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Played with a Throne Butt Kicker for the First Time
It was fantastic. I could feel every thump from every stroke in the seat and my wife said that she thought my playing seemed much tighter than in other situations I get thrown into.
I think that one of these gizmos is going to be my next gear purchase. It's like now that I've tried one, I've got to have it.
Any brands that any of you would recommend or suggest I stay away from?
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Sorry, but this gets my vote for silliest gimmick ever.
Ironwood kit Tiki kit Openhanders Vids
Re: Played with a Throne Butt Kicker for the First Time
Haha. I don't know about silly. A lot of drummers that play in large venues and other scenarios that have a different monitor mix from venue to venue use them.
I've heard about them for years but have never tried one.
I don't know about the gimmick factor but it is a bit of a luxury drum gear item.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
I think 'sadistic' is the word, it can be addictive, you can always turn it off though.
The thing needs an external amplifier to work, cords, set-up. All the extra stuff to cary could add-up to one deciding just to leave the beating chores to a partner.
Re: Played with a Throne Butt Kicker for the First Time
I had some experience with it.
It started with a buttkicker from Fisher Amp. It was nice but nothing special because it mounted at the throne's base and not itself.
After a few years I was invited by Swiss Chris (at the time the drummer and MD for John Legend) and he had the original ButtKicker witch was very powerfull and connected to the throne directly:
Mannn on full power you even felt it a few meters away from the riser.
The advantage for me was that I could silence my in-ear to a nice level and still feel the kick/bass/other low freq's.
So for the ears sake i would say YES YES YES.
Yamaha Drums | DTX | Zildjian | Vic Firth | Remo | Ears4U | EXA Ltd. Cymlok
Re: Played with a Throne Butt Kicker for the First Time
I've been a ButtKicker user/lover/endorser for over 7 years, and I suppose it's easy for anyone who's not familiar with it to regard it as a gimmick. Also, they're not to be confused with any of the shakers and thumpers that have been out in the past, and were highly inefficient by comparison. ButtKicker is a pro-level, serious kicker.
I've always had it/them attached to the seat, never on the stand:
Yes, there are two on there, but not because a single one is inefficient. On the contrary, one is plenty for most drummers. But I've always kept two on two throne tops, because I run them hard and they have a thermal switch that shuts them down for 15-20 minutes if they overheat. It eventually dawned on me to just mount two on one seat, and simply switch over the cable when necessary. Then I figured out it was simpler still to bridge the two so they'd never overheat... and I've not had any issues since.
I send only the kick to the ButtKicker, with a gated signal so that other sounds like low end or snare hits don't thump me, run onto a crossover to focus the thump, and a Crown K2 amp, which has plenty of power for them.
I absolutely love mine.
Re: Played with a Throne Butt Kicker for the First Time
I've been reading up on these transducers and I have a few questions.
The rig I played on did not have the kick signal coming back to the ButtKicker from the board. It utilized a trigger on the bass drum that ran directly to the ButtKicker.
Unfortunately, I didn't get to poke around and check out the whole set up.
Besides "feeling" my kick drum placement with what I can hear and foot-feel, I truly enjoyed physically feeling the thump to reinforce my feel for precision (the bass drum was very boxy sounding and was very muddy in the mix)
Would the ButtKicker Mini Concert set up with the appropriate amp and trigger be adequate? I can get this unit for about $100, so it wouldn't really be an extravagant purchase. I think the units you're using are about $700 each.
Bermuda, how does your help you in playing situations? Is it more about the thump for when you can't hear well or for other reasons?
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Is your own bass drum connected to what does the shaking or the bass guitar....???
The reason I ask is because if you are off rhythm how would this keep your playing tight when you are feeling your own rhythm, and if it is the bass guitar and he is off how would this help? It would seem to me it would work fine if it was connected to a click or metronome....
Retirement...August 21, 2015
Feel. Control the Bounce.
Re: Played with a Throne Butt Kicker for the First Time
Well I don't have very much experience with this so I'll leave it up to Bermuda, but I think it helps with when you can't hear your bass drum very well in the mix and you want more than foot-feel.
It's great to kick that drum and feel the thump in the seat.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
The purpose is to use it as a monitor for a very intimate, accurate, and undeniable sense of the kick, which for me is the heart of the groove. I went beyond physical monitors about 10-15 years ago when they simply got out of hand because I wasn't hearing/feeling enough kick. My own monitors were competing with foh, and that's not good. They were blowing everyone else away, except me. I was too close to actually benefit from the wave the monitors were generating, and smaller more 'efficient' monitors didn't give me enough of what I wanted: to really feel the kick.
Granted, I've been playing some large venues and hitting hard, so the kick has to be the most present aspect of my mix. Not sheer volume, but the 'loudest' thing to me. With a ButtKicker, I pretty much become the kick, and can tell with compklete accuracy how my dynamics are, and where each beat is placed, without clogging my headphone mix further with a loud kick. I do hve some kick click in my phones, and that makes for a very complete kick sensation. Also, I run only the kick in my seat. I don't need to feel the bass or have it make other thumps in my seat when I'm not also playing them. that's a personal preference of course, but that's part of what makes the kick so perfect for me.
I'm sure I don't have to explain how crucial a mix is to one's performance. Imagine playing drums, and even having the tactile sensation of making contact with heads, your foot feeling when the hats close, etc... but you can't hear any of it. Could you play well? No - you have to hear what you're playing. Obviously that's an xtreme example, but anything in between a greatt mix and not being able to tell what you're doing is a hindrance to your performance. Because of the kick's lower frequency and generally poor monitor situations, the kick is usually the least-heard of all the drums, so it needs the most help to balance it in the mix. Perhaps I prefer it a bit 'louder' than most, and the ButtKicker has been the only way to achieve that without huring my ears, the ears of others, and the overall mix of the band.
No, it's not for every situation. I don't really miss it in most club situations, because I'm not playing so hard that I can't hear the kick. And yes, a ButtKicker and amp are an added expense. But it's a pro-level piece of gear that's become indispensable to those who demand more kick in their 'mix' for a better performance.
Re: Played with a Throne Butt Kicker for the First Time
Great post Bermuda. Thanks.
Since my last post I found out that the unit I was using had a ddrum trigger routed through an old Simmons drum module running to the ButtKicker.
This set up allows for being able to feel the transducer when playing in smaller rooms where the kit is not mic'd. So in essence it functions more like the more inexpensive throne shakers that are out there.
Since I don't have the monitor requirements that you do and I don't play in larger venues, I don't think I need to go with the higher end models of the ButtKicker.
I think I'm going to look for the Mini Concert model for around $100 bucks and experiment with the trigger/drum module set up. I'll pick up an inexpensive power amp and I can borrow a friends TD7 and see how it works and feels.
I really appreciate the more personal and subtler aspects of your comments. They really helped better understand the benefits, especially since I have only played with a set up like this once.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
BUTTKICKER concept for drums is still a work in progress IMO.
Would love to see an integrated throne/seat top using the same concept of vibrational feedback.
A 'club' version wouldn't need to be that powerful, just enough.
A class D amp with a pre, using the signal from a (kick) mic... all 21st century doable.
Re: Played with a Throne Butt Kicker for the First Time
I know what you mean by "vibrational feedback", but the ButtKicker doesn't simply vibrate. there's a piston inside, house in liquid, and it kicks accordingly when the source (kick drum) sends a signal. It's like having someone hit you every time you step on the pedal, but it's a completely dynamic - and less painful - situation.
Might be cool to have something built into a seat with a simple input jack, that would make a personal kicker more accessible for more drummers. But there's still the amp and signal issues. It wouldn't work if there wasn't a mixer with a send for the kick, meaning it wouldn't be usable whenever the kick wasn't miked in the first place. Unless the drummer wants to bring his own 'rig' just for the sake of feeling the kick better.
Please understand that I'm not going on about this because I endorse the product. I just want to make sure people know what it is and why it's different before making judgements about whether it works or is necessary for them. It does work, and while it's not an absolutely necessary piece of gear, it sure makes monitoring drums a lot better!
Re: Played with a Throne Butt Kicker for the First Time
For $279, I can get a Simmons drum module with two 9" pads and two triggers.
$100 for the ButtKicker and all I have to find is an inexpensive amp and I can put together a ButtKicker rig and add two pads to my set up for other sounds (i.e. hand clap, or whatever)
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Re: Played with a Throne Butt Kicker for the First Time
Good to know.
Any suggestions on amps. That Crown amp that you referred to.. ..is it overkill for what I need?
Thanks again for your feedback. I really do appreciate it.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
My Crown amp is older, a K2, and I'm not sure if it's even made anymore. But it's basic rating is 950 or 1200 watts or something like that, and I've failed to damage either ButtKicker in 7 years of using them. So the amp itself is not overkill.
What really matters is how intimate you need to be with your kick, and where you can draw the line between gigs that really require that extra punch. The ButtKicker isn't about having a little more reinforcement, it's an important link in the monitoring chain for those who need a lot of kick. You could adjust the level to wherever you want it of course, but it's a real commitment if you're not going to go all the way with it. Guitammer (the parent company) offers some other versions that are better suited for lower volume situations.
A few other things you need to know specifically about their Concert model...
The system won't work well if you like an open or resonant kick. You'll just get a lot of rumble, and very little sense of impact or where the beat is. I'm not suggesting you pad up the kick just to get a tight kick in the butt, although if that's how your kick is already, you're going to be thrilled! I suppose if you simply triggered the batter head through a module and used a tight kick to drive ButtKicker, that would accomplish the same thing.
Also, other sounds can set-off the ButtKicker, even the snare being hit hard, and you'll be thumped each time. Perhaps that gives a sense of every hit, but it also gets a little annoying when all you really want is kick. For miking, the signal to the ButtKicker should be gated, so only the kick opens it up. With a trigger, the sensitivity can be adjusted to help with extraneous signals, but that may also affect the dynamics of the kick. That is, if you're playing ghost notes, they may fall below the sensitivity and not register in the seat.
And, they work best when attached directly to the seat, which means you have to have enough space to mount it. A smallish round seat isn't going to work, although most saddle seats and cannister thrones will be just fine. For the smaller seats, the company offers a mounting plate that goes under the throne seat's mount and the ButtKicker hangs off the back of it. But with either method, the unit becomes somewhat permanent. You could remove and attach it for every gig, but that gets old if you're working even a few times a week.
As I mentioned above, this is a commitment.
Re: Played with a Throne Butt Kicker for the First Time
Keep in mind BUTTKICKER wasn't designed 'specifically' for the drum throne, its been adapted to it. It does what it does well, but its not totally practical for the drum stool by 2011 standards.
21 century technology can easily create an integrated seat/top unit, one with its own pre and power amp able to trigger off a mic signal, or better yet off a mechanical trigger on the pedal itself like the AXIS design. Under seat mounted adjustable gain/sensitivity controls, one (power) cord etc. Air conditioning, cup holder, maybe even a flip-out chromatic tuner display as available options, all doable.
So yeah, IMO the concept of mechanical feedback on the stool is still a work in progress.
Re: Played with a Throne Butt Kicker for the First Time
That photo illustrates an alternate method for mounting the unit, but certainly not preferred. I can understand that judging the ButtKicker by that mounting suggests that the kick won't be very strong, and it's not. It's still really nice, but for the best result (and where possible,) the unit needs to be mounted directly to the seat.
For those who've tried it and didn't absolutely love it, it's very possible that it wasn't set-up correctly, in the same way that if a drum isn't tuned well, it's easy to dismiss it as a bad drum. I tried Pearl's 'kicker' at NAMM - some have said it's OEM'd by the ButtKicker folks - and it was just an embarrassment. Barely a vibration from it, yet touted as an invaluable addition to electronic and acoustic kits. Well, I was certainly one of the guys saying how bad it was, and in hindsight, I realize it was probably not set-up correctly. Such items that aren't demonstrated properly are a real disservice to the companies that make them, and I think that's happening with the ButtKicker for those who perhaps tried one that wasn't set-up correctly, or read too much into a photo.
Seriously, the ButtKicker is the ultimate answer for those who need to feel more of their kick, but it's also not for everyone. Please don't feel that I'm trying to 'sell' anyone on it, I just want everyone to understand what it does before making judgments. I might be the only one here who owns and uses the ButtKicker, and I hope my experiences using it on various kicks over the last 7 years will be regarded as helpful.
Last edited by bermuda; 03-24-2011 at 12:06 AM.
Re: Played with a Throne Butt Kicker for the First Time
Well it took me a month, but I finally put together my Buttkicker rig.
I decided to wait and save a little more money and purchase all the items online to save a bit. I had to go to a gaming and audio video store hear in Atlanta to demo the unit and it wasn't installed on a drum throne. It was a couch and recliner chair set up with four Buttkickers installed to demonstrate the low frequency benefits integrated with a high end surround sound audio video set up. It was very impressive but not a good representation of the control you have when you play a bass drum pedal. Plus it thumped with the concert dvd on bass drum and bass notes.
So I got the Buttkicker Mini-Concert with the mounting plate for my Roc n Soc throne.
I got a Crown XLS1500 amp and a couple of cables I needed too. I couldn't wait to set it up and test it out. I sent my kick drum mic signal back out of my mixer and fired it up. After a bunch of fiddling, I was pretty disappointed in the results.
It became quite obvious right away that the bass drum note duration was pretty long. Even after I muffled the crap out of my bass drum, the thump and feel was a little muddy and didn't seem to have the attack I remembered when playing with one the first time.
I don't have any compression or more importantly gating on my kick mic signal so I realized that I would need a few more electronics to get it right. Since I'm not spending any money right now on any recording gear and I really only want the Buttkicker for the thump, I decided to set up a trigger rig for the Buttkicker.
I got a great deal on a Simmons E kit pack from Guitar Center. It comes with their cheapest bottom of the line drum module, two pads and two triggers and cabling for $279. Not bad since I could integrate the pads into my kit if I want for effects.
When I got this set up and adjusted I was still experiencing some of the same muddiness as before but when I picked one of the more electronic and clicky bass drum sounds on the module the Buttkicker immediately perked up and produced a tight thump in the seat. Some of the Roland type synthy drum sounds, I guess, are shorter than others and that was the key to overcoming the gating issues of setting off the Buttkicker with a kick mic signal.
When I started upping the power to the Buttkicker it got better and better. It totally works better when running close to full power.
Remembering Bermuda's advice, I started getting worried after a few hours of playing if the thing would shut off if I ran it too long close to full power. My drums are set up in my basement which has a carpeted concrete floor. Usually my wife says she can barely hear of feel the bass drum upstairs. She actually poked her head in the first day I had it set up with the trigger rig and was looking at me like, WTF?
You could feel it 5-10 feet away in your feet and I had her stomp the pedal for a while and you could definitely feel it a little upstairs through the house and floor.
Remember you don't hear anything. You only feel the bass.
Using the triggered electronic kick sound is cleaner because there is nothing bleeding into the kick mic and since I don't have it gated to overcome this I get the same benefit of the improved kick drum monitoring. I don't play big shows, so I usually deal with having to play my drums unmic'd and a little louder than I prefer to sit in the mix properly. Often I have a hard time hearing myself, especially my kick drum.
I've always relied on foot feel, like we all do regardless, in placing my kick drum notes when I can't hear my bass drum very well.
It is such a difference. It doesn't take long at all to get used to the ass smack it gives you and it immediately boosted my confidence that my kick placement was nice and tight. Especially on busier beats and funkier stuff.
The amp was the most expensive part of the rig and I can definitely see the whole set up as one of the first things I would leave behind and not pack up for small gigs or when you don't want to bring a larger set up.
The Buttkicker adds bulk and weight to my throne but the amp is the real pain. Having a small rack for it or a case is no big deal but you still have to put it somewhere. Some of the places I play, the stage is so small that bringing a larger kit much less and amp that I have to have sitting next to or behind me isn't practical.
Thanks to Bermuda for the great insight and advice. I absolutely love it.
I'm telling you. You play with one and you will want one.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
All set up for my first gig tonight with my Buttkicker rig. Will let you know how it went.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Monday nights gig went off without a hitch. My Buttkicker thumped away and was only noticeable to our bass player besides me. He said he could feel it right through the floor.
I didn't mess too much with it once I got it turned up a little more after the first two songs.
I also played last night at my regular Friday night jam and everybody could feel it.
My kit is on about a 5' x 8" rug on a wooden floor in a large 34' x 34' upstairs room. A couple of friends that were out front listening said they could really hear my kick well.
Sort of funny when you think about it. I guess being able to feel the kick's low frequencies added a little to their perception of the kick sound.
The novelty of it hasn't worn off yet so I'm not sure what it will be like in a few months but I like the way I can monitor my kick playing now. It's actually quite helpful using the thump in the seat as an indicator of when I'm losing consistency in my strokes.
Since I'm triggering it, I've noticed that there could be some improvements. The Simmons trigger is not bad but I think higher quality or more sensitive triggers might offer more responsiveness. It also takes a little fiddling with the volume on the drum module so that you get the right level in conjunction with power levels from the amp.
Your description before as to how it creates a more intimate feel of your kick drum sound is spot on. I think it will also improve my playing too. I noticed a few times last night that I was dropping a few double strokes every once in a while when I did not intend to.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
You should check out the BC 2. It's what you suggested Les Ismore. An awesome product.
Re: Played with a Throne Butt Kicker for the First Time
Looks very interesting.
I would love to hear about what Bermuda thinks of this product if he knows anything about it.
Latency is a big issue with these transducers so I don't know.
I'm happy with my Buttkicker rig but it's always cool to learn about something new or different.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Chris had it mounted like this (as you can see on the pic) And it worked perfect and was very strong also because its mounted to the bottom of the seat itself (but without drilling extra holes in the top)
It doesn't work fine when mounted to the post of the chair so ive noticed with the Fischer Amp (witch is mounted to the post)
Stil thinking of getting a buttkicker set (with the buttkicker amp)
Now I recall... Chris had it connected directly to his powered mackie mixer. So that is an option I guess?
Did anybody tested the Mini Concert btw?
Yamaha Drums | DTX | Zildjian | Vic Firth | Remo | Ears4U | EXA Ltd. Cymlok
Last edited by MusiQmaN; 05-16-2011 at 11:20 PM.
Re: Played with a Throne Butt Kicker for the First Time
You still have to screw the bracket into the seat..
.. so it makes good sense to just screw the unit directly into the seat. I'm going to try it.
You definitely have to have a bicycle seat style throne or a larger round throne to have room to fit the middle rear of the seat.
As long as you crank it up, it works fine with the bracket. I'll have to try remounting mine to let you know if it feels stronger. I'll bet it will.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Fischer Amps is releasing the 1HE! Buttkicker Amp for powering 1 Concert or 2 LFE Buttkickers:
It contains a few very nice and usefull options like a link trough with XLR/Jack combo (instead of making to have a split cable for the kick) switchable power voltages and a crossover and highpass.
They also make products like a In Ear Mixer, Bodypacks and more:
Yamaha Drums | DTX | Zildjian | Vic Firth | Remo | Ears4U | EXA Ltd. Cymlok
Re: Played with a Throne Butt Kicker for the First Time
Thanks for posting this. If the price is right, I may get one of these and then use the amp I bought for my rig for our failing PA amp.
The Crown amp I bought for my ButtKicker is way more than I need to power it.
Philippe - Eat, Sleep and Drum.. .. it makes for a good weekend.
Re: Played with a Throne Butt Kicker for the First Time
Check out Joe Crabtree's (Wishbone Ash etc) review of the BC2. Worth a watch.http://www.youtube.com/watch?v=m-yK9...=FL35uPHypojpI
Re: Played with a Throne Butt Kicker for the First Time
Very interesting thread.
I'm looking for a way to upgrade my new Carmichael throne by some tactile monitor system. I learned that Fischer Amps (Germany) are distributing the Porter & Davies systems so I sent them an e-mail and got a reply today. The throne top I have is only 13'' in diameter so the shaker would be mounted to the base of the throne as there's hardly any space to mount it to the bottom side of the top.
On a German forum I read that mounting the shaker(s) to the throne base can work, too - it might be less 'kicky' but create a more homogenuous vibration. I happen have 4 cheapo shakers - nothing decent but I guess 2 of them might work. Let's see.
The P&D look like the perfect solution if money is no concern though.
At this year's Frankfurt Musikmesse I briefly tried some butt kick system at the Pearl booth - they had a bunch of them, I guess it's their Throne Thumper system - but that one wasn't too impressive. It produced some rumble but it felt like there was too much of a latency and no real kick, 'just' some undirected rumble - better than nothing but I guess different systems are way better than this.
Re: Played with a Throne Butt Kicker for the First Time
I'm wondering if it wouldn't get out of hand with fast double bass rolls.
Either you have a purpose behind your expression... or you don't.
JoJo Mayer
Re: Played with a Throne Butt Kicker for the First Time
Re: Played with a Throne Butt Kicker for the First Time
just picked up a BC Gigster from Porter and Davies. In a word, this unit is marvelous. It really helps for a big room to feel where you are placing your bass notes. Doesnt seem like a big deal and I hemmed and hawed at the idea of it, but I took a leap of faith on this unit and couldnt be happier. For small venues, it may not be ideal, but for large venues, I think it is a must.
Sonor Ascent/S Classix/SQ2
Porter & Davies
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Embodiments of the present invention relate to a method for analyzing pulse data. In one embodiment, the method comprises receiving a signal containing data representing a plurality of pulses, the signal generated in response to detecting light scattered from blood perfused tissue. Further, one embodiment includes performing a pulse identification or qualification algorithm on at least a portion of the data, the pulse identification or qualification algorithm comprising at least one constant, and modifying the at least one constant based on results obtained from performing the pulse identification or qualification algorithm, wherein the results indicate that a designated number of rejected pulses has been reached.
1. A method for analyzing pulse data, comprising:
receiving a signal at a pulse oximeter, the signal containing data representing a plurality of pulses, and the signal generated in response to detecting light scattered from blood perfused tissue;
performing a pulse qualification algorithm on at least a portion of the data using a processor of the pulse oximeter, the pulse qualification algorithm rejecting non-qualified pulses, the pulse qualification algorithm comprising at least one constant; and
modifying the at least one constant using the processor based on results obtained from performing the pulse qualification algorithm, wherein the results indicate that a designated number of rejected pulses has been reached.
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19. A system for analyzing pulse data, comprising:
a signal generator configured to generate a signal in response to detecting light scattered from tissue, the signal containing data representing a plurality of pulses;
a filter configured to run a pulse qualification algorithm on at least a portion of the data, the pulse qualification algorithm configured to reject non-qualified pulses, the pulse qualification algorithm comprising at least one constant; and
a subsystem configure to modify the at least one constant based on results obtained from performing the pulse qualification algorithm, wherein the results indicate that a designated number of rejected pulses has been reached.
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31. A method for analyzing pulse data, comprising:
receiving a signal at a pulse oximeter, the signal containing data representing a plurality of pulses, and the signal generated in response to detecting light scattered from blood perfused tissue;
performing a pulse qualification algorithm on at least a portion of the data using a processor of the pulse oximeter, the pulse qualification algorithm detecting pulse amplitudes, the pulse qualification algorithm comprising at least one constant; and
modifying the at least one constant using the processor based on results obtained from performing the pulse qualification algorithm, wherein the results indicate that the pulse amplitudes are generally below a threshold.
This invention relates generally to the field of medical devices and, more particularly, to adjusting constants (e.g., thresholds and coefficients) used in pulse oximetry analysis algorithms based on performance criteria.
This section is intended to introduce the reader to various aspects of art that may be related to various aspects of the present invention, which are described and/or claimed below. This discussion is believed to be helpful in providing the reader with background information to facilitate a better understanding of the various aspects of the present invention. Accordingly, it should be understood that these statements are to be read in this light, and not as admissions of prior art.
A pulse oximeter is a medical device that may be used to measure various blood characteristics such as oxygen saturation of hemoglobin in pulsing blood and/or a patient's pulse rate. To measure these characteristics, a non-invasive sensor may be used to pass light through a portion of blood perfused tissue (e.g., a finger, earlobe, or toe) and photo-electrically sense the absorption and scattering of light in the tissue. The amount of light absorbed and/or scattered is analyzed to estimate the amount of blood constituent in the tissue.
A detector signal resulting from measurement of the light absorbed and/or scattered by the blood perfused tissue includes information that describes the blood characteristics. As an example, pulses refer to the varying amount of arterial blood present in the tissue during a cardiac cycle. The varying amount of arterial blood yields cyclic attenuation of the light passing through the tissue. Accordingly, the detector signal from measurement of the light exhibits the familiar plethysmographic waveform representative of the cardiac cycle.
Analysis of detector signals involves processes that use various parameters. As an example, an analysis may involve filtering estimates of hemoglobin saturation to improve the accuracy of the saturation estimates. As another example, the analysis may involve filtering of plethysmographic waveforms. The filtering may use parameters such as filter weights or coefficients to adjust the filtering process. As another example, the analysis may involve applying pulse qualification criteria to qualify or disqualify pulses. The pulse qualification criteria may include parameters used to adjust the pulse qualification.
Under challenging conditions, it can be difficult to discern a valid arterial pulse from detector signals when using established pulse oximetery systems and methods. For example, under certain circumstances, pulse waveforms may be distorted by noise, which may make it difficult to discern a valid pulse among the distortions. Accordingly, it is desirable to provide a flexible and robust system and method for detecting valid arterial pulse signals when experiencing challenging conditions.
Certain exemplary embodiments are described in the following detailed description and in reference to the drawings in which:
One or more specific embodiments of the present invention will be described below. In an effort to provide a concise description of these embodiments, not all features of an actual implementation are described in the specification. It should be appreciated that in the development of any such actual implementation, as in any engineering or design project, numerous implementation-specific decisions must be made to achieve the developers' specific goals, such as compliance with system-related and business-related constraints, which may vary from one implementation to another. Moreover, it should be appreciated that such a development effort might be complex and time consuming, but would nevertheless be a routine undertaking of design, fabrication, and manufacture for those of ordinary skill having the benefit of this disclosure.
The exemplary embodiments described below are best understood by referring to
As discussed in detail below, the pulse oximeter system 100 is configured to identify and qualify a patient's blood flow pulses using algorithms that may be referred to as pulse identification or qualification algorithms. These pulse identification algorithms implement variable constants or weighting factors to facilitate pulse detection during challenging detection conditions. For example, during challenging data acquisition conditions, an initial set of constants in the algorithms may be switched with alternative constants based on a count of consecutive rejected and qualified pulses. This use of alternative constants has been demonstrated to reduce pulse rate dropouts (i.e., failed pulse readings) while maintaining or improving pulse accuracy under certain challenging conditions.
A specific example of providing alternative constants in algorithms is provided herein. It should be noted that while the embodiments discussed in detail below utilize specific constant values and equations, other embodiments may utilize different constant values and different equations in a manner in accordance with embodiments of the present invention. For example, while in one embodiment, a primary constant value has a specific alternative value, one of ordinary skill in the art will recognize that different values based on different data may be implemented as primary and alternative constants, and that a plurality of alternative constants may be used based on the data.
Turning to
The pulse oximeter 102 utilizes various oximeter components to analyze the detector signals, control the acquisition of blood characteristic data, and facilitate data access. For example, in the illustrated embodiment, the pulse oximeter 102 includes general processing and interface components such as a microprocessor 114, a ROM 116, a RAM 118, a display 120, control inputs 122, and a detector/decoder 124, coupled to an internal bus 126. The microprocessor 114 calculates oxygen saturation based on the values of signals received from the sensor 104 and certain corresponding weighting coefficients. The ROM 116 stores the coefficients used in the calculations, and the detector/decoder 124 selects the appropriate coefficients according to signals received from the encoder 112. The control inputs 122 are components configured to receive input data and instructions. For instance, the control inputs 122 may include a switch on the pulse oximeter, a keyboard, or a port configured to provide instructions from a remote host computer. The display 120 (e.g., a computer monitor) provides feedback and results of the analysis.
The pulse oximeter 102 also includes components that operate to control the light that passes through the tissue 106. For example, in the illustrated embodiment, the pulse oximeter 102 may include a time processing unit (TPU) 126 and light drive circuitry 128. The TPU 126 is configured to provide timing control signals to the light drive circuitry 128, which controls when the light source 108 is illuminated. Additionally, in some embodiments that utilize multiple light sources 108, the drive circuitry 128 controls multiplexed timing.
During system operation, signals from the detector 110 are received for processing by the pulse oximeter 102 through an amplifier 128. The pulse oximeter 102 includes several components that operate to process the received signals. Specifically, in the illustrated embodiment, the pulse oximeter 102 includes a switching circuit 130, an amplifier 132, a low pass filter 134, an analog-to-digital converter 136, and a queued serial module (QSM) 138. The switching circuit 130 controls the sampling of the signals in response to instructions from TPU 126. For example, sampling times may be set to predetermined or calculated values. If multiple light sources are used, the sampling times may depend upon which of the light sources 108 are illuminated.
The signals from the switching circuit 130 are passed through the amplifier 132, the low pass filter 134, and the analog-to-digital converter 136. Digital data from the detector signals is then stored in the QSM 138. Further, the digital data may be downloaded to the RAM 118 as the QSM 138 is filled. In some embodiments, analog data may be stored before converting it to digital data. Further, in some embodiments, there may be multiple parallel paths of separate amplifiers, filters, and analog-to-digital converters corresponding to different light wavelengths.
The pulse identification and qualification subsystem (PIQS) 202 of the illustrated embodiment is configured to identify potential pulses and qualify the potential pulses as likely or unlikely arterial pulses. Additionally, the PIQS 202 is configured to detect the presence of noise, indicate the occurrence of individual pulses, and provide descriptive metrics used by other subsystems to fine-tune oximeter performance. In operation, the PIQS 202 utilizes various algorithms to process waveforms received from a patient. This processing by the PIQS 202 may be divided into several parts. For example, a first part may include identifying pulses by finding maximum and minimum phases. A second part may include detecting partial pulse events (e.g., noise and dicrotic notches) and concatenating the detected partial pulse events into a complete pulse. A third part may include qualifying pulses and rejecting potential pulses that are unsuitable for pulse-rate calculation.
The PIQS 202 is configured to operate during challenging conditions. For example, the PIQS 202 facilitates pulse detection and identification of qualified pulses while encountering arrhythmias, rapid changes in pulse rate, motion, low perfusion (poor signal-to-noise ratio), respiratory artifact, and unusually shaped pulses from test devices. In operation, the PIQS 202 may detect a potential pulse as a waveform having a maximum phase followed by a minimum phase. Once detected, a potential pulse is ignored by the PIQS 202 if it is deemed to be an artifact of the pulse shape, such as a dicrotic notch. If the pulse is not designated as an artifact, the PIQS 202 treats the potential pulse as a "pulse" that is either "qualified" or "rejected." The PIQS 202 then provides qualified pulses to the pulse rate calculation subsystem (PRCS) 204 for pulse-rate estimation. The PIQS 202 may output a pulse quality of individual pulses, a degree of arrhythmia, pulse amplitude variations, and/or qualified pulse periods and age.
The optical waveform produced by human pulses typically falls faster than it rises, and the DC level does not change significantly on a pulse-to-pulse basis. This asymmetry is more pronounced at low pulse rates. In accordance with present embodiments, the PIQS 202 operates under an assumption that its input waveforms have been highpass filtered, which makes the upstroke a long plateau and the downstroke a brief, sharp minima, so that the highpass-filtered pulse has a pronounced negative skew. It should be noted that a highpass filter (e.g., a derivative filter) may be deemed to provide sufficient AC-coupling to substantially eliminate baseline shifts between pulses such that its output is generally zero-mean.
The PIQS 202 may receive input waveforms that have been pre-processed by the signal conditioning subsystem (SCS) 206. In the illustrated embodiment, the SCS 206 is configured to receive digitized Red and IR light signals 211 and output pre-processed Red and IR signals. Specifically, in operation, the SCS 206 conditions signals to emphasize higher frequencies associated with a human plethysmograph and to attenuate lower frequencies associated with interference from noise sources. For example, the SCS 206 may condition received signals by taking a first derivative to reduce or eliminate a baseline shift and then low pass filter the signals with coefficients based on hardware characteristics. It should be noted that derivative-filtered plethysmographs characteristically have a negative skewness. The signal conditioning subsystem 206 may also divide the lowpass filtered values by the average of the respective IR or Red signals.
The waveforms received by the PIQS 202 may also be pre-processed by the ensemble averaging system (EAS) 208. Indeed, in the illustrated embodiment, both the SCS 206 and/or the EAS 208 can pre-process the waveforms provided to the PIQS 202. The EAS 208 incorporates a low pass filter. In operation, the EAS 208 may receive normalized pre-processed Red and IR signals, average pulse period, and/or low pass filter weighs and ensemble averaging filter weights provided by the signal quality metrics calculator (SQMC) 210. The EAS 208 ensemble averages and filters the normalized and preprocessed signals from the SQMC 210. The EAS 208 then outputs filtered Red and IR signals and/or age. Additionally, the EAS 208 may track the age of the signal and/or filtering results. It should be noted that ensemble averaging may involve attenuating frequencies that are not of interest. For example, ensemble averaging may involve attenuating frequencies that are not at the estimated pulse rate or harmonic.
The SQMC 210 computes signal quality metrics. The SQMC 210 may receive various types of input, including: raw digitized Red and IR signals, a degree of arrhythmia, individual pulse quality, pulse amplitude variation, pre-processed Red and IR signals, and/or average pulse period. The SQMC 210 may output lowpass and ensemble averaging filter weights, normalized pre-processed waveforms, and/or percent modulation. These signal quality metrics may then be utilized in accordance with present embodiments to set parameters for other processes.
As set forth above, the PIQS 202 operates to qualify or reject potential pulses. In accordance with present embodiments, the PIQS 202 includes a counter 212 that keeps a record of consecutive rejected and qualified pulse counts. Specifically, when a pulse is qualified or rejected, the counter 212 updates counts of consecutive qualified or rejected pulses. Specifically, in one embodiment, the counter 212 sets a Reject_Count_High flag to a TRUE state once a designated number (e.g., 4) of pulses have been rejected and sets the Reject_Count_High flag to a FALSE state when a designated number (e.g., 3) of consecutive pulses have been qualified. Based on the state of the Reject_Count_High flag and other system variables (e.g., type of sensor), certain constants in algorithms utilized by the PIQS 202 may be adjusted, as will be discussed in detail below. For example, alternate constant values may be implemented when the state of the Reject_Count_High flag is TRUE. These bi-valued constants, as well as some other constants utilized in the PIQS 202, may include constants developed and tuned on large oximetry databases using genetic algorithms.
In accordance with present embodiments, the PIQS 202 may incorporate a state machine 214 that identifies maximum and minimum pulse phases. For example, the state machine 214 may identify a maximum phase when the current input sample value is less than the minimum of the previous N samples, and the state machine 214 is searching for a maximum phase. A minimum phase may be identified when the current input sample value is greater than the maximum of the previous N samples and the state machine 214 is searching for a minimum phase. It should be noted that the state machine 214 may be adapted to identify each phase at its final sample, not at the maxima or minima within that phase. Accordingly, the PIQS 202 may buffer the previous N samples of its input waveform, in addition to the current sample. Maximum and minimum phases may overlap. Several pulse parameters must be saved at the state transitions for use in qualifying the pulse. These parameters and their use are discussed in further detail below.
The state machine 214 may track regular pulses up to 300 BPM inclusive. In one embodiment, a designated sample interval, such as 17.5 msec, is utilized. To track 300 BPM pulses at a 17.5 msec sample interval, N is no greater than 60/(300*0.0175)=11.42=11 samples. If there are significant beat-to-beat variations in pulse amplitude, pulse period, and DC level, it has been observed that an N as low as 8 may be used to reliably track even 250 BPM pulses, particularly with arrhythmias.
In one embodiment, the value of N determines the shortest pulse that the state machine 214 can detect, and therefore acts as a time-based noise gate. If it is known that the pulse rate is substantially lower than 300 BPM, a larger value of N would be desirable in order to reduce the likelihood of high frequency interference being interpreted as pulses. Accordingly, in some embodiments, N is set based on the average pulse period for the PIQS 202, Avg_Period (the average pulse period), which is provided by the PRCS 204:
A waveform that has been highpass filtered may have a minimum phase that is much shorter than its maximum phase. Its duration can also vary due to physiological factors other than the pulse rate. Some adult patients have occasional pulses where the minimum phase lasts less than 12 samples (e.g., 210 msec), but that otherwise appear normal. To assure that the subsystem detects and then qualifies such pulses when they are definitely too large to be noise, a minimum phase may be identified when the current input sample value is greater than the maximum of the first M of the previous N samples. M is normally equal to N, but may be limited to 8 samples if both of the following conditions are met:
Detecting a potential minimum when the current sample exceeds the maximum of the earliest M of N samples, rather than the latest M samples, helps to assure that pulses that would be detected without this exception are still detected on the same sample. This, in turn, prevents this exception from adding an extra source of variability to the pulse periods. To minimize the number of comparisons required when searching the N-sample window, the subsystem starts comparing the current sample to the earliest, rather than the latest, sample.
Detecting maximum and minimum phases using a moving window excludes phases that are shorter than M or N samples. The state machine 214 may fail to detect pulses at rates significantly greater than 250 BPM. In the aberrant case of a divergent highpass-filtered waveform, the state machine 214 could theoretically identify a new phase each sample, detecting pulse with periods as short as two samples (e.g., 1710 BPM at a sample rate of 17.5 msec). Such output would be rejected by the pulse qualification criteria discussed below.
Data from certain types of sensors, such as head sensors, may include overly strong harmonics due to other influences, such as the influence of venous pulsation, which would be particularly emphasized in the highpass-filtered waveform. Accordingly, when a head sensor is in use, the subsystem lowpass filters its pulse identification waveform, to assure proper identification of physiologic pulse periods despite strong harmonics. A filter equation in accordance with present embodiments is as follows:
When a non-head sensor is in use and no pulses have been qualified yet, the PIQS 202 may perform minimal lowpass filtering to reduce noise susceptibility:
Some conditions may cause the state machine 214 to identify multiple potential pulses within each physiologic pulse. For example, interference may cause a single pulse to appear as though it includes multiple potential pulses. However, the PIQS 202 includes criteria for identifying and ignoring these extra potential pulses that occur due to noise or dicrotic notches. The PIQS 202 may compare these criteria with observed data when the minimum phase of each potential pulse is identified. In one embodiment, when a potential pulse is ignored, the period of the pulse will keep incrementing instead of being reset to zero.
The criteria for detecting noise and dicrotic notches introduce several variables, including the following:
By way of example, in a highpass-filtered waveform, local minima may occur in the middle of each pulse. However, these "potential pulses" may have an amplitude substantially smaller than the real pulse amplitude, the minimum may be above the baseline, and/or the rise time after the real pulse minimum may be relatively short. If the physiologic pulses were regular, they would be more readily distinguished from high-frequency interference by requiring the minima to be below Baseline. However, this approach could cause real pulses to be missed in cases of arrhythmia or irregular pulse amplitude. In such cases, it would be desirable to detect noise by looking at the rise of the waveform in the samples after the local minima. In accordance with present embodiments, the PIQS 202 gradually shifts its noise detection from the latter to the former approach as Frequency_Ratio increases (e.g., an increase from 1.25 to 1.85), while assuring that potential pulses that go well below baseline will not be ignored if their rise after the minimum is slow. A Frequency_Ratio value of 1.25 is typical of normal pulses after processing by SCS 206, while a Frequency_Ratio value of 1.85 is characteristic of normal pulses with high frequency interference that is not quite large enough to prevent a human from visually identifying the pulses.
Short-term high-frequency artifacts have been observed to be particularly common in surgical cases. Therefore, PIQS 202 also shifts towards requiring the minimum to be below Baseline as the Pulse_Period becomes significantly shorter than Avg_Period, particularly with little or no arrhythmia as quantified by the Period_Var metric, which relates to variablility of the Pulse_Period. The equations for these criteria are as follows:
In some cases, strong dicrotic notches could have amplitudes larger than the noise gate. However, dicrotic notches can be clearly distinguished by a human because the waveform alternates between large and small "potential pulses." With a highpass-filtered waveform, the distance between the minima and the pulse average is typically much smaller for the dicrotic notch than for the entire pulse.
The rules for identifying and ignoring dicrotic notches in accordance with present exemplary embodiments are as follows:
Notch_Flag is TRUE if the following two criteria are met, otherwise Notch_Flag is FALSE:
To prevent underflow, the second update equation may be skipped if Notch_Percent is very close to zero (≧0.01). Potential pulses are ignored if Notch_Flag is TRUE and Notch_Percent>Notch_Percent_Thresh. It should be noted that Notch_Percent_Thresh is the threshold value, which is a weighting factor relating to characterizing pulse shapes. In one embodiment, Notch_Percent_Thresh has a value of 33 and in other embodiments (e.g., embodiments implementing a head sensor), Notch_Percent_Thresh is not used. Additionally, in some embodiments values other than 33 may be set for the threshold depending on desired results. In accordance with present embodiments, the value of Notch_Percent_Thresh may be automatically alternated based on certain conditions (e.g., performance data). Specifically, if Reject_Count_High is TRUE and/or certain other criteria are met (e.g., a head sensor is not in use), an alternative Notch_Percent_Thresh is used. For example, a value of 24 may be used instead of 33 for Notch_Percent_Thresh. This alternate value modestly increases the likelihood that the dicrotic notch check will keep interference from being misidentified as a pulse.
The response time and threshold for Notch_Percent are intended to allow dicrotic notches to be ignored in a timely manner once they appear, without causing real pulses to be ignored due to arrhythmia or intermittent interference. When dicrotic notches are present, Notch_Percent should have a value near 50. If a patient suddenly develops dicrotic notches, Notch_Percent will take about 13 pulses (26 potential pulses) to increase from zero to a threshold of 33. Notch_Percent may start to increase while the notches are small enough to still fail the Noise_Gate check. If dicrotic notches are not ignored, they will typically be disqualified by the pulse qualification criteria shown below, and be misclassified as artifact.
The method 400 begins at block 402, which represents establishing an ensemble averaging weight. An ensemble averaging weight may refer to a weight value that is used to calculate a weighted average of new samples and previously ensemble averaged samples from a previous pulse period. Any suitable ensemble averaging weight may be used. In one embodiment, Ensemble_Averaging_Weight is the ensemble-averaging weight used to compute the subsystem's input waveform by the Ensemble Averaging subsystem, if applicable. If the input waveforms are not ensemble-averaged, the value of Ensemble_Averaging_Weight will be 1.0, while a value of Ensemble_Averaging_Weight near zero would indicate a high degree of ensemble-averaging.
Pulses are received at block 404. Variables describing the pulses are updated at block 406. The variables may be updated in any suitable manner. For example, the variables may be updated for each sample, prior to the every-potential-pulse, according to the following operations:
At block 408, the pulse period may exceed a threshold that indicates that a pulse has just been missed or will occur shortly. The threshold may have any suitable value, such as two seconds. In one exemplary embodiment, once Pulse_Period exceeds two seconds, approximated as 114 samples, it is likely that the pulse has already been missed or will occur very shortly. If the pulse period exceeds the threshold at block 408, the method 400 proceeds to block 410. In block 410 mean square parameters such as Mean_Square and Gated_RMS are reduced as follows.
After block 410, the method 400 proceeds to block 412. Additionally, if the pulse period does not exceed the threshold at block 408, the method 400 proceeds to block 412. The minimum phase of a potential pulse is identified at block 412. The minimum phase may be identified when the value of Curr_Samplet has a specified relationship to previous or subsequent Curr_Sample values. For example, a minimum phase may be identified when Curr_Samplet exceeds samples that occurred in the previous 100 to 150 msecs. Blocks 414-418 describe updating the noise gate parameter of a noise gate criterion. A noise gate criterion may refer to a parameter that controls the threshold that identifies whether a waveform includes noise. For example, the noise gate parameter may be adjusted to reduce the noise gate level if the ensemble averaging weight indicates an increased degree of ensemble averaging.
According to one embodiment, the noise gate parameter Noise_Gate may be defined according to the following equation:
The noise floor multiplier of the noise gate parameter is set at step 414. The noise floor multiplier may be set in any suitable manner. As an example, noise floor multiplier m may initially be set to a unit value (e.g., m=1.0). Subsequent values of m may be set according to the following equation:
Parameter l may be determined by the following equation:
According to one embodiment, if Avg_Period is zero, then m is calculated using the previous Potential_Pulse_Period in place of Avg_Period, provided that the previous Potential_Pulse_Period is acceptable for modifying m. For example, the duration of the previous Potential_Pulse_Period may be required to satisfy a threshold indicating that the pulse periods are less likely to reflect noise (e.g., Potential_Pulse_Period may be required to corresponds to a rate that is slower than about 150 BPM where "slower than 150 BPM" is implemented as "≧23 samples," or 402.5 msec at a 17.5 msec sample rate). This function may be represented by the following formula:
The noise gate multiplier n is established at block 416. The noise gate multiplier n may be established in any suitable manner. According to one embodiment, n may be established according to the following equation:
As set forth above, Potential_Pulse_Skew represents the skewness of the potential pulse. The equation for skewness is:
In accordance with embodiments of the present invention, under certain designated conditions, alternative values are applied to constants in the equations above. Specifically, constants or terms in the equations set forth above may be automatically replaced with an alternate value or one of several alternate values based on system performance and system attributes. For example, in one embodiment, if Reject_Count_High is TRUE and a head sensor is not in use, two of the constants may be changed as follows:
Block 418 represents adjusting the noise gate parameter according to the noise floor multiplier and the noise gate multiplier. After updating the noise gate parameter, the method 400 may end. However, it should be noted that modifications, additions, or omissions may be made to the method 400 without departing from the scope of the invention.
The period-dependent noisegate adjustments discussed above help to reduce the likelihood of real pulses being ignored, particularly those that are not highly skewed, while improving the likelihood of dicrotic notches and high-frequency interference being ignored. The first skew-based adjustment reduces the likelihood of ignoring more than one real pulse immediately after transient interference. In some embodiments a derivative is used. Because a derivative goes up slower than it goes down, this skew-based adjustment reduces the likelihood that the shallow rise of the derivative will be treated as noise. The skew-based adjustment that occurs when Skew_Derivative_Input_Weight>c14 may apply when the waveform used to compute the Skew metric gives a high positive weight to the derivative of curr_sample. This has been observed to occur almost exclusively with head sensors.
During monitoring, if a patient's heart happens to skip a beat on the first qualified pulse, or if the first qualified pulse is actually an artifact near half the true heart rate, then subsequent pulse periods would consistently be near half of the resultant initial value of Avg_Period. This would increase the value of m, and make it more difficult to update Avg_Period, potentially causing the pulse rate to get "stuck" at half the correct value. Accordingly, in accordance with some embodiments, the pulse period used to scale m is "phased in" over the first several (e.g., 5) qualified. For example, in one embodiment, the following equation is utilized:
This reduces the influence that a single qualified pulse period can have on noise gate scaling for future pulses, so that these can be properly detected, and qualified, and allows the PRCS 204 algorithm pulse-rate estimate to converge quickly if it does start out too low. Varying a "150 BPM" threshold slightly based on Potential_Pulse_Amp has been found empirically to improve pulse identification. A 0.0005 threshold for Potential_Pulse_Amp corresponds to a raw IR modulation of about 0.2%.
If a potential pulse is smaller than the Noise Floor, it is concatenated into the next potential pulse in accordance with present embodiments. This reduces the likelihood of breaking up pulses with amplitudes close to the Noise Floor into multiple "potential pulses" that could drive the pulse-rate estimate too high. In the event that some real pulses with amplitudes smaller than the Noise Floor are concatenated with the next pulse, these concatenated pulses will have very high Path_Ratio metrics that get them disqualified. This will generally keep pulses with marginal signal-to-noise ratios from driving the pulse-rate estimate too low. Specifically, the following exceptions are made if a potential pulse fails the Noise_Gate test when Noise_Gate is equal to m*Noise_Floor:
The equation for Noise_Floor assumes that the oximeter's noise floor contains a component that is independent of IR gain (ADC noise, etc.), and another component that is proportional to the oximeter's gain (I-V converter noise, etc.):
In accordance with present embodiments, the PIQS 202 may use a neural net to determine whether a potential pulse is a dicrotic notch. In one embodiment, it outputs a value between 0.0 and 1.0, where values above 0.50 indicate a dicrotic notch. In one embodiment, the neural net is trained in Matlab using the Levenberg-Marquardt back propagation method. Such a training algorithm may be responsible for finding and optimizing the relationships between the neural net's inputs and its desired output. The neural net can be retrained if desired. Retraining and recharacterization of the neural net is a well-defined, semi-automated process. In one embodiment, the trained neural net is implemented as an array of dot products and a few transcendental functions. Retraining may only require an update to the neural net's coefficients, leaving the code unchanged. In one embodiment, the neural net may be trained, optimized and evaluated on large databases containing a wide range of patients and conditions, including arrhythmia, noise, motion, and respiratory artifact.
A human can reliably identify dicrotic notches by looking at the relative amplitudes and periods of consecutive potential pulses. In ambiguous cases, a human may be able to look at additional data, such as ECG, to make a determination. In general, dicrotic notches are substantially smaller than the pulse amplitude, are sustained over periods of many pulses, have a fixed phase relationship to the pulse, and substantially increase the energy at the second harmonic of the heart rate. Some arrhythmias also involve alternating large and small pulses, but most of the energy is still near the average pulse rate, instead of at half the pulse rate. Respiratory artifact may occur at close to half the pulse rate, but does not tend to stay in-phase with the pulse.
For every potential pulse, the PIQS 202 may compute the following four inputs for its Dicrotic Notch Detection Neural Net in accordance with present embodiments:
METRIC 1—quantifies the relative depth of the current and previous potential pulse minima:
The clipping, and log scaling all help to limit the input range over which the neural net must be trained. Avg_Potential_Pulse_Avg is used to compute Metric 1 because it represents a baseline value for the entire pulse, whether dicrotic notches are present or not. The default value of ln(100) is the limit of Metric 1 as Last_Potential_Pulse_Min converges toward Avg_Potential_Pulse_Avg without exceeding it.
METRIC 2—quantifies the relative period of the potential pulse:
In accordance with one embodiment, the neural net is a feed-forward network with a six-node hidden layer and a single-node output layer. All nodes are fully connected, and have associated bias inputs. The hidden layer therefore contains (4+1)*6=30 tunable coefficients, and the output layer contains (6+1)*1=7 tunable coefficients. These coefficients may be specific both to the types of oximetry data that were used to train the neural net and to the particular processing that occurs in earlier parts of the algorithm, such as blocks 206 and 208.
The jth neuron in a layer has n inputs, x1 . . n, n weights, w1,j . . n,j, a bias, bj, a transfer function F( ), and an output, yj:
Because the neural net's training goal is to output a weight between 0 and 1, the output node and all hidden nodes use the logarithmic sigmoid, or logsig( ), transfer function, which compresses an infinite signed input range into an output range of 0-1. The formula for the logsig( ) transfer function is:
In order to prevent the exponential in this equation from over or underflowing, x should be constrained to appropriate limits. Limiting x to +/−64 is sufficient to prevent over or underflow with an 8-bit floating-point exponent. Limiting x to +/−11 provides sufficient resolution for a 16.16 fixed-point representation.
To qualify pulses reliably during interference, as well as during clinical situations such as arrhythmia, dicrotic notches, etc., it is desirable for pulse qualification software to take a variety of principles into account such as:
The PIQS 202 qualifies pulses using neural nets whose input metrics and training enable them to quantify all of the above properties, based on combinations of multiple metrics. The inputs metrics exclude any absolute representation of pulse period or rate, so that the neural net will continue to qualify pulses during arrhythmia or other large pulse-rate changes. Three neural nets, as represented by reference numbers 216, 218, and 220, may be used in accordance with present embodiments:
In one embodiment, these neural nets are fully-connected feed-forward nets with a single hidden layer and logarithmic sigmoid transfer functions in both layers. In one embodiment, the Pulse Characterization net 216 has 12 inputs and 10 hidden nodes, and the Pulse Qualification nets 218 and 220 have 17 inputs and 10 hidden nodes. In one embodiment, the Pulse Characterization net 216 and the first instance of the Pulse Qualification net 218 have been trained and evaluated using clinical databases containing over 300,000 manually classified pulses representing a wide range of physiological and artifactual conditions, and the feedback layer has been tuned empirically.
The following variables must be introduced in order to define the neural nets' inputs:
High-frequency interference can sometimes drive Noise_Gate up so high that one or more valid pulses occurring right after the artifact fail the noise-gate check and are concatenated together with the artifact. This could cause the entire sequence of "potential pulses" (artifact+pulse) to be submitted as one "pulse" for qualification, and then rejected. In order to qualify more of these missed pulses, the final potential pulse may be submitted for Pulse Qualification instead of the entire "pulse," provided that its period is closer to the average qualified pulse period and its shape and size look better. Specifically, the final potential pulse may be required to meet all of the following criteria to be submitted for pulse qualification:
Evaluating these criteria and submitting the final potential pulse for pulse qualification may include computing several new terms over those samples corresponding to the final potential pulse, including Potential_Pulse_Path_Length, Potential_Pulse_Path_Ratio, Potential_Pulse_Alt_Path_Ratio, and Potential_Pulse_Alt_Skew. The meanings of these variables are clear based on the definitions set forth above. If the potential pulse is submitted, then Potential_Pulse_Period, Potential_Pulse_Max, Potential_Pulse_Min, and Potential_Pulse_Sum will be used instead of Pulse_Period, Pulse_Max, Pulse_Min, and Pulse_Sum in the pulse qualification criteria and rate update equations below.
Ensemble-averaging tends to attenuate harmonics of the pulse more than the fundamental, resulting in slightly smaller pulses and a more sinusoidal pulse shape. This may cause the instance of the PIQS 202 that receives ensemble-averaged waveforms to qualify fewer pulses if the pulses are already very small and/or near-sinusoidal. In one embodiment, to compensate for this effect, Skew, Alt_Skew, and Pulse_Amp are adjusted at this point, prior to pulse qualification. Exemplary equations are as follows:
It should be noted that while different constants may be utilized, the exemplary embodiment uses specific values. The skew slope of 0.0181/sample was calculated for 13 adults whose heart rates ranged from 40 to 120 BPM. The 80-sample limit on the adjustment for Pulse_Period in the above equation corresponds to 1.4 seconds, or about 43 BPM. In one embodiment, as illustrated by block 504, these constants are automatically replaced with alternate constants when certain conditions are met. For example, if Reject_Count_High is TRUE or a head sensor is in use, an alternative value of 0.0151 per sample may be used to compute Adjusted_Skew instead of the value of 0.0181 shown above. For head sensors, the alternate value provides a more appropriate period-based adjustment for the less-skewed pulse shapes typical of these sites. For non-head sensors, the alternate value reduces the likelihood of misqualifying high-frequency interference as a pulse. As will be appreciated by one of ordinary skill in the art, different constant and alternative constant values may be utilized for different results, as well as different criteria for applying the alternative constant value to different constant and alternative constant values.
In accordance with present embodiments, for the first instance of the Pulse Qualification net 218, metrics 0-8 and 10 are identical to those of the Pulse Characterization net 216. Pulse Qualification metric 9 is identical, except that the value used for Pulse_Periodt-3 is held for up to two pulses when Pulse_Char_Outputt-3<0.5. This refinement to metric 9 increases the likelihood that this metric represents the difference in period between the current pulse and a previous good pulse. The t subscript here denotes all pulses, including the ones for which Pulse Characterization neural net's output was not calculated. While 0.5 is used as a constant, one of ordinary skill in the art would recognize that other values may be used to obtain different results. Further, in one embodiment if certain conditions are met, the constant is automatically replaced with an alternate value. For example, in one embodiment, if Reject_Count_High is TRUE and a head sensor is not in use, an alternative threshold of 0.06 may be applied instead of the threshold of 0.5 shown above.
The output of the Pulse Characterization net, Pulse_Char_Outputt, is used to determine a variable weight, w, used to update the Pulse Qualification neural net's long-term pulse history metrics:
12 Average Path_Ratio variability may be calculated in block 602 as follows: Path_Ratio_Vart=(1−w)*Path_Ratio_Vart-1+w*|Path_Difft-1|. Note that this input replaces the final input in the Pulse Characterization net 216.
Very large sudden increases in pulse amplitude could cause subsequent pulses to be disqualified until Avg_Ln_Pulse_Amp catches up. Therefore, if N is at least a set number of pulses (e.g., 25), Avg_Ln_Pulse_Amp may be updated with a faster response in the presence of pulses that produce consistently high Pulse Characterization neural net output as follows:
On occasion, extremely large changes can occur in the characteristics of two consecutive "pulses." For instance, a several-second asystole might create a very large Per_Diff value, and a large transient interference might create a very large Amp_Diff value. To prevent such rare anomalies from biasing the long-term history metrics, single-step increases in the Path_Ratio_Var, Amp_Var, Period_Var, and Skew_Var metrics may be limited to a maximum (e.g., 0.05 per "pulse").
The second instance of the Pulse Qualification 220 net differs only in the pulses used to provide short-term pulse history metrics 1 and 3-9. The t-1, t-2, and t-3 subscripts in the equations for these metrics no longer denote the most recent pulses, but rather the three most recent "good" pulses, where "good" means Dual_Pulse_Qual_Outputt>c1 AND Pct_Rejected<c2, where c1 and c2 may be 0.8636 and 0.45, respectively. An output threshold of 0.8636 indicates a very high probability that the qualified pulse was physiologic. A Pct_Rejected threshold of 0.45 means that nearly half of recent pulses were qualified for pulse-rate calculation. Implementing a history of only "good" pulses may include saving the Pulse_Period, Adjusted_Skew, Pulse_Amp, and Path_Ratio each time a "good" pulse occurs.
As illustrated by block 616, the output of the dual instances of the Pulse Qualification net 218 and 220 is combined at the feedback layer as follows:
Combining of the outputs from the two nets improves the likelihood of qualifying a pulse that looks like either previous good pulses or very recent pulses, without biasing the output too high. The feedback equation then penalizes its output for previous bad outputs, to decrease the likelihood of qualifying artifactual "pulses" during periods of prolonged uninterrupted artifact.
The method 700 begins at block 702, which represents establishing an ensemble averaging weight. Pulses are received at block 704. Additional blocks, as set forth below, describe evaluating the received pulses in accordance with pulse qualification criteria. The pulse qualification criteria may be applied in any suitable order. According to one embodiment, the pulse qualification criteria are applied in the order set forth herein, and if a pulse fails in one criterion, subsequent criteria are not applied.
In one embodiment, the pulse qualification criteria are applied to each pulse, which includes a non-ignored potential pulse plus zero or more previously ignored potential pulses. The criteria introduce the following variables: NN_Thresh, Pulse_Qual_Output_Integralt, Initial_Pulse_Count, Last_Pulse_Period, Pulse_Sum, Pulse_Avg, Last_Pulse_Min, Avg_Min. The Initial_Pulse_Count may be set equal to the number of non-ignored pulses found since the subsystem was reinitialized. Further, Initial_Pulse_Count may be incremented after the pulse qualification criteria are evaluated. For certain pulse qualification criteria in accordance with present embodiments, Initial_Pulse_Count does not need to exceed 100, and therefore may be explicitly limited to 100 to prevent integer overflow. The Last_Pulse_Period variable represents the Pulse_Period for the previous non-ignored pulse. The Pulse_Sum variable represents the sum of all samples in a pulse. Pulse_Sum may be updated every sample and reset to zero after calculating Pulse_Avg. The Pulse_Avg variable may be defined as Pulse_Sum/Pulse_Period. The Last_Pulse_Min variable represents Pulse_Min for the previous pulse. The Avg_Min variable may be defined as (Last_Pulse_Min+Pulse_Min)/2. The variables NN_Thresh and Pulse_Qual_Output_Integralt are discussed in detail below.
Block 706 represents calculation of the Pulse_Qual_Output_Integralt , in accordance with present embodiments. The Pulse_Qual_Output_Integralt may be defined by the following equation:
Block 710 represents calculation of NN_Thresh in accordance with present embodiments. In one embodiment, NN_Thresh may be given by the following equation:
These equations may vary the neural-net output threshold for qualifying a pulse from 0.4 when the pulse period is equal to the subsystem's average qualified period to 0.65 when these differ by a factor of two or more. In accordance with present embodiments, alternative thresholds may be utilized when certain conditions are met, as illustrated by block 712. For example, if Reject_Count_High is TRUE and/or other conditions are met (e.g., a head sensor is not in use), alternative thresholds may be applied (e.g., instead of the thresholds of 0.4 and 0.5 shown above, thresholds of 0.03 and 0.06 may be applied). This improves the ability of the PIQS 202 to continue to qualify pulses during periods of interference.
Pulse qualification criteria comprising one or more criteria are applied at block 714. For example, pulses may be rejected when a pulse fails any of the following criteria:
Block 716 represents setting variable values based on pulse qualifications. Specifically, the method 700 sets Qualified_Pulse_Period to Pulse_Period, and sets Pulse_Qualified and Beep_Now flags, on each pulse that passes all of the pulse qualification criteria. Qualified_Pulse_Period may then be made available to the PRCS 204, which may calculate Avg_Period and corresponding pulse rate. Further, method 700 sets a Pulse_Rejected flag on each non-qualified pulse and sets Qualified_Pulse_Period to zero. It also sets the Beep_Now flag on non-qualified pulses that meet all of the following requirements:
In one embodiment, the Consecutive_Qualified count is incremented when a pulse is qualified and set to zero when it is rejected. The Consecutive_Rejected count is incremented when a pulse is rejected and set to zero when it is qualified. The Reject_Count_High flag is set to TRUE if Consecutive_Rejected≧4 and is set to FALSE if Consecutive_Qualified≧3. Consecutive_Qualified and Consecutive_Rejected do not need to exceed 100, and are therefore explicitly limited to 100 to prevent integer overflow.
The subsystem updates Head_Sensor_LP_Filter_Weight each time it attempts to qualify a pulse. It has been observed that if extra high-frequency "wiggles" are added to the derivative of a normal human plethysmograph, the skewness of the individual "wiggles" is, on average, less negative than the skewness of the same waveform computed over a time interval that encompasses one or more pulses periods. Therefore, each time the subsystem computes its Alt_Skew metric for a "pulse period," it also computes a Fixed_Interval_Skew metric for the most recent two seconds of Curr_Sample. The subsystem then adjusts Head_Sensor_LP_Filter_Weight to assure that the value of Alt_Skew is not significantly less negative than the value of Fixed_Interval_Skew. This goal will only be achieved if the subsystem is using complete physiologic pulse periods to compute Alt_Skew.
Because the shape of consecutive high-frequency "wiggles" is much more variable than the shape of consecutive physiologic pulse periods, the PIQS 202 also quantifies the variability of Alt_Skew in its Alt_Skew_Var metric. In one embodiment, as illustrated in block 718, it updates Alt_Skew_Var after the Pulse Qualification neural net has evaluated each "pulse," using the following equations:
The equations for Head_Sensor_LP_Filter_Weight are as follows:
These equations were determined empirically based on analysis data from challenging surgical cases with mixed arterial and venous pulses that included strong harmonics. The minimum weight of 0.1 levels off the frequency response of the PIQS 202 highpass-filtered input waveforms at around 2 Hz. As Pct_Rejected decreases from approximately 0.5 to zero, the minimum weight also increases from 0.1 to approximately 0.5. A weight of approximately 0.5 levels off the frequency response of the PIQS 202 input waveforms at around 10 Hz. However, high values of Alt_Skew_Var mitigate the effect of low Pct_Rejected values, and accelerate the adjustment of Head_Sensor_LP_Filter_Weight.
The Pct_Rejected metric reflects the fraction of recent pulses that have been rejected. It is updated each time a pulse is qualified or rejected as follows:
On qualified pulses:
Pct_Rejectedt =Pct_Rejectedt-1−0.1*Pct_Rejectedt-1
When a pulse is rejected because pulse qualification criterion 6) above failed:
Pct_Rejectedt is also updated if a potential pulse is "ignored" because it is smaller than the subsystem's noise gate AND the elapsed time since the previous non-ignored potential pulse exceeds the lesser of 172 samples or 2*Avg_Period (provided it is non-zero) AND more than 172 samples have elapsed since the last qualified pulse. This latter condition is intended to recognize that so much time has elapsed between non-ignored pulses that intervening pulses were missed.
Those skilled in the art will readily appreciate that it may be necessary to reinitialize the PIQS 202 in response to various events, for example when a sensor is applied to a new patient. The initial values of the various events in the PIQS 202 are specified in the Data Dictionary in Appendix A. Appendix A specifies non-zero default values for several variables related to the Pulse Qualification neural nets that are selected so as not to strongly dispose the neural nets to either accept or reject a pulse. Those skilled in the art will also recognize that, depending on the embodiment of the oximetry hardware, there may be brief periods when the subsystem cannot be updated with valid data from the SCS 206 or EAS 208, and that selected variables may need to be reset, updated, or left unchanged during these brief periods.
The normal processing of the PIQS 202 may be executed on every sample for which a pulse is deemed to be present. According to one embodiment, two instances of the PIQS 202 may receive their IR and Red inputs, from the SCS 206 and EAS 208 respectively, and their Qualified_Pulse_Periods may be processed by two corresponding instances of the PRCS 204. The instance that receives the ensemble-averaged waveforms also receives the Ensemble_Averaging_Weight. The Avg_Period input may be provided by the instance of the PRCS 204 that receives the non-ensemble-averaged Qualified_Pulse_Periods.
The Calculate Noise Gate transform 806 may compute Mean_Square and Gated_RMS every non-ignored sample, and uses them to compute Noise_Gate when a potential pulse is found. The Set Noise Floor transform 808 may set Noise_Floors at startup and when Gains change, for use in calculating Noise_Gate and in correcting the Adjusted_RoR_Variance metric for the oximeter's hardware noise floor. The Qualify Pulse transform 810 may use values and buffers maintained by the Find Potential Pulse transform 802 to calculate the pulse parameters required by its pulse qualification criteria. The Qualify Pulse transform 810 may output Qualified_Pulse_Periods and set the Artifact, Beep_Now, Pulse_Rejected, and Pulse_Qualified flags as specified. Finally, it may reset the values maintained by the Find Potential Pulse transform 802, in preparation for the next pulse.
As set forth above, embodiments of the present invention include switching to alternative values of selected constants in the PIQS 202 that are used to identify and qualify pulses. Specifically, in one embodiment, the PIQS 202 switches to using the alternative constants when four consecutive pulses have been rejected (i.e., disqualified). The PIQS 202 then switches back to using the normal or original constants once three consecutive pulses have been qualified. In some embodiments, multiple alternative constants may be utilized. For example, different constants may be employed for different circumstances (e.g., six consecutive pulses have been rejected). Further, alternative constants may be switched directly without transitioning through use of the original constant.
TABLE 1 lists seven constants for which alternative values may be selected, along with two alternate values in accordance with embodiments of the present invention. These constants relate to settings for the noise gate (e.g., NGATE_GATED_RMS FRACTION, HALF_PERIOD_MULTIPLIER), characterizing pulse shapes (e.g., NOTCH_PERCENT_THRESH, SKEW_ADJUSTMENT_PER_SAMPLE), and setting thresholds for pulse quality (e.g., MIN_PER_VAR_FOR_REDUCED_ALT_SKEW_DIFF, NN_THRESH_DEFAULT, NN_THRESH_OFFSET). In one embodiment, these particular constants were selected, and their alternative values were determined, with the aid of genetic algorithms. Several large sets of pre-collected pulse oximetry data were manually analyzed to create files specifying best estimates of a true pulse rate over time. Genetic algorithms were then utilized to modify the values of one or more constants in the code for the PIQS 202. The modified code was then implemented. Pulse rates output by the modified code were compared to the manually determined pulse rates to quantify rate errors and posting time. These metrics were then combined into a fitness score for each code modification. The genetic algorithm then ranked the code modifications by their associated fitness scores, and continued to modify the constant values from the "fittest" modifications.
The trends of the various constants subject to modification by the genetic algorithm runs were manually analyzed to select those constants whose values were most strongly related to the fitness scores assigned to the various sets of modified constants. The final selection of constants, alternative values, and rules for using the alternative values were made based on the tradeoffs between the pulse rate errors and dropouts in these three databases. In one embodiment, a total of seven constants have alternative values provided out of roughly one-hundred constants in the pulse qualification code that were evaluated. Various conditions were found to benefit from alternative constants. In some instances, certain values were desirable when a head sensor was or was not being used.
Three bodies of data were analyzed to obtain the results set forth herein. A first body of data included tests on volunteers exposed to cold to induce poor perfusion in the fingers. This body of data is referred to as the cold-room database. The cold-room database includes 328 digits total from six study dates. Half of the digits has motion in these studies. A second body of data comprised files from 113 hospitalized patients exhibiting a variety of sensor sites, clinical conditions, and artifacts. This second body of data may be referred to as the hospital database. A third body of data included data from over 40 patients having various surgical procedures with sensors on their foreheads under conditions where venous pulsation had been observed. This third body of data may be referred to as the forehead/surgical database.
While the invention may be susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and have been described in detail herein. However, it should be understood that the invention is not intended to be limited to the particular forms disclosed. Rather, the invention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the following appended claims.
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