Clinical Partners Meeting - 20/03/2012 - Trinity College, Cambridge Dr Richard Iles - Consultant Respiratory Paediatrician - Addenbrooke's Hospital, Cambridge University Health Partners

1. Structured Light Plethysmography
Dr Richard Iles
Consultant in Respiratory Paediatrics
Addenbrookes Hospital
10 April 2012

2. Welcome
• Research in Progress
o Addenbrookes
o Papworth
• Future work
• Demos / Tours
• Lunch
• Workshops
• Dr Simon Crick- Research Adviser, NIHR
RDS for the East of England
• Dinner - Browns
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3. PneumaCare Limited
 Executive Management Team:
 Dr. Ward Hills – CEO
 Dr. Richard Iles – CMO*
 Dr. Simon Baker – Product Director
 Eric Stewart – Commercial Director
 Willem de Boer – Head of Software
 Present products on the market
 PneumaScan™ Lung Function Assessment Device
 Products in test phase
 PneumaScan™ 3 Dimensional Analysis application
 PneumaScan™ Real-Time Data acquisition module
 PneumaScan™ Tracker Tool

4. • “PneumaCare, the first company to receive funding from the
University of Cambridge Discovery Fund, is a new model for
utilising academic expertise. “ Research Horizons Cambridge
Research Office
• Medical Futures Innovation Awards 2011 PneumaCare
Limited, came out on top in the respiratory category, and was
also named as having the best business proposition of all the
winners.
• PneumaCare is an investor funded operation presently
transitioning into a self-fund generation model. With over
£2M in backing by a strong investor board, £1M in
Government grant funding, the company is operating on a
solid foundation.
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5. 5

6. Structured Light Plethysmography
A new method of respiratory assessment
Dr Richard Iles
Consultant in Respiratory Paediatrics
Addenbrookes Hospital

7. Recent History of Spirometry and Lung
Function Tests
1902 Brodie T.G. was the first using a dry
bellow wedge spirometer, the precursor of
the still today used Fleisch spirometer.
1904 Tissot introduces a close-circuit
spirometer
1929 Knipping H.W. introduces a
standardisized method for spiroergometry.

8. 1959 Wright B.M. and McKerrow
C.B. introduces the peak flow meter.
1969 DuBois A.B. and van de
Woestijne K.P. present the whole body
plethysmograph on humans.
1974 Campbell et al presents a cheap
and light development of a peak flow
meter.

9. “The Need” - Lung Growth
100
90
80
70
60
50
40
30
20
10
0
24 30 32 36
lung growth
40 1 yr 2yrs

10. “The Need”
100
90
80
70
60
50
40
30
20
10
0
lung growth

11. “The Need”
100% FEV1 Normal decline
Normal growth
Symptoms
Death
0 5 10 15 20 30 40 50 60 70
Age (years)

12. Functional assessments of lung growth and
development now possible from birth
throughout the preschool years
Stocks: Infant and Preschool Lung Function testing, Ch 7 in Kendig's
Disorders of the Respiratory Tract in Children, 2006
Paediatric Lung Function Testing, Hammer & Eber: Karger 2005
Ped Resp Rev 2005: Vol 6, Issue 4 Preschool Lung Function Tests

13. Measuring Lung Function
• Old technology – technique dependant – too big !
• Calibration
• Infection risk Can we do better….. ?

14. Concept - Motion Capture
Patton Oswalt Remy
“Stand up comic” “A country rat”

15. “Avatar” – Motion
Capture

17. Optoelectronic Technology
Breathing movement
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18. Marker recognition and 3D reconstruction
Surface definition and volume computation
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19. Optoelectronic Plethysmography
Limitations
• Research System
• High Price Points
• Fixed Capital System
• Heavy Software Management

20. 1954 Structured Light beams create a contour map of a human head
during an Air Force study of jet-pilot helmets
Jet Age Man
Ralph Morse,
Originally published,
as the cover image,
on the December 6,
1954, issue of LIFE

21. 1984 - Optical mapping of the thoraco-abdominal wall
AJ PEACOCK, MDL MORGAN, S GOURLAY, C TURTON, DM DENISON
Lung Function Unit, Brompton Hospital, London, and UK Science Centre, IBM, Winchester
Thorax 1984 39: 93-100
• “An optical technique has been developed for mapping
the size and shape of the thoraco-abdominal wall and the
change in its shape with breathing”.
• A fixed pattern composed of stripes of light is projected
on to both sides of the trunk.
• These stripes become distorted when viewed from in
front and behind, forming contours over the trunk
surface.
• The contours are photographed and then encoded
digitally.

22. Optical mapping of the thoraco-abdominal wall
A J Peacock, M D Morgan, S Gourlay Thorax 1984 39: 93-100

23. 1985: Optical mapping of the thoraco-abdominal wall
• “The digital information can be used to compute
automatically the volume of the trunk, the position of any
point on its surface, and its cross sectional shape at any
level.”
• Linear dimensions can be calculated to within 0.5 mm,
• Cross sectional area to within 5%,
• Volume to within 3-7%.
• “These results suggest that this non-invasive technique
measures the shape and volume of complex three
dimensional surfaces with sufficient accuracy to be tried in
clinical practice.”

24. 2009 – Dynamic and real time measurements
Structured Light Plethysmography
PneumaScan™ assesses breathing Presentations are in formats familiar to the
remotely without patient interaction clinician and conform to regulatory
or contact standards.
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25. Research in Progress
• Addenbrooke’s
Ms Jenny Conlon - Clinical Trial:
Correlations with conventional
measurements of lung function
• Papworth
Dr Irisz Levai - SLP for the non-contact
estimation of chest/abdominal motion
changes after thoracic surgery –
feasibility study
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26. Volume (litres)
Tidal breathing
Time (sec)

27. Tidal breathing
Linear regression Bland –Altman plot
Correlation
coefficient = 0.998
VPT – VSLP (L)
VSLP (L)
VPT (L) N= 40 (VPT + VSLP)/2 (L)
Mean Correlation 0.925
SD 0.046

28. Forced expiration
Linear regression Bland –Altman plot
VSLP
(L)
VPT (L) N=40
Mean Correlation = 0.98
SD = 0.012

29. From Signals to True Volumes
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30. From Signals to True Volumes
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31. From Signals to True Volumes
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33. Novel outcomes - Regional Assessment

35. Tidal Breathing: The correlation in the time domain of the chest and abdomen data
from the first 1000 samples (TB).
We find that the maximum of the correlation occurs at sample 997, which is
equivalent to telling us that there is phase lag of 3 samples (0.05sec).

36. Regionalisation of Tidal Breathing

38. 1967 K-M Plots

41. Konno-Mead equal plots
Healthy
After Left Thoracotomy
After Right Thoracotomy