Biomedical Sound

Achmad Rizal BioSPIN

Auscultation (1)
Auscultation : listening the biomedical sound (lungsound, heartsound, etc), usually using stethoscope - Auscultation common techniques to determine condition of lung and/or heart - Some diseases produce unique biomedical sound - Physician classifies the sound subjectively based on his/her skill

Auscultation (2)
Some problems in auscultation : Low frequency, 20-600Hz, Low amplitude Noise problem Ear sensitivity Low variety of the pattern of biomedical sound (exp, lungsound, heartsound)

Auscultation (3)
Common error in auscultation

Auscultation (4)

2. Lung sound (1/3)

Lung sound generation Lung sound turbulent airflow through the respiratory tree - Inspiration : The turbulence happen when air flow from wider air cavity to narrower air cavity - Expiration : air flow from narrower air cavity to wider cair cavity less turbulence

Lung sound (2/3)

Traditionally, lung sounds are classified based on : 1. intensity 2. pitch 3. location 4. inspiration-expiration ratio

Lung sound (3/3)

Lung sound classification Normal Tracheal Vesicular Bronchial Bronchovesicular Abnormal Absent/decreased Bronchial Adventitious Crackles (rales) Wheeze Rhonchi Stridor Pleural rub Mediastinal crunch (Hamman's sign)

Lung sound (4/ )

Some lungsounds
Tracheal breath sounds are high-pitched and loud, with a harsh and hollow (or "tubular) quality. The inspiratory and expiratory phases are of equal duration, and there is a definite pause between phases Bronchial sounds normally are heard over the upper manubrium, these breath sounds directly reflect turbulent airflow in the main-stem bronchi

Lung sound (4/ )

Normal lungsounds
Bronchovesicular sounds are normally heard in the anterior first and second intercostal spaces and posteriorly between the scapulas, where the mainstem bronchi lie Vesicular sound audible over peripheral lung fields, these breath sounds are soft and lowpitched, without the harsh, tubular quality of bronchial and tracheal breath sounds

Lung sound (4/7)

Some examples Crackles (Rales) discontinuos, non musical, short time, and often heard in inspiration cycle This sound is classified as fine (high pitch, soft, very short) or coarse (low pitch, harsher, no too short ) condition : bronchiectasis, chronic bronchitis, consolidation, pnemonia

Lung sound (5/7)

- Wheeze continuos, high pitch, soft, normally heard in expiration and sometime in inspiration. Cause by collapsed air track, secretion of mucus, injured or stranger object

condition : CHF, chronic bronchitis, COPD, pulmonary edema , asthma

Heartsound
The heart sounds are the noises (sound) generated by the beating heart and the resultant flow of blood through it. Heart sound = heartbeat ECG Heartsound = S1 (lub) + S2 (dub) The first heart sound (S1) and second heart sound (S2), produced by the turbulent flow against the closed AV valves and semilunar valves respectively

Heartsound
The first heart tone, or S1, forms the "lubb" of "lubb-dub" is caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves, i.e. mitral and tricuspid, at the beginning of ventricular contraction, or systole.

Heartsound
The second heart tone, or S2, forms the "dub" of "lubb-dub" is caused by the sudden block of reversing blood flow due to closure of the aortic valve and pulmonary valve at the end of ventricular systole, i.e beginning of ventricular diastole. As the left ventricle empties, its pressure falls below the pressure in the aorta, aortic blood flow quickly reverses back toward the left ventricle, catching the aortic valve leaflets and is stopped by aortic (outlet) valve closure.

Heart Sound (2/2)

Heart murmurs are produced as a result of turbulent flow of blood, turbulence sufficient to produce audible noise. They are usually heard as a whooshing sound. The term murmur only refers to a sound believed to originate within blood flow through or near the heart; rapid blood velocity is necessary to produce a murmur. Though not fully reliable, soft murmurs are less likely to reflect a serious, if any, health problem; loud murmurs essentially always reflect a problem.

Heart Sounds Auscultation Areas

Heart Sound (2/2)

The following paragraphs overview the murmurs most commonly heard in adults who do not have major congenital heart abnormalities. Regurgitation through the mitral valve is by far the most commonly heard murmur, sometimes fairly loud to a practiced ear, even though the volume of regurgitant blood flow may be quite small. Yet, though obvious using echocardiography visualization, probably about 20% of cases of mitral regurgitation do not produce an audible murmur. Stenosis of the aortic valve is typically the next most common heart murmur, a systolic ejection murmur. This is more common in older adults or in those individuals having a two, not a three leaflet aortic valve.

Heart Sound (2/2)

Regurgitation through the aortic valve, if marked, is sometimes audible to a practiced ear with a high quality, especially electronically amplified, stethoscope. Generally, this is a very rarely heard murmur, even though aortic valve regurgitation is not so rare. Aortic regurgitation, though obvious using echocardiography visualization, usually does not produce an audible murmur. Stenosis of the mitral valve, if severe, also rarely produces an audible, low frequency soft rumbling murmur, best recognized by a practiced ear using a high quality, especially electronically amplified, stethoscope.

Heart Valves
Healthy heart valve opening Unhealthy heart valve opening (Diastolic)

Healthy heart valve closing

Unhealthy heart valve closing (Systolic)

Instrument for Auscultation

Sthetoscope - Monaural Sthetoscope Invented by the French physician R.T.H. Lannec THE MONAURAL STETHOSCOPE (1816) Ren Thophile Hyacinthe Lannec is generally considered to be the father of chest medicine.

THE BINAURAL STETHOSCOPE

Actually, the idea for a binaural stethoscope was first introduced in 1829, just ten years after the publication of Laennec's text illustrated his original instrument. The idea belonged to Nicholas Comins, who devised a stethoscope that he described as "a bent tube" that had several hinges, allowing the physician to not have to assumeuncomfortable positions during the examination.

George Tiemann, circa 1852

Alison's Differential Stethoscope, circa 1860

Dr. Cammann, W.F. Ford & Co, circa 1870

Re-educative scope, circa 1931.

Instrument for Auscultation

Binaural sthetoscope in 20th century

David Littmann, circa 1972

A Sanborn Company and HP Rappaport-Sprague binaural stethoscope, 1960s.

Janson M. Pope, Jr., 1980

Instrument for Auscultation

Sthetsocope anatomy

 Electronic Sthetoscope

JABES Electronic Stethoscope and Analyzer Software

Heart sound (PCG

Phonocardiogram) analysis S/W JABES Electronic Sthetoscope

Some features Save, print, and send patient's phonocardiogram and information Record, play, and pause patient's body sound and phonocardiogram Manage virtually unlimited number of patients' information Maintain patient's examination records Compare unfamiliar sound with reference data

Lungsound/heartsound Analysis Techniques

Generalized system

Doctors Comp.

Lungsound/heartsound Analysis Techniques

Typical Lungsound/heartsound analysis S/W

Recording Signal acquisition, sampling frequency, format, depth Preprocessing normalisation, noise reduction Feature extraction resolve information Classification NN, SVM, AI, Expert System

Lungsound/heartsound Analysis Techniques

Data acquisition simple electronic sthetoscope

Lungsound/heartsound Analysis Techniques

Some feature extraction techniques: Wavelet DWT, WPD Spectrogram Max, mean, frequency LPC Linear prediction code RMS Root mean square

Lungsound/heartsound Analysis Techniques

Data
Heart Heart Heart Heart Lung Lung Lung

Class
4 15 4 6 4 4 28

Technique s
LPC RMS WPD Shannon WPD LPC WPD

Classifier
BP NN ART2 ART2 BP NN crosscorrelati on BP-NN ART2

Accuracy
80% 95% 90,97% 60% 60% 100% 86%