” ) .
  • the symmetry plane in Rn is preferably computed in 3 steps , such as :
  • Feedback computer device for rendering ECG related feedback and outputting the same comprising :
  • processing device comprising a processor and at least a memory for processing input information and rendering output information
  • a 3D camera unit preferably including an image camera and a depth camera
  • a camera interface arranged to interface between the processing device and the 3D camera unit .
  • Feedback computer device comprising a housing, the housing comprising the processing device , 3D camera unit , camera interface , proj ector unit and proj ector interface , preferably the housing comprising mounting means for mounting the housing to a positioning device , such as a stand or mount such as a wall mount .
  • Feedback computer device comprising a point of interest processing module , such as for processing, monitoring or observing of the at least one point of interest .
  • Feedback computer device comprising a determination module for determining of suitability of an ECG recording of a heartbeat for further processing and/or storage thereof .
  • Feedback computer device comprising means for identi fying and/or monitoring of breathing related movement of at least one of the at least one point of interest , preferably including means for relating to this movement to a breathing rhythm .
  • a proj ector unit for proj ecting feedback information based on the feedback signals
  • a proj ector interface arranged to interface between the processing device and the proj ector unit
  • a mixed reality device like a HoloLens device for outputting rendered feedback signals
  • a mixed reality device interface arranged interface between the processing device and the mixed reality device .
  • Method implemented on a feedback computer device comprising a processing device comprising a processor and at least a memory, for recording and processing of ECG measurement data and for rendering feedback signals by the feedback computer device ,
  • a 3D or anatomic model and/or processing thereof such as a heart model and/or a torso model comprising the heart model ,
  • a 3D camera unit preferably including an image camera and a depth camera
  • a 3D camera unit preferably including an image camera and a depth camera
  • processing imaging information through a camera interface arranged to interface between the processing device and the 3D camera unit .

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Abstract

La présente invention concerne un dispositif informatique de retour d'informations pour effectuer le rendu d'un retour d'informations associées à un ECG et sa fourniture comprenant : - un dispositif de traitement comprenant un processeur et au moins une mémoire pour traiter des informations d'entrée et effectuer le rendu d'informations de sortie, - des moyens de réception conçus pour recevoir un modèle 3D ou anatomique et/ou un traitement associé, tel qu'un modèle de cœur et/ou un modèle de torse comprenant le modèle de cœur, - des moyens de réception conçus pour recevoir des données d'enregistrement d'ECG et/ou un traitement associé, comportant de préférence des informations de torse 3D correspondantes, d'un ECG, réalisés sur le torse, une unité de caméra 3D, comprenant de préférence une caméra d'images et une caméra de profondeur, - une interface de caméra conçue pour servir d'interface entre le dispositif de traitement et l'unité de caméra 3D, - une unité de projecteur pour projeter les informations de retour d'informations sur la base des signaux de retour d'informations, - une interface de projecteur conçue pour servir d'interface entre le dispositif de traitement et l'unité de projecteur.
PCT/NL2022/050523 2021-09-16 2022-09-16 Dispositif informatique de retour d'informations et procédé de traitement d'ecg WO2023043314A1 (fr)

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110092809A1 (en) * 2009-04-07 2011-04-21 Pacesetter, Inc. Cardiac coordinate system for motion analysis
US20210068695A1 (en) * 2018-04-25 2021-03-11 Peacs Investments B.V. Method Providing ECG Analysis Interface and System

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110092809A1 (en) * 2009-04-07 2011-04-21 Pacesetter, Inc. Cardiac coordinate system for motion analysis
US20210068695A1 (en) * 2018-04-25 2021-03-11 Peacs Investments B.V. Method Providing ECG Analysis Interface and System

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