Gopalakrishnan, Keerthy

The measurement of physiologic pressure helps diagnose and prevent associated health complications. From typical conventional methods to more complicated modalities, such as the estimation of intracranial pressures, numerous invasive and noninvasive tools that provide us with insight into daily physiology and aid in understanding pathology are within our grasp. Currently, our standards for estimating vital pressures, including continuous BP measurements, pulmonary capillary wedge pressures, and hepatic portal gradients, involve the use of invasive modalities. As an emerging field in medical technology, artificial intelligence (AI) has been incorporated into analyzing and predicting patterns of physiologic pressures. AI has been used to construct models that have clinical applicability both in hospital settings and at-home settings for ease of use for patients. Studies applying AI to each of these compartmental pressures were searched and shortlisted for thorough assessment and review. There are several AI-based innovations in noninvasive blood pressure estimation based on imaging, auscultation, oscillometry and wearable technology employing biosignals. The purpose of this review is to provide an in-depth assessment of the involved physiologies, prevailing methodologies and emerging technologies incorporating AI in clinical practice for each type of compartmental pressure measurement. We also bring to the forefront AI-based noninvasive estimation techniques for physiologic pressure based on microwave systems that have promising potential for clinical practice.

Respiratory disorders, being one of the leading causes of disability worldwide, account for constant evolution in management technologies, resulting in the incorporation of artificial intelligence (AI) in the recording and analysis of lung sounds to aid diagnosis in clinical pulmonology practice. Although lung sound auscultation is a common clinical practice, its use in diagnosis is limited due to its high variability and subjectivity. We review the origin of lung sounds, various auscultation and processing methods over the years and their clinical applications to understand the potential for a lung sound auscultation and analysis device. Respiratory sounds result from the intra-pulmonary collision of molecules contained in the air, leading to turbulent flow and subsequent sound production. These sounds have been recorded via an electronic stethoscope and analyzed using back-propagation neural networks, wavelet transform models, Gaussian mixture models and recently with machine learning and deep learning models with possible use in asthma, COVID-19, asbestosis and interstitial lung disease. The purpose of this review was to summarize lung sound physiology, recording technologies and diagnostics methods using AI for digital pulmonology practice. Future research and development in recording and analyzing respiratory sounds in real time could revolutionize clinical practice for both the patients and the healthcare personnel.

Abstract Bowel sounds have been previously used to study intestinal motility and overall digestive health in various clinical settings. However, the blurred definition of bowel sounds and their subtypes, limited resources for interpretation, poor sensitivity, and low positive predictive value led to their restricted utility. Recent advances in artificial intelligence and machine learning have steered interest in developing unique tools using the phonoenterogram to analyze diverse bowel sounds. In our study, bowel sounds were recorded from eight healthy volunteers using the Eko Duo stethoscope. A novel deep-learning algorithm was designed to classify the recordings into baseline or prominent bowel sounds. A total of 11,210 data points (5,605 balanced sounds) were used to train and test the model to yield an accuracy of 0.895, a precision of 0.890, and a recall of 0.854 reflecting successful segregation of these sounds into respective groups. More extensive studies enrolling healthy and diseased subjects with a device specifically tailored to record bowel sounds are needed to generalize these results and determine their application in the patient population.

Abstract Blood pressure measurement in current medical practice relies on manual methods with the most widely used modality being sphygmomanometers. Utilizing the principle of Photoplethysmography, it is possible to provide an accurate reading of one’s blood pressure through light signals and photodetector devices. This research paper introduces a new Artificial Intelligence driven approach to predict Blood pressure levels and classify them according to the updated ACC (American College of Cardiology) criteria as Normal, Elevated, Stage I, and II Hypertension from the given PPG signal values using Machine Learning Models. This research paper aims to accurately read the Systolic and Diastolic Blood Pressure using Artificial Intelligence, place them into the correct value bins and further prove that the blood pressure values differ based on different skin tones in different light wavelengths such as red, infrared, and green. Machine Learning models such as the Support Vector Machine have shown an accuracy of 70.58% for Systolic Blood Pressure and Decision Tree with an accuracy of 74.4% for Diastolic Blood Pressure classification. The models used in this research are Support Vector Machine, Decision Tree and K-Nearest Neighbor. This research study has future applications and extensions to predict blood pressure levels for patients with different skin tones under different light radiations and PPG signal readings. Neural Network models will be developed to compare the blood predictions from this work.

Abstract Majority of hospitals still utilize manual methods for patient scheduling and predicting future appointments, resulting in longer wait times, hospital burnout and inadequate use of resources. A variety of avenues have been explored, including priority patient routing, tele-health, neural networks for improving ER efficiency, predicting no-shows, consultation duration variations, and optimizing operating room utilization. Addressing this issue, a study was conducted using 700 pre-visit notes of pancreatic patients to determine the requirement of endoscopic or biliary procedure. Through natural language processing and traditional or transfer learning algorithms, data could directly be sent to EPIC for nurses to assess in further decision making. Performance of the models was above average with the transfer learning method outperforming the traditional method. Although limited by less dataset and fewer circumstances to test the models on, the results exposed potential for future development with the possibility of patients reporting their chief concerns, in turn analyzed by algorithms, ultimately creating a smooth and effective patient itinerary.

Abstract Chronic cough is not only one of the leading causes of seeking healthcare all over the world but also a huge emotional drain on the affected patient population. In this study, we used 24-hour cough recordings to analyze the intervening conversations for sentiment analyses to better diagnose, guide, and manage treatment in such patients. We surveyed a cough clinic and selected four subjects with active cough complaints using relevant ICD-10 codes. Subjects were given and instructed to wear a device to record cough for 24 hours and the recordings were collected at weeks 0, 4, 8, and 12 of the treatment. The collected data was preprocessed to eliminate sections with no data (sleep, silence) and the number of coughs was counted. Google search API calls were used to transcribe the audio files and NLTK’s VADER analyzer was used to classify sentiments on a scale of 0 to 1. Finally, average scores were calculated and plotted over a graph to interpret any trends. 12 weeks of cough treatment had varied results on the four subjects. We categorized the exhibited sentiments into negative, neutral, positive, and compound and noted that they also showed no general trends. Among these, the compound sentiment displayed the most erratic patterns, and the obtained results could not generate a steady trend. Further studies are required with a large cohort to collect data over a longer duration to accurately analyze the sentiments associated with chronic cough.

Abstract Optical coherence tomography (OCT) is an advanced imaging modality to detect Barrett’s esophagus (BE) dysplasia, providing widefield, cross-sectional imaging and microscopic resolution. BE dysplasia is characterized under OCT by the presence and number of glandular structures with atypical morphology. Accurate detection and interpretation of BE glands under OCT is essential to detect dysplastic lesions. Object Detection using deep learning has the potential to identify glands from OCT images. We developed a YOLO model to identify the presence of glands in BE tissue. The YOLOv4 object detector was trained on a custom BE dataset of 30 patients with confirmed BE who underwent OCT imaging, of which 222 OCT images included at least one gland. Our model identified glands with a high average precision of 88.79% on the test dataset. We showed that the developed model is robust to rotation, brightness, and blur in images. We have implemented an object detection model to identify glands from OCT images with promising results accurately. This model has the potential to improve the diagnosis and surveillance of BE by eliminating human error and missed dysplastic lesions adaptable for capsule endoscopy applications.

Microwaves are non-ionizing electromagnetic radiation with waves of electrical and magnetic energy transmitted at different frequencies. They are widely used in various industries, including the food industry, telecommunications, weather forecasting, and in the field of medicine. Microwave applications in medicine are relatively a new field of growing interest, with a significant trend in healthcare research and development. The first application of microwaves in medicine dates to the 1980s in the treatment of cancer via ablation therapy; since then, their applications have been expanded. Significant advances have been made in reconstructing microwave data for imaging and sensing applications in the field of healthcare. Artificial intelligence (AI)-enabled microwave systems can be developed to augment healthcare, including clinical decision making, guiding treatment, and increasing resource-efficient facilities. An overview of recent developments in several areas of microwave applications in medicine, namely microwave imaging, dielectric spectroscopy for tissue classification, molecular diagnostics, telemetry, biohazard waste management, diagnostic pathology, biomedical sensor design, drug delivery, ablation treatment, and radiometry, are summarized. In this contribution, we outline the current literature regarding microwave applications and trends across the medical industry and how it sets a platform for creating AI-based microwave solutions for future advancements from both clinical and technical aspects to enhance patient care.