Artefact reduction in photoplethysmography
The use of optical techniques in biomedical monitoring and diagnosis is becoming increasingly widespread, primarily because of the non-invasive nature of optically derived measurements. Physiological analysis is usually achieved by characterisation of the spectral or temporal properties of the interaction between light and the anatomy. Although some optical measurements require complex instrumentation and protocols, recent technological advances have resulted in robust and compact equipment that is now used routinely in a multitude of clinical contexts. Unfortunately, these measurements are inherently sensitive to corruption from dynamic physical conditions or external sources of light, inducing signal artefact. Artefact is the primary restriction in the applicability of many optical measurements, especially for ambulatory monitoring and tele-medicine. The most widely used optical measurement is photoplethysmography, a technique that registers dynamic changes in blood volume throughout the peripheral vasculature and can be used to screen for a number of venous disorders, as well as monitoring the cardio-vascular pulse wave. Although photoplethysmographic devices are now incorporated into many patient-monitoring systems, the prevalent application is a measurement known as pulse oximetry, which utilises spectral analysis of the peripheral blood to estimate the arterial haernoglobin oxygen saturation. Pulse oximetry is well established as an early warning for hypoxia and is now mandatory under anaesthesia in many countries. The problem of artefact is prominent in these continuous monitoring techniques, where it is often impossible to control the physical conditions during use. This thesis investigates the possibility of reducing artefact corruption of photoplethysmographic signals in real time, using an electronic processing methodology that is based upon inversion of a physical artefact model. The consequences of this non-linear artefact reduction technique for subsequent signal analysis are discussed, culminating in a modified formulation for pulse oximetry that not only has reduced sensitivity to artefact but also possesses increased generality. The design and construction of a practical electronic system is then used to explore both the implementation issues and the scope of this technique. The performance of artefact reduction obtained is then quantified under realistic experimental conditions, demonstrating that this methodology is successful in removing or reducing a large proportion of artefact encountered in clinically relevant situations. It is concluded that non-linear artefact reduction can be applied to any photoplethysmographic technology, reducing interpretation inaccuracies that would otherwise be induced by signal artefact. It is also speculated that this technology could enable the use of photoplethysmographic systems in applications that are currently precluded by the inherent severity of artefact.