Final Year Project Y05

Project Proposal (updated)

for

Portable cerebral blood clot detection

By
050001A G.K.I. Abeyrathna
050131V G. Gartheeban
050234N E.D.R. Kumara
050440R W.M.D. Soysa

Supervised By
Dr. A.A. Pasqual

Department of Electronics & Telecommunication

University of Moratuwa
Approval Form

I hereby certify that I accept this project as the final year project of Group – 20 which
will come under my supervision.

……………………………………………
Dr. A.A. Pasqual
B.Sc. Eng.(Moratuwa), M.Eng.(Tokyo), Ph.D(Tokyo), MIEEE, MACM
Senior Lecturer
Department of Electronic and Telecommunication Engineering
University of Moratuwa

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Contents

Introduction .......................................................................................................................... 1
Classification ......................................................................................................................... 2
Objectives ............................................................................................................................... 3
Justification ............................................................................................................................ 3
Literature survey ................................................................................................................. 4
References …….......................................................................................................... 5
Analysis ....................................................... .........................................................,….. 5
Scope ......................................................................................................................................... 8
Possible resource requirements ................................................................................... 8
Basic architecture and required methodologies .................................................... 9
Timeline………………………………………..…………………………………………………. 12

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Introduction

Hematoma, the collection of blood, generally the result of hemorrhage, also known
as, internal bleeding may, at times, be fatal. Hematomas may exist as bruises on outer
skin but when they develop in organs require extra attention. In most cases the sac of
blood eventually dissolves; however, in some cases they may continue to grow, and fatal
especially if it is cerebral.

Intracranial hemorrhage or brain damages caused by traumatic brain injuries cause the
following types of cerebral hemorrhages.

 Intra-axial hemorrhage
 Extra-axial hemorrhage

o Subgaleal hematoma — between the galea aponeurosis & periosteum

o Cephalhematoma — between the periosteum & skull
o Epidural hematoma — between the skull & dura mater
o Subdural hematoma — between the dura mater & arachnoid mater
o Subarachnoid hematoma — between the arachnoid mater and pia
mater (the subarachnoid space)

Intra cerebral hemorrhages are mostly untreatable

and Subgaleal hematoma and Cephal hematoma are
less dangerous compared to the other three as they
happen outside the skull.

Epidural hematoma is a buildup of blood occurring between the Dura

mater (the brain's tough outer membrane) and the skull. The condition is potentially
deadly because the buildup of blood may increase pressure in the intracranial space and
compress delicate brain tissue. The condition is present in one to three percent of head
injuries. Between 15 and 20% of patients with epidural hematomas die of the injury.

Subarachnoid blood clot usually happens in the setting of other traumatic brain
injury and has been linked with a poorer prognosis. It is unclear; however, if this is a
direct result of the SAH or whether the presence of subarachnoid blood is simply an
indicator of severity of the head injury and the prognosis is determined by other
associated mechanisms.

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Subdural hematoma is a form of traumatic brain injury in
which blood gathers between the dura and
the arachnoid (the middle layer of the meninges). Unlike
in epidural hematomas, which are usually caused by tears
in arteries, subdural bleeding usually results from tears in
veins that cross the subdural space. This bleeding often
separates the dura and the arachnoid layers. Subdural
hemorrhages may cause an increase in intracranial
pressure (ICP), which can cause compression of and
damage to delicate brain tissue. Acute subdural hematoma
(ASDH) has a high mortality rate and is a severe medical
emergency. 1 Subdural hematoma

The early detection of the aforementioned blood clots is paramount, and will be a life
saver. Currently only Computer Tomography (CT scan) is capable of identifying it,
nonetheless unfortunately, it is prohibitively expensive and rarely available.
The project was proposed by Dr. A. A. Pasqual, and requires some extensive analysis
into the problem involving multiple domains, such as neurology, Traumatic Brain Injury
(TBI) / brain surgery, sensor technologies, micro controller programming, embedded
application development and electronic circuits.

Classification

This project idea was proposed by Dr A. A. Pasqual and is mainly focused on providing a
solution to early detection of cerebral blood clots. This involves a significant amount of
research, hence comes under product development with research component, under the
departmental classification of final year projects.

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Objectives

Our objective is to enable the availability of a portable, inexpensive robust unit for
early detection of extra cerebral blood clots that could be used for pre-examination
before CT scan test is scheduled.

The core purpose, we undertook this project for, is to

provide a system for early detection of blood clots that
would help reducing fatalities on aftermath of accidents.
We find the limited availability of CT scanners the crux of
all the problems that needs to be addressed. The
availability of pre-examination and detection will lead to
the efficient utilization of CT scanners.

For instance, on the occurrence of such an injury, this

portable device could be used to ensure the presence of
blood clots and alert the immediate attention required. If 2pie chart showing head injury fatalities
by percentage of causes
CT scanner is available, the patient can be moved up in
the queue for CT scan on the positive detection using such a unit, otherwise this could
be used as a simple substitute for CT scan and with thorough checking the exact location
could be identified and operated.

We believe this is an opportunity for us to serve the community by providing a solution

to a much needed problem, which is the bottom line of our objective.

Justification

This is one of the highly sought after technology in the field of medicine and the
bestowment of noble prize for the invention of CT scanner proves the supreme
importance of it. The importance of early detection of cerebral blood clots is thus
obvious. The proposed project clearly addresses the above mentioned detection
requirement.

The benefits of the proposed solution will be huge and disreputable and they are
analyzed below in terms of the reduction of hazardous effects, and economics and
logistics concerns.

CT scan is regarded as a moderate to high radiation diagnostic technique. While

technical advances have improved radiation efficiency, there has been simultaneous

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pressure to obtain higher-resolution imaging and use more complex scan techniques,
both of which require higher doses of radiation. Head CT scan normally generates 1.5
mSv dose of radiation. Increased CT usage has led to an overall rise in the total amount
of medical radiation used, despite reductions in other areas. Statistics show that, in the
United States and Japan, there were 26 and 64 CT scanners per 1 million populations in
1996. In the U.S., there were about 3 million CT scans performed in 1980, compared to
an estimated 62 million scans in 2006 which emphasize the need of a pre-examination
technology to sort out, prioritize and avoid the use of CT scan unnecessary, which will
enhance the utilization of CT scanners especially in developing and under developed
countries where there is a great demand and long waiting list for.

Amber diagnostics radiology equipment sales quote the minimum prize at 2.2 million
USD for CT scanner. Further it is notable that from 1974 to 2004, the list price of a CT
scanner has gone up faster than inflation (from $385K to $2200K, 471% increase,
versus 342% increase in consumer price index). This sends the ‘clarion call’ for a need
of an inexpensive unit that could give a true / false trigger as a pre-detection technology
or a perfect substitute for CT scanners.

The development of the proposed solution will involve knowledge and skills of multiple
study areas - the research into neurology, bio-medical sensor systems, development of
sensor system, microcontroller programming, embedded application development,
algorithm development, and electronic and product design and realization. We believe
the scope and depth of the project and the technical complexity required would be quite
challenging and more than sufficing for a final year project.

Literature survey

The research to find alternatives for CT scan has started long time back, and has begun
to show promising results. It will be an important source of information for the
development of sensor systems. Neurology online [1] and American academy of
neurology [2] are the two ultimate sources for information pertained to the medical
aspects of cerebral hemorrhage.

Near Infra-Red spectroscopy is one of the area that is being research and found to be
ideal. “Use of near infrared spectroscopy to identify traumatic intracranial hematomas."
by C. S. Robertson, S. P. Gopinath, and B. Chance also seems to be encouraging.

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As an alternative technology ultrasonic sensors have also been considered and it is
found that solutions have been developed to detect blood clots/air bubbles in arteries.
However NIRS remains ultimate answer to the call due to several other limitations.

References

[1] Neurology Online,

http://www.neurology.org/cgi/collection/intracerebral_hemorrhage, last
accessed 2009, June
[2] American Academy of Neurology, http://www.aan.com, last accessed 2009, June
[3] Gopinath SP, Robertson CS, Grossman RG, Chance B., "Near-infrared
spectroscopic localization of intracranial hematomas." J Neurosurg 1993 Jul;
79(1): 43-47.
[4] Gopinath SP, Robertson CS, Grossman RG, Chance B., "Near-infrared
spectroscopic localization of intracranial hematomas." Comment in J
Neurosurg. 1994 Jan; 80(1): 181-182.
[5] S.P. Gopinath, B. Chance, and C.S. Robertson, "Near-infrared spectroscopy in
head injury”. Chap. 12 in Neurotrauma, R.K. Narayan, J. Wilberger, and J.
Povlishock. Eds., pp. 169-184, McGraw-Hill, New York, NY (1994).
[6] Robertson CS, Gopinath SP, Chance B., "A new application for near-infrared
spectroscopy: detection of delayed intracranial hematomas after head injury." J
Neurotrauma 1995 Aug; 12(4); 591-600.
[7] Gopinath SP, Robertson CS, Contant CF, Narayan RK, Grossman RG, Chance B.,
"Early detection of delayed traumatic intracranial hematomas using near-
infrared spectroscopy." J Neurosurg 1995 Sep; 83(3): 438-444.
[8] C. S. Robertson, S. P. Gopinath, and B. Chance, "Use of near infrared spectroscopy
to identify traumatic intracranial hematomas." J. Biomed. Opt. 2, 31–41 (1997).
[9] C. S. Robertson, S. P. Gopinath, and B. Chance, "Identifying intracracranial
hematomas with near-infrared spectroscopy." in Transcranial Cerebral
Oximetry, G. Litscher and G. Schwarz. Eds., pp. 131–141, Pabst Science, Berlin
(1997).
[ 10 ] Zhang Q, Ma H, Nioka S, Chance B., "Study of near infrared technology for
intracranial hematoma detection." J. Biomed. Opt. 5, 206-213 (2000).

Analysis

Both the technologies we looked into were noninvasive, and first between them was
ultrasonic Doppler Effect. This has been primarily used for blood parameter detection
such as speed of the cells, congestion, etc. Professor David H Evans and Professor A Ross
Naylor in the Department of Cardiovascular Sciences at the University of Leicester

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developed a technique involving the use of Doppler ultrasound for emboli detection.
The work was recently presented at an international conference on Ultrasound in
Medicine in Australia. In the case of emboli detection, the 'transducer' is placed on the
side of the patient's head, just in front of the ear, and is used to detect the movement of
emboli through blood vessels in the brain. The technique is painless and harmless.

Patients undergoing various types of operation have this small ultrasound transducer
attached to the side of their head to give early warning of embolism occurring. Although
this is particularly useful in the event of embolism occurring which is common in a post-
surgery, impractical for TBI due to requirement of particle movements which maybe
absent in extra cerebral hemorrhage.

The second method uses Near Infrared

Spectroscopy (NIRS) which has many
interesting properties related to the
absorption by various chemicals. Research in
the field of near infrared spectroscopy NIRS
for measuring tissue properties dates back to
Millikan, who first developed a dual
wavelength muscle oximeter, and Jobsis who
was the first to note that the spectral
absorption of both hemoglobin and
cytochrome aa3 could be observed in vivo
with near infrared transillumination.
Intracranial hematoma detection is one of the
most basic and important applications of near
infrared spectroscopy. The basic principle of
hematoma detection with NIRS is that water
absorption in the near infrared range is
relatively small and hemoglobin contributes to most of the tissue absorption; extra
vascular blood absorbs NIR light more than
normal brain tissue since there is a greater
concentration of hemoglobin in an acute
hematoma. By comparing the re reflected and
diffusing optical signal I2 from the suspicious
hematoma side and I1 from the healthy side
or from a standard model, the optical density
OD be calculated:

OD = log (I1 /I2)

Also we hope, from continuous use of the unit we could come up with a statistical
pattern that will also help finding coarse detection which can be used to raise an alert

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and differential reflection can be used to obtain acute results. The following graphs [8]
illustrate significant difference in OD caused by hemorrhage.

A single NIRS examination reliably identifies patients with an intracranial hematoma

(98% had a ΔOD > 0.05), and gives a suggestion of whether the hematoma was
intracerebral (most had a ΔOD <0.6) or extracerebral (most had a ΔOD >0.6).

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Scope

The project will focus on developing a unit for detection of the presence of blood clots at
a particular location particularly extra cerebral. The unit will be able to indicate the
existence, however wouldn’t be able to guarantee the non-existence which will require
years of experience of analyzing the data displayed by the system.

The unit is expected to be capable of detecting the following three types of extra
cerebral blood clots.
 Epidural hematoma
 Subarachnoid hematoma
 Subdural hematoma

However aforementioned corresponds to the most of the reported cases that led to
death due to extra cerebral hemorrhages, and intra cerebral hemorrhages are yet
inoperable.

The system will be able to show quick indication from past statistics and detailed
illustration in an embedded device such as smart phone or PDA through Bluetooth. The
delivered solution will be portable, inexpensive and real time.

Possible resource requirement:

 Sensor requirement – Infrared transmitter/receivers

 Controller requirement – Microcontroller with Bluetooth support
 IO system requirement – Embedded system; a mobile phone or a PDA
 Other requirements – A sample space of patients taking CT scan test
 The CT scan reports of those patients
 Resource person with medical academic background

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Basic Architecture and required methodologies

The above block diagram shows the basic architecture of the system that we intend to
implement during the final year project.

The Transmission subsystem

This sub-system will be responsible for the generation and

transmission of the NIR signals. The control circuit receives its
input from the micro-controller and hence enables finer
control over the strength of the transmission signal. A pulsed
driving circuit drives the LED light source. The current control
circuit can either be a DAC or a voltage divider. According to the command given by the
microcontroller, it generates different control voltages to adjust the light intensity.

The receiver subsystem

The reception of the reflected diffusing light

signal will be detected by the photodiode.
The received signal is amplified and the
output of the amplifier is fed to the ADC.

Controller subsystem

The controlling subsystem will be implemented through a micro-controller. The

microcontroller is in charge of the whole operation, which includes acquiring the signal,
calculations, adjusting the incident light intensity, and communicating the output.

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ADC

During the light pulse off period, the detected signal,

which is actually ‘‘dark current’’ or background light, is
sampled and held for dark signal correction. During the
light pulse on period, the reflected diffusing light signal
detected by the photodiode is amplified and also input
into the ADC. Since the ADC is working in a differential
input state, the dark voltage is subtracted from the light
voltage; the corrected signal is amplified inside the
ADC, then digitized, and finally transported to the
microcontroller. The ADC communicates with the microcontroller through a serial port.

Operation

With specified wavelength ranges, optical light source and photo detector are placed at
a distance, which allows proper NIRS absorption measurements in a desired volume of
tissue. The NIRS probe is placed successively in the left and right frontal, temporal,
parietal, and occipital areas of the head and the absorbance of light at selected
wavelengths is recorded.

LEFT SIDE RIGHT SIDE

 Frontal Left/Right forehead, above the frontal sinus

 Temporal In the Left/Right temporal fossa
 Parietal Above the Left/Right ear, midway between the ear and the midline
of the skull
 Occipital Behind the Left/Right ear, midway between the ear and the
occipital protuberance

The results are analyzed differentially and OD is found. Further from the reception
levels and ODs for various wavelengths will be recorded.

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Input-Output subsystem

The microcontroller will be interfaced with the IO

subsystem, through a wireless technology like Bluetooth.
The IO subsystem would involve a display of the NIR
image, and the regions with the possibility of blood clots.
The IO subsystem will be built on a mobile device like a
mobile phone or a PDA.

It is hoped to produce two levels of outputs. First from the

statistical learning, upon the reception of a critical value
red alert can be triggered with an LED indication. This will
be independent of person but depending on the location of
the detection (F / T / P / O).

The second is the mapping of the spectrographic analysis from the differential obtained.
We hope to export the data to an embedded device such as a PDA through Bluetooth,
perform the computation and display the results through an embedded application
running.

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Timeline

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