Series in Medical Physics and Biomedical Engineering

ELECTRICAL IMPEDANCE TOMOGRAPHY

Methods, History and Applications
Edited by

David S Holder
Department of Medical Physics and Bioengineering University College London London

Institute of Physics Publishing Bristol and Philadelphia

Copyright 2005 IOP Publishing Ltd.

# IOP Publishing Ltd 2005 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. Multiple copying is permitted in accordance with the terms of licences issued by the Copyright Licensing Agency under the terms of its agreement with Universities UK (UUK). British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN 0 7503 0952 0 Library of Congress Cataloging-in-Publication Data are available

Series Editors: C G Orton, Karmanos Cancer Institute and Wayne State University, Detroit, USA J H Nagel, Institute for Biomedical Engineering, University Stuttgart, Germany J G Webster, University of Wisconsin-Madison, USA Commissioning Editor: John Navas Editorial Assistant: Leah Fielding Production Editor: Simon Laurenson Production Control: Sarah Plenty Cover Design: Victoria Le Billon Marketing: Louise Higham, Kerry Hollins and Ben Thomas Published by Institute of Physics Publishing, wholly owned by The Institute of Physics, London Institute of Physics Publishing, Dirac House, Temple Back, Bristol BS1 6BE, UK US Oce: Institute of Physics Publishing, The Public Ledger Building, Suite 929, 150 South Independence Mall West, Philadelphia, PA 19106, USA Typeset by Academic+Technical, Bristol Printed in the UK by MPG Books Ltd, Bodmin, Cornwall

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The Series in medical Physics and Biomedical Engineering is the ocial book series of the International Federation for Medical and Biological Engineering (IFMBE) and the International Organization for Medical Physics (IOMP). IFMBE The International Federation for Medical and Biological Engineering (IFMBE) was established in 1959 to provide medical and biological engineering with a vehicle for international collaboration in research and practice of the profession. The Federation has a long history of encouraging and promoting international co-operation and collaboration in the use of science and engineering for improving health and quality of life. The IFMBE is an organization with membership of national and transnational societies and an International Academy. At present there are 48 national members and two transnational members representing a total membership in excess of 30 000 world wide. An observer category is provided to give personal status to groups or organizations considering formal aliation. The International Academy includes individuals who have been recognized by the IFMBE for their outstanding contributions to biomedical engineering. Objectives The objectives of the International Federation for Medical and Biological Engineering are scientic, technological, literary, and educational. Within the eld of medical, clinical and biological engineering its aims are to encourage research and the application of knowledge, and to disseminate information and promote collaboration. In pursuit of these aims the Federation engages in the following activities: sponsorship of national and international meetings, publication of ocial journals, co-operation with other societies and organizations, appointment of commissions on special problems, awarding of prizes and distinctions, establishment of professional standards and ethics within the eld, as well as other activities which in the opinion of the General Assembly or the Administrative Council would further the cause of medical, clinical or biological engineering. It promotes the formation of regional, national, international or specialized societies, groups or boards, the coordination of bibliographic or informational services and the improvement of standards in terminology, equipment, methods and safety practices, and the delivery of health care. The Federation works to promote improved communication and understanding in the world community of engineering, medicine and biology. Activities The IFMBE publishes the journal Medical and Biological Engineering and Computing which includes a special section on Cellular Engineering. The IFMBE News, published electronically, keeps the members informed of the developments in the Federation. In cooperation with its regional conferences,

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IFMBE publishes the series of IFMBE Proceedings. The Federation has 2 divisions: Clinical Engineering and Technology Assessment in Health Care. Every three years the IFMBE holds a World Congress on Medical Physics and Biomedical Engineering, organized in cooperation with the IOMP and the IUPESM. In addition, annual, milestone and regional conferences are organized in dierent regions of the world, such as Asia Pacic, Baltic, Mediterranean, Africa and South American regions. The administrative council of the IFMBE meets once a year and is the steering body for the IFMBE. The council is subject to the rulings of the General Assembly, which meets every three years. Information on the activities of the IFMBE are found on its web site at http://www.ifmbe.org. IOMP The IOMP was founded in 1963. The membership includes 64 national societies, two international organizations and 12 000 individuals. Membership of IOMP consists of individual members of the Adhering National Organizations. Two other forms of membership are available, namely Aliated Regional Organization and Corporate members. The IOMP is administered by a Council, which consists of delegates from each of the Adhering National Organizations; regular meetings of council are held every three years at the International Conference on Medical Physics (ICMP). The Ocers of the Council are the President, the Vice-President and the Secretary-General. IOMP committees include: developing countries, education and training; nominating; and publications. Objectives To organize international cooperation in medical physics in all its aspects, especially in developing countries. . To encourage and advise on the formation of national organizations of medical physics in those countries which lack such organizations.
.

Activities Ocial publications of the IOMP are Physiological Measurement, Physics in medicine and Biology and the Series in Medical Physics and Biomedical Engineering, all published by the Institute of Physics Publishing. The IOMP publishes a bulletin Medical Physics World twice a year. Two council meetings and one General Assembly are held every three years at the ICMP. These conferences are normally held in collaboration with the IFMBE to for the World Congress on Medical Physics and Biomedical Engineering. The IOMP also sponsors occasional international conferences, workshops and courses. Information on the activities of the IOMP are found on its web site at http://www.iomp.org/.

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This volume is dedicated to Brian Brown and David Barber, for their pioneering work in Electrical Impedance Tomography.

Copyright 2005 IOP Publishing Ltd.

Contents

LIST OF CONTRIBUTORS INTRODUCTION

PART 1

ALGORITHMS

1. THE RECONSTRUCTION PROBLEM William Lionheart, Nicholas Polydorides and Andrea Borsic 1.1. 1.2. 1.3. 1.4. Why is EIT so hard? Mathematical setting Measurements and electrodes Regularizing linear ill-posed problems 1.4.1. Ill-conditioning 1.4.2. Tikhonov regularization 1.4.3. The singular value decomposition 1.4.4. Studying ill-conditioning with the SVD 1.4.5. More general regularization Regularizing EIT 1.5.1. Linearized problem 1.5.2. Back-projection 1.5.3. Iterative nonlinear solution Total variation regularization 1.6.1. Duality for Tikhonov regularized inverse problems 1.6.2. Application to EIT Jacobian calculations 1.7.1. Perturbation in power 1.7.2. Standard formula for Jacobian Solving the forward problem: the nite element method

1.5.

1.6.

1.7.

1.8.

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Contents 1.8.1. Basic FEM formulation 1.8.2. Solving the linear system 1.8.3. Conjugate gradient and Krylov subspace methods 1.8.4. Mesh generation Measurement strategy 1.9.1. Linear regression 1.9.2. Sheeld measurement protocol 1.9.3. Optimal drive patterns Numerical examples Common pitfalls and best practice Further developments in reconstruction algorithms 1.12.1. Beyond Tikhonov regularization 1.12.2. Direct nonlinear methods Practical applications References 33 36 39 40 42 42 44 45 47 50 52 52 53 54 56

1.9.

1.10. 1.11. 1.12.

1.13.

PART 2

HARDWARE

65 67 67 67 69 69 70 79 80 80 86 87 88 88 90 90 93 94 95 96 98 101 103

2. EIT INSTRUMENTATION Gary J Saulnier 2.1. 2.2. 2.3. Introduction EIT system architecture Signal generation 2.3.1. Waveform synthesis 2.3.2. Current sources 2.3.3. Driving the current source 2.3.4. Multiplexers 2.3.5. Current source and compensation circuits 2.3.6. Cable shielding 2.3.7. Voltage sources Voltage measurement 2.4.1. Dierential versus single-ended 2.4.2. Common-mode voltage feedback 2.4.3. Synchronous voltage measurement 2.4.4. Noise performance 2.4.5. Sampling requirements Example EIT systems 2.5.1. Single-source systems 2.5.2. Multiple-source systems Discussion and conclusion References

2.4.

2.5.

2.6.

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Contents PART 3 APPLICATIONS

xi 105 107

3. IMAGING OF THE THORAX BY EIT H J Smit, A Vonk Noordegraaf, H R van Genderingen and P W A Kunst 3.1. 3.2. General introduction Equipment 3.2.1. Sheeld mark 1 system 3.2.2. Newer systems Cardiac imaging 3.3.1. Introduction 3.3.2. Electrode positioning 3.3.3. EIT and stroke volume 3.3.4. Right ventricular diastolic function 3.3.5. Summary Pulmonary perfusion measurements 3.4.1. Introduction 3.4.2. Pulmonary perfusion defects 3.4.3. Pathological changes of the pulmonary vascular bed 3.4.4. Summary Assessment of regional lung function 3.5.1. Introduction 3.5.2. Experimental and clinical studies 3.5.3. Future directions General summary and future perspectives References

3.3.

3.4.

107 107 107 109 110 110 110 112 112 113 113 113 114 114 117 117 117 118 122 123 123

3.5.

3.6.

4. ELECTRICAL IMPEDANCE TOMOGRAPHY OF BRAIN FUNCTION David Holder and Thomas Tidswell 4.1. 4.2. Introduction Physiological basis of EIT of brain function 4.2.1. Bioimpedance of brain and changes during activity or pathological conditions 4.2.2. Eect of coverings of the brain when recording EIT with scalp electrodes EIT systems developed for brain imaging 4.3.1. Hardware 4.3.2. Reconstruction algorithms for EIT of brain function 4.3.3. Development of tanks for testing of EIT systems

127 127 129 129 136 137 137 141 146

4.3.

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xii 4.4.

Contents EIT of slow evoked physiological activity in the brain 4.4.1. Proof of concept in animal studies 4.4.2. Human studies EIT of epilepsy 4.5.1. Proof of concept in animal and single channel human studies 4.5.2. Human studies EIT in stroke EIT of neuronal depolarization Conclusion and future work References 148 148 149 154 155 156 157 159 160 161

4.5.

4.6. 4.7. 4.8.

5. BREAST CANCER SCREENING WITH ELECTRICAL IMPEDANCE TOMOGRAPHY Alex Hartov, Nirmal Soni and Ryan Halter 5.1. Rationale for using impedance measurements for breast cancer screening 5.1.1. Introduction 5.1.2. Other methods in use for breast cancer detection 5.1.3. Breast impedance data from preliminary studies Dierent approaches to breast EIT 5.2.1. Impedance mapping 5.2.2. Tomographic imaging 5.2.3. Limitations of impedance measurements 5.2.4. Advantages of impedance as a screening tool Clinical results summaries 5.3.1. Planar arrays 5.3.2. Circular arrays 5.3.3. Discussion of the clinical trials References

167

167 167 168 169 171 171 172 172 173 173 174 178 181 182

5.2.

5.3.

6. APPLICATIONS OF ELECTRICAL IMPEDANCE TOMOGRAPHY IN THE GASTROINTESTINAL TRACT Clare Soulsby, Etsuro Yazaki and David F Evans 6.1. 6.2. Rationale for EIT within the gastrointestinal tract Methods of measurement of gastric emptying 6.2.1. Radiology (barium contrast) 6.2.2. Manometry 6.2.3. Gamma scintigraphy 6.2.4. Chemical Ultrasonography

186 186 188 188 188 188 189 190

6.3.

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Contents 6.4. Electrical impedance tomography to measure gastric emptying 6.4.1. EIT system 6.4.2. Equipment and general methods 6.4.3. Experimental method 6.4.4. Analytical methods 6.4.5. Suitable test meals Published data in support of EIT as a valid method to assess gastric volume and residence time 6.5.1. Validation of EIT in vitro 6.5.2. Accuracy of EIT 6.5.3. Gastric emptying of liquid meal 6.5.4. Gastric emptying of a semi-solid meal 6.5.5. Gastric emptying of a solid meal 6.5.6. Eect of acid secretion on measurement of gastric emptying by EIT Paediatric studies Recent applications: use of EIT to measure gastric emptying during continuousinfusion of nasogastric feed Summary General conclusions References Appendix

xiii 191 191 191 191 192 193 194 194 195 196 198 198 198 200

6.5.

6.7. 6.8.

6.9. 6.10.

201 201 202 203 205

7. OTHER CLINICAL APPLICATIONS OF ELECTRICAL IMPEDANCE TOMOGRAPHY David Holder 7.1. 7.2. 7.3. Hyperthermia EIT imaging of intra-pelvic venous congestion Other possible applications References

207 207 208 209 209

PART 4

NEW DIRECTIONS

211 213 213 214 215 218 218

8. MAGNETIC INDUCTION TOMOGRAPHY H Griths 8.1. 8.2. 8.3. 8.4. 8.5. Introduction The MIT signal Coils and screening Signal demodulation Cancellation of the primary signal

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xiv 8.6.

Contents Working imaging systems and proposed applications 8.6.1. MIT for the process industry 8.6.2. Biomedical MIT Image reconstruction Spatial resolution, conductivity resolution and noise Propagation delays Multi-frequency measurements Imaging permittivity and permeability Conclusions Acknowledgements References 220 220 222 225 228 230 230 231 232 233 233

8.7. 8.8. 8.9. 8.10. 8.11. 8.12.

9. MAGNETIC RESONANCE ELECTRICAL IMPEDANCE TOMOGRAPHY (MREIT) Eung Je Woo, Jin Keun Seo and Soo Yeol Lee 9.1 9.2. 9.3. Introduction Problem denition Forward problem and numerical techniques 9.3.1. Forward problem in MREIT using recessed electrodes 9.3.2. Eects of recessed electrodes and lead wires 9.3.3. Computation of voltage V and current density J 9.3.4. Computation of magnetic ux density B using the BiotSavart law 9.3.5. Computation of magnetic ux density B using FEM 9.3.6. Computation of current density J from magnetic ux density 9.3.7. Numerical examples of 3D forward solver Measurement techniques in MREIT 9.4.1. Review of MRCDI techniques 9.4.2. How to measure one component of B 9.4.3. Measurements of all three components of B by subject rotations 9.4.4. Computation of current density image J in MRCDI 9.4.5. Data processing 9.4.6. Signal-to-noise ratio (SNR) in magnetic ux and current density image Image reconstruction algorithms 9.5.1. Requirements in data collection methods for uniqueness

239 239 242 244 244 245 246 247 249 249 249 256 256 257 258 258 259 259 260 261

9.4.

9.5.

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Contents 9.5.2. Early algorithms 9.5.3. J-substitution algorithm 9.5.4. Current constrained voltage scaled reconstruction (CCVSR) algorithm 9.5.5. Direct algorithms based on equipotential lines 9.5.6. Harmonic Bz algorithm 9.5.7. Partial Bz algorithm 9.5.8. Other algorithms MREIT images 9.6.1. Images using the J-substitution algorithm 9.6.2. Images using the harmonic Bz algorithm Possible applications of MREIT Current status and future of MREIT research References

xv 262 263 265 266 266 270 273 274 274 280 288 289 291

9.6.

9.7. 9.8.

10. ELECTRICAL TOMOGRAPHY FOR INDUSTRIAL APPLICATIONS Trevor York 10.1. 10.2. Introduction Data acquisition 10.2.1. Electrical resistance tomography 10.2.2. Electrical capacitance tomography (ECT) 10.2.3. Electromagnetic tomography (EMT) 10.2.4. Electrical impedance tomography 10.2.5. Intrinsically safe systems 10.2.6. Summary of data acquisition systems Data processing Industrial applications of electrical tomography 10.4.1. Application of electrical resistance tomography technology to pharmaceutical processes 10.4.2. Imaging the ow prole of molten steel through a submerged pouring nozzle 10.4.3. The application of electrical resistance tomography to a large volume production pressure lter 10.4.4. A novel tomographic ow analysis system 10.4.5. Application of electrical capacitance tomography for measurement of gas/solids ow characteristics in a pneumatic conveying system 10.4.6. Imaging wet gas separation process by capacitance tomography Summary Acknowledgements References

295 295 298 299 302 303 305 306 307 307 312 312 316 318 326

10.3. 10.4.

330 335 338 340 340

10.5.

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xvi

Contents 348 348 349 350 351 352 355 356 356 358 359 359 361 363 364 365 365 366 366 367 367 368 368 371

11. EIT: THE VIEW FROM SHEFFIELD D C Barber 11.1. 11.2. Beginnings Making images: applied potential tomography 11.2.1. Back-projection 11.2.2. Normalizing the data Dierential imaging Collecting data 11.4.1. The Mark 1 11.4.2. The Mark 2 11.4.3. Limitations Multifrequency images 11.5.1. The Mark 3 11.5.2. Marks 3a and 3b The third dimension Clinical studies What we have learned 11.8.1. High resolution imaging is not possible 11.8.2. Making reliable in vivo measurements is dicult 11.8.3. Humans are 3D 11.8.4. What do we need to do? 11.8.5. Some suggestions The future of medical EIT Appendix. The Sheeld algorithm revisited References

11.3. 11.4.

11.5.

11.6. 11.7. 11.8.

11.9.

12. EIT FOR MEDICAL APPLICATIONS AT OXFORD BROOKES 19852003 C McLeod References 13. THE RENSSELAER EXPERIENCE J Newell 13.1. 13.2. 13.3. 13.4. 13.5. 13.6. 13.7. 13.8. Early developments Reconstruction algorithms Hardware Applied currents Optimal currents Static in vivo images with non-circular boundary and optimal currents 3D In vivo applications

373 386 388 388 391 395 398 399 400 400 401

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Contents 13.9. 13.10. 13.11. 13.12. Paying for it People Meetings Concluding remarks Complete Bibliography Selected Abstracts

xvii 403 404 405 406 407 410 411 411 416 418 418 419 420 421 422

Appendix A BRIEF INTRODUCTION TO BIOIMPEDANCE David Holder A.1. A.2. A.3. Resistance and capacitance Impedance in biological tissue Other related measures of impedance A.3.1. Unit values of impedance A.3.2. Other indices of impedance Impedance measurement Relevance to Electrical Impedance Tomography Further reading

A.4. A.5.

Appendix B INTRODUCTION TO BIOMEDICAL ELECTRICAL IMPEDANCE TOMOGRAPHY 423 David Holder B.1. B.2. Historical perspective EIT instrumentation B.2.1. Individual impedance measurements B.2.2. Data collection B.2.3. Electrodes B.2.4. Setting up and calibrating measurements B.2.5. Data collection strategies EIT image reconstruction B.3.1. Back-projection B.3.2. Sensitivity matrix approaches B.3.3. Other developments in algorithms Clinical applications B.4.1. Performance of EIT systems B.4.2. Potential clinical applications Current developments References 423 425 425 428 431 431 432 435 435 435 439 439 439 442 445 446

B.3.

B.4.

B.5.

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List of contributors

D C Barber Medical Imaging and Medical Physics, Royal Hallamshire Hospital, Glossop Road, Sheeld S10 2JF, UK A Borsic School of Mathematics, The University of Manchester, PO Box 88, Manchester M60 1QD, UK D F Evans Centre for Adult and Paediatric Gastroenterology, The Wingate Institute, Barts and the London School of Medicine and Dentistry, 26 Asheld Street, London E1 2AJ, UK H R van Genderingen Departments of Pulmonary Medicine and Physics and Medical Technology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands H Griths Department of Medical Physics and Clinical Engineering, Swansea NHS Trust, Singleton Hospital, Swansea SA2 8QA, UK R Halter Thayer School of Engineering, Dartmouth College, 8000 Cummings Hall, Hanover, NH 03755-8000R, USA A Hartov Thayer School of Engineering, Dartmouth College, 8000 Cummings Hall, Hanover, NH 03755-8000R, USA D S Holder Departments of Clinical Neurophysiology and Medical Physics and Bioengineering, University College London, Mortimer Street, London W1T 3AA, UK P W A Kunst Departments of Pulmonary Medicine and Physics and Medical Technology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands S Y Lee Department of Biomedical Engineering, Impedance Imaging Research Center (IIRC), Kyung Hee University, 1 Seochun, Kiheung, Yongin, Kyungki, South Korea 449-701

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W R B Lionheart School of Mathematics, The University of Manchester, PO Box 88, Manchester M60 1QD, UK C McLeod School of Technology, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP, UK J C Newell Jonsson Engineering Center, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York 12180, USA N Polydorides School of Mathematics, The University of Manchester, PO Box 88, Manchester M60 1QD, UK G J Saulnier Jonsson Engineering Center, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York 12180, USA Jin Keun Seo Department of Mathematics, Yonsei University, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-749, South Korea H J Smit Departments of Pulmonary Medicine and Physics and Medical Technology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands N Soni Thayer School of Engineering, Dartmouth College, 8000 Cummings Hall, Hanover, NH 03755-8000R, USA C Soulsby Centre for Adult and Paediatric Gastroenterology, The Wingate Institute, Barts and the London School of Medicine and Dentistry, 26 Asheld Street, London E1 2AJ, UK T A T Tidswell Department of Medical Physics and Bioengineering, University College London, Mortimer Street, London W1T 3AA, UK A Vonk Noordegraaf Departments of Pulmonary Medicine and Physics and Medical Technology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands E J Woo Department of Biomedical Engineering, Impedance Imaging Research Center (IIRC), Kyung Hee University, 1 Seochun, Kiheung, Yongin, Kyungki, South Korea 449-701 E Yazaki Centre for Adult and Paediatric Gastroenterology, The Wingate Institute, Barts and the London School of Medicine and Dentistry, 26 Asheld Street, London E1 2AJ, UK T A York School of Electrical Engineering and Electronics, UMIST, PO Box 88, Sackville Street, Manchester M60 1QD, UK

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Introduction

Electrical impedance tomography (EIT) is a relatively new medical imaging method which has managed to excite interest in a broad range of disciplines. This includes mathematicians interested in uniqueness proofs and inverse problems, physicists interested in bioimpedance, electronics engineers, and clinicians with particular clinical problems where its unique portability, safety, low cost and safety suggest it could provide a novel imaging solution. There have been two previous books on EITa general textbook in 1990 (Webster 1990), one on biomedical applications, resulting from a conference in 1992 (Holder 1993) and a comprehensive review in 1996 (Rigaud 1996, Morucci 1996). It therefore seems timely to produce another book intended as a broad overview of the subject. What have we achieved in the 14 years since the rst book? When the rst EIT systems were built and then became available for human studies, in the mid 1980s, there was a ush of enthusiasm and prototype systems were tested in about ten dierent clinical areas. There was good success in pilot studies which showed a good correlation with gold standard techniques in gastric emptying and, to a lesser extent, in imaging lung ventilation. Over the intervening period, there has been a steady interest in the eld, mainly from medical physics groups, and there are probably more groups working now on the subject than in 1990. There have been annual conferences, organized initially under the auspices of a European Community concerted action, and later by a UK EPSRC engineering network. Since this nished in 2001, volunteer host groups have come together in a cooperative but informal way using the organization inherited from this happy tradition. It would have been gratifying if this book could contain news of a radical breakthrough of our method into mainstream clinical practice. Unfortunately, this is not the case. However, there has been substantial steady progress since the last book and, in my opinion, important hopeful developments which augur well for the eld. These are all reviewed in this volume; each chapter is an overview which includes a review of recent developments, and is authored by a leading exponent in the eld.

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Reconstruction algorithms have improved markedly, with the introduction of algorithms capable of imaging in 3D with realistic models, and the development of powerful nonlinear approaches (chapter 1). Instrumentation has improved incrementally, with systems able to image over multiple frequencies and apply current patterns through multiple electrodes (chapter 2). There have not been any breakthroughs in clinical applications, but there has been a continuing stream of pilot and proof of principle studies. A new development is the acceptance of imaging breast cancer and brain function among the likely leading candidates for eventual clinical take-up. At the same time, some new potentially powerful possible applications have been proposed and clinical trials are in progress in screening for breast cancer, using EIT as an end-point for articial ventilation in intensive care units, and in acute stroke and epilepsy (chapters 37). Completely new developments have been magnetic induction tomography (chapter 8) and Magnetic Resonance (MR-EIT) (chapter 9). Finally, there is a welcome overview of our sister research area, industrial process tomography (chapter 10), and personal retrospective views from three of the most productive and longstanding groups in EITSheeld and Oxford Brookes Universities, UK, and the Rensellaer Polytechnic Institute, USA (chapters 1113). The nature of EIT is interdisciplinary. All the authors have been encouraged to write in a non-specialist style so that their subject should be comprehensible to most readers. All chapters should be comprehensible to readers with a postgraduate or experienced undergraduate level in medical physics or bioengineering. The clinical sections and much of the other sections should be accessible to readers with a clinical background. Two introductory non-technical appendices have been added for readers of any background who would like a brief simple introduction to bioimpedance or the methods of EIT. All authors have been encouraged to draw conclusions from their experience and make recommendations, positive or negative, for future directions in development and research. I hope that the book will be of use to those wishing to enter the eld of EIT research, and that these opinions will be of help in setting up new methods and experiments. Finally, I should also like to thank John Navas and Leah Fielding from the Institute of Physics Publishing for their initiative in commissioning this volume and patience and support in getting it published. I would like to thank all the authors for their excellent contributions and hard work, and the other researchers in our eld who have contributed so much to the material in these pages and made up the happy throng at our annual conferences. Biomedical EIT research is not a subject for the faint-hearted. At the recent conference in Gdansk, I seemed to strike a resonance in saying that the attraction and drawback of EIT is that it doesnt clearly work, so we can reap the fruits of its images, or not work, so we can change direction; it usually almost works, which is an incitement to redouble our eorts. It is particularly exciting at the time of writing, as we wait for the results of these clinical trials,

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and to see if the developments in hardware and reconstruction algorithms will bear fruit. I hope that when the next book comes out in another decades time, it will have realized at least some of its unarguable potential, and taken a place alongside the other standard bearers of medical imaging. David Holder London September 2004

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